In Yemen, the coronavirus pandemic is overwhelming hospitals and cemeteries. More young people are dying there than in most other countries, and the virus is spreading so fast the World Health Organization believes it could infect nearly the entire Yemeni population.
Meanwhile, almost everyone who is in a position to prevent a catastrophe is instead making the situation worse.
The Houthis, the armed group under whom most Yemenis live, are refusing to acknowledge the extent of the outbreak and threatening people who do, fueling panic and conspiracy theories among the public while they seek to protect their own power. The Houthis’ opponents ― Yemen’s internationally recognized government, along with Saudi Arabia and the U.S. ― are failing to provide the level of needed aid or to halt bombings and a blockade of Houthi-controlled areas, causing inflation and mass hunger that makes many Yemenis especially vulnerable to COVID-19.
Both sides of the conflict are ignoring pleas for a ceasefire, and one fighting force, a coalition of southern Yemenis supported by the United Arab Emirates, has escalated an offensive against fellow anti-Houthi fighters since Yemen reported its first coronavirus case in April. None of the governing authorities across Yemen are seriously enforcing policies to limit the virus’ spread ― imposing a greater burden on a health care system that has already lost half its capacity to the war and now has 700 ICU beds and 157 working ventilators for a nation of 30 million, according to the United Nations.
“The money they have spent to destroy the lives of people in Yemen ― if they spent one tenth, one hundredth of that to develop Yemen, Yemen will be an ally to them for the rest of their history.”
- Aisha Jumaan, president, Yemen Relief and Reconstruction Foundation
The WHO predicts a coronavirus death toll of at least 65,000 in Yemen unless officials change course, its representative in the country told the medical journal The Lancet. Amid the added strain on health care resources, experts also expect more deaths among Yemenis with ailments other than COVID-19, like endemic cholera, malaria, diphtheria or dengue, and those hurt by recent cuts to humanitarian food programs.
Just as powerful Yemenis and international players previously decided to turn Yemen into a battleground, they now seem committed to letting thousands of Yemeni families suffer ― showing that even a shared global challenge like a pandemic can’t end the country’s treatment as a global punching bag.
“The money they have spent to destroy the lives of people in Yemen ― if they spent one tenth, one hundredth of that to develop Yemen, Yemen will be an ally to them for the rest of their history,” said Aisha Jumaan, the president of the Yemen Relief and Reconstruction Foundation.
The leaders in Sanaa, Washington, Riyadh and elsewhere who will decide Yemen’s future still have a chance to get it right. But time is running short.
Refusing To Take Responsibility
The Houthis took over Yemen’s capital city of Sanaa in September 2014, despite advice not to do so from their patron, Iran. Wary of Iran’s reach, Saudi Arabia, the UAE and their allies began fighting the militants six months later to shore up the Houthi’s Yemeni opposition. Military and intelligence support from the U.S. and other wealthy Western countries has been crucial to their intervention.
Each of those players has worsened the coronavirus pandemic for Yemen.
The U.S. has provided more than $2 billion in aid to the country since 2015. But it began changing its approach just as the global pandemic grew. In late March, the U.S. cut off tens of millions of dollars in humanitarian assistance over Houthi interference in its delivery. Weeks later, Trump’s decision to end funding for the WHO worsened a funding crunch for the body, which began to wind down payments to thousands of Yemeni health workers and support for nearly 200 hospitals.
The State Department announced nearly $225 million in emergency food aid for Yemen, where millions live in famine-like conditions, and a $1.7 million donation specifically for coronavirus relief in early May.
Yet it’s hard to know if that support is reaching the people who need it most, particularly the majority of the population living in Houthi-controlