Yemenis struck by cholera in a time of war

SANA'A — Huda Amr Dahesh is only 14 months old. She has cholera. Like so many poor Yemenis seeking treatment for the disease in the midst of a rapidly growing nationwide outbreak, her family has brought her to a camp in the middle of the capital of Sanaa

There aren't enough beds for all the patients here in Al Sabeen camp, and so the toddler is sharing a bed with another young cholera patient.

There are now a total of some 246,000 suspected cases of cholera and acute watery diarrhoea. The disease has caused more than 1,500 deaths – now killing one Yemeni every hour.

Huda is the only child of a poor worker, who lost his job as a guard of a foreign company in Sanaa at the beginning of the Saudi-led war in April 2015. That bombing campaign has only intensified, so her father has little chance of finding another job.

Amr Dahesh, Huda's 26-year-old father, confirmed that Huda was not the only cholera patient in the Al Qa'a neighbourhood of Sanaa where they lived. Cholera had already hit other neighbourhood children, but the family did not know how to prevent the disease.

"I had already heard about the spread of cholera in our neighbourhood, but I couldn't protect my only child," Dahesh told TRT World in a cradling his sick child in his arms. "She caught cholera from other children, not from polluted water or food."

When Dahesh noticed that his daughter had symptoms of what could be cholera, he immediately took her to Al Sabeen Camp. Around 15 kilometres away from their neighbourhood, the camp is dedicated to the treatment of cholera patients from Sana'a and the surrounding provinces.

"When I arrived at the camp, I could not find a bed for my daughter, but relatives of another patient agreed to let my daughter sleep on the same bed as their family member," Dahesh added. "The relatives of patients are helpful and understand other families' suffering, because all of them belong to poor families."

Patients receive free treatment at the camp and don't pay anything for accomodation. The camp works under the supervision of the health ministry and various international organisations.

Al Sabeen camp consists of two main tents: one for children and another for women (men, meanwhile, are referred to Sanaa's 22 May Hospital). There are about ten beds in each tent. It was set up in October 2016, near Al Sabeen Maternal Hospital, specifically to receive the influx of patients with cholera and the acute watery diarrhoea it causes, and to isolate them from other patients – cholera is highly infectious.

Since the camp was founded, the rate of new diagnoses has spiralled. According to the latest figures from the World Health Organization, the war-torn country is currently dealing with up to 5,000 new cases a day. That's ten times the number of cases compared to two months ago.

Not enough beds

The strain the epidemic is placing on Al Sabeen camp's scarce resources is obvious. Some patients must wait for hours to get a spot on the bed. Many of the single beds are cramped with two, or even three, patients at a time.

Dr Ibrahim Dabwan, in charge of new patients at the camp, confirmed that about 200 people with cholera and acute watery diarrhoea arrive every day, mainly from rural and poor areas.

"Most of the cases come from Khawlan, Al Rawdha and other areas out of the capital Sana'a," the doctor told TRT World. "Most of those cases belong to poor families, who haven't been educated about cholera."

Ali Mohammed brought his six-year-old daughter Safa'a from Al Rawdah, a village in the northern suburbs of Sanaa, 60 kilometres away from the camp. He wasn't aware that his daughter had cholera or that it might kill her. He had tried to have her treated at several other different general hospitals, but all of them declined to treat his daughter. Instead, he was told to take her to Al Sabeen camp for cholera patients.

Mohammed works as a prickly pear farmer. He can barely support his eight children as it is. When he arrived at the camp, he had less than YR1,000 ($4) in his pocket.

"When I and my wife arrived at the camp on June 19, doctors told me that we should stay with Safa'a at the camp, as this disease may kill her if she doesn't receive proper care," Mohammed told TRT World. "This made us cry – firstly, because our daughter is in danger, and secondly because we don't have enough money to afford to stay in Sanaa."

Only the poor come to Al Sabeen

The relatives of patients usually sleep under trees or on the pavement, outside the camp. The noise and the fear of catching cholera prevent them from sleeping inside. The camp provides patients with free care and medication, so only the poor come to this camp. The rich go to private hospitals.

"This is our destiny, we are victims twice over in this atrocious conflict," Mohammed said. "The first issue is that I can no longer buy fuel to pump water to irrigate my farm. And now, cholera is spreading and killing our children."

Most of the patients who make it here receive proper care and recover from cholera. Once here, only a few – those who arrive in an extreme state of dehydration – die.

"We receive about 200 cases a day and only three patients died last week. I appeal (to) people who see the symptoms of cholera in their relatives to take them immediately to the nearest health facility."

Yemen's healthcare under blockade

In the two years since it began, the conflict has devastated the country's healthcare facilities. Despite medical facilities being protected by international law, hospitals and ambulances in Yemen have been bombed repeatedly by Saudi coalition jets. The international NGO Médecins Sans Frontières (MSF) has called for an international commission to investigate some of these attacks.

