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Cholera, Access to Care Remain Significant Challenges in War-Torn Yemen: Public Health Watch

Experts say the country remains at risk for infectious disease outbreaks as long as fighting continues.

Daniel L. Byman, Senior Fellow-Foreign Policy, Center for Middle East Policy, Brookings Institution, in an article posted on July 17, describes the ongoing civil war in Yemen as a “disaster” and a “humanitarian crisis [that] only seem[s] to worsen by the day.”

He’s not alone in this opinion.

In a conflict that has seemed to devolve into a proxy war between Saudi Arabia and its regional allies against rival Iran, which has backed Houthi rebels in the fight against the ruling regime in Yemen, the only real losers are, as usual, innocent civilians. According to a report by Al-Jazeera in March, it is believed that at least 40,000 Yemeni civilians have died in the fighting, which began in earnest in 2015. However, this may be a gross under-estimation: That same report notes that charity Save the Children estimates that more than 50,000 children died in the country in 2017 alone.

The United Nations Office for the Coordination of Humanitarian Affairs says that some 3 million Yemenis have been displaced, and that nearly 300,000 have sought asylum in other countries.

Not surprisingly, the brutal fighting has created significant public health challenges as well. Leslie F. Roberts, PhD, professor of Population and Family Health at Columbia University Medical Center in New York, notes that World Health Organization (WHO) data suggests that risk for cholera, a disease that has plagued the country since fighting began, remains high. The WHO estimates a disease attack rate for cholera of 4%.

“Even if there are 10 times as many asymptomatic infections, [this] implies most of the population is still immunologically susceptible, although it’s likely that people still susceptible live in safe environments and are less likely to get infected compared to those infected [in 2017],” Dr. Roberts told Contagion®. The WHO reports that there have been more than 1.1 million suspected cases of cholera in Yemen since April 2017. Roughly 28 million people live in Yemen, or did as of 2016.

On the positive side, though, the WHO has reported successes in vaccinating Yemeni children against troubling diseases such as polio and measles.

However, there is reason to believe such successes may be short-lived, given the risks to health care providers in the country. An analysis co-authored by Dr. Roberts and published in May in the journal Conflict and Health reveals that there have been 93 attacks on health care facilities in Yemen—an average of 4.65 per month—between March 2015 and December 2016, alone. In their concluding remarks, the authors note, “The figures in Yemen are also troubling, but the lack of defined methodologies prevents us from reaching a firm conclusion. It also cannot be determined if intentional attacks on health care have increased given the varying definitions of what constitutes an attack in the methodologies.”

Medecins Sans Frontieres (MSF)/Doctors Without Borders reported in December that fighting in the capital of Sanaa had destroyed health care facilities and severely affected access to care for civilians. Of course, MSF workers have come under attack in Yemen as well, most recently while providing care at a hospital in the Haydan district of the country.

Unfortunately, such challenges are likely to continue until the conflict in Yemen is resolved. However, given the significant geopolitical implications for the region, an end to the civil war doesn’t appear imminent.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous health care-related publications. He is the former editor of Infectious Disease Special Edition.