Yemenis are choosing to go without medical care because of stigma and fear, causing anxieties among those who need attention the most.
Medecins Sans Frontieres (MSF) says unprecedented fear of the virus is preventing people in Yemen’s capital, Sanaa, from seeking medical care.
The organisation recently began supporting a new Covid-19 treatment centre in Sheikh Zayed hospital in the Yemeni capital.
Like a number of other hospitals in the country, Sheikh Zayed was designated by health authorities as a Covid-19 treatment centre, and shifted from providing maternity services and trauma care, to tackling a pandemic that has challenged some of the world’s most developed health systems.
According to MSF staff, an overwhelming number of people in Yemen perceive hospitals as the source of infection and only half of the 20 beds for patients with moderate coronavirus symptoms in Sheikh Zayed hospital, are currently occupied.
Another reason is that some people are also spreading rumours about what happens in hospitals to patients who suffer from symptoms of Covid-19.
Dr Abdulrahman, an MSF doctor who works in the intensive care unit (ICU), explains that because of the shortage of medical staff at the moment – a real problem, both in this hospital and countrywide – he has also started working and supporting colleagues in the inpatient department.
“As a doctor working in a Covid-19 treatment centre, certainly I’m concerned about possible infection, especially with all the news about health workers contracting the virus. But I’m a doctor; it’s impossible for me to stay home. It’s my duty to come to this hospital every day and provide a meaningful service to people while I can,” he said.
According to Dr Abdulrahman, they have noticed an increased number of patients with moderate symptoms arriving at the hospital.
“In our ICU, we see patients arriving very late and needing to be put on oxygen straight away. We see patients over the age of 60 and others with diseases such as diabetes, hypertension, cardiovascular disease and heart problems. They require greater attention and constant observation.”
On the other hand, some in Yemen are fearful of being stigmatised by their communities should they test positive for the disease. As a result, many Yemenis are not seeking medical care until their condition becomes serious.
“We are seeing at first hand the detrimental impact of misinformation that is being circulated all over the country, augmenting fear of the virus in society,” says Dr Abdulrahman.
A system on the brink
Many patients arriving at Sheikh Zayed hospital’s emergency room are in a critical condition and need immediate support with their breathing. All six beds are occupied in the intensive care unit where patients in severe respiratory distress receive round-the-clock care - this attention is entirely dependent on oxygen cylinders that require changing every three hours.
“We are concerned over what we see in the hospital, but an even greater concern is the patients we don’t see – those who choose not to seek medical treatment until their condition deteriorates considerably,” says Caroline Ducarme, MSF’s Head of Mission in Yemen.
Yemen has very limited testing capabilities for Covid-19 and so the virus is spreading across the country in an untraced fashion. After years of war, the health system was already under considerable strain before the pandemic. Now it appears that people have lost trust in the health system and health staff.
Recent reports emerged that health workers are at high risk of falling ill with the virus - this has raised serious concerns about their safety among medical staff across the country, leading many to quit their jobs and stay at home, ultimately leaving hospitals short-staffed.
“One of the consistent challenges we face is finding skilled medical staff willing to work in a Covid-19 treatment centre, where they are needed most,” says MSF’s Ducarme. “This is despite the use of personal protective equipment and the strict implementation of infection prevention and control measures in this hospital. The departure of health workers is further weakening the Yemeni health system.”
Sheikh Zayed hospital is the second Covid-19 treatment facility in Sanaa supported by MSF, along with Al-Kuwait hospital. Some of MSF’s patients have travelled long distances to get treatment in the capital, suggesting that there are many unmet medical needs elsewhere.
“A number of our patients in Sheikh Zayed hospital come from governorates as far as Taiz and Ad Dhale in search of essential medical care that may be inaccessible in their areas,” explains Roger Gutiérrez, MSF’s Head of Emergencies in Yemen. “The patients we see have the means to travel, but what about those who are seriously ill with no means to travel and no other medical options around?”
MSF says that more resources are desperately needed in Yemen, both for Covid-19 patients and for those with other health needs. It is calling on the international community to mobilise resources to help Yemen cope with this crisis, and calling on Yemeni authorities to facilitate the implementation of lifesaving programmes.
“A massive scale-up of the overall health response is required to urgently address the silent needs,” says Ducarme.
“Instead of cutting down support at such a critical time, the international community should be mobilising maximum resources to maintain humanitarian interventions in Yemen, while local authorities must exert all efforts to facilitate the implementation of lifesaving programmes and ensure that people can safely access humanitarian aid.”