"Nothing has been spared – not even hospitals, even though medical facilities are explicitly protected by international humanitarian law," Raquel Ayora, MSF Director of Operations, said in a statement in January 2016.

"Increasingly, we are seeing attacks on medical facilities being minimised, being labelled "mistakes" or "errors".

The end result of the bombing campaign is that less than half of Yemen's hospitals are still fully functional. Many public health professionals have not been paid in months.

Speaking at a joint news conference with representatives of the United Nations Children Fund (UNICEF) and the World Bank, Nevio Zagaria, the World Health Organization's (WHO) representative in Yemen said that there had been some 246,000 suspected cases in the period up to June 30.

The death toll from a major cholera outbreak in Yemen has risen to 1,500, Zagaria, said on Saturday, and appealed for more help.

Together with UNICEF, the WHO says it is attempting to stop cholera from crossing over from the worst-affected areas. Yet cholera has already spread across much of the country, affecting 21 out of 22 provinces.

"We see that the numbers are going up, it's really trying to race against the spread and try to get treatment and water and sanitation measures to every corner [of the country], especially to those corners that are basically exporting the bacteria to other places," Tarik Jasarevic, a spokesperson for the WHO, told reporters at a press briefing on June 20 in Geneva.

And although cholera can be treated quickly if caught early, getting the necessary treatment out in the middle of a conflict "is not so easy," the WHO said in a statement.

The agency added that its health, water, sanitation and hygiene partners need $66.7 million to scale up the cholera response.

To date, the WHO has helped to set up 144 diarrhoea treatment centres and 206 oral rehydration points, along with more than 1,900 beds for cholera patients in 21 provinces.

A source in the health ministry in Sana'a spoke with TRT World, on condition of anonymity because he is not authorised to speak to media, about the incredible challenges Yemeni authorities are facing to provide for their citizens.

"The ministry does not have budget to face the spread of cholera, and we live under blockade that forbids us to import treatment, medicines or any medical needs to face cholera, so we depend on international organisations such as UNICEF and WHO to help victims of cholera," he said.

Sana'a Airport has been closed by the coalition countries since August 2016. Only planes belonging to international organisations can use Sana'a Airport to import medical needs and aid to Yemenis. Yet no Yemenis can use the country's air or seaports.

On Thursday, about 26 tonnes of medicines for cholera arrived at Sana'a Airport in two UNICEF planes. A new batch arrived on Saturday, containing another eight tonnes of medicines, according to the spokesperson of UNICEF in Yemen, Mohammed Al Asa'adi.

"I appeal (to) the international organisations to double their work in the rural areas," the ministry source said, "which are (the) main environment where cholera is thriving, and appeal to the international community to help with fighting cholera, since this deadly disease spreads so quickly."

Cholera is more prevalent in the northern provinces than in the south, according to the source.

Cholera in a time of war

While the families of Safa'a and Huda'a were able to find treatment for their children, many others are not as lucky, especially those staying out of the capital. Four-year-old Zaed Al Roa'aini died before ever receiving any proper healthcare.

Abdullah Al Roa'ani, Zaed's father, said that his son was suffering from diarrhoea and vomiting. The family thought it was commonplace diarrhoea and gave him medicine from a shop in their village in the southwestern Taiz province.

"After two days of suffering, one of our neighbours told me that Zaed may suffer from deadly disease called cholera and advised that I should take him to Sana'a for treatment," Roa'ani told TRT World.

Roa'ani is from the Haifan district of Taiz, some 270 kilometres from Sana'a. To get there, he would need to travel through mountain passes and valleys. since Taiz is a conflict zone, and its main roads have been closed due to the fighting. These days, the journey from Taiz to Sana'a takes more than ten hours – especially tiring for a sick child.

"On June 15, I arrived in Sana'a. My son was already exhausted by the road and the cholera, so he died at the same day," Roa'ani explained. "The doctors told me that cholera depleted the liquids in his body and he did not receive the proper treatment on time."

Roa'ani took his son's body back to his village to bury him.

Nagi al Alei, a doctor at Al Sabeen camp, confirmed that many patients from rural areas die before they arrive at the camp.

"Residents of rural areas need warnings about the symptoms of cholera, how to do first aid and that they should take patient to the nearest hospital," he told TRT World. "Some people die before they receive treatment."

The lack of health faciltiies in rural areas is a huge issue, everyone interviewed agreed.

"I urge international organisations to set up camps for cholera patients in the rural areas."

Back in Al Sabeen camp, Huda's father Amr Dahesh, agreed that there had to be more camps, both in rural areas and in the cities, where beds are literally overflowing with patients like his young daughter.

"Not only the patients need beds. Their relatives also need to sleep," he said, calling on the organisations to do more to halt the spread of cholera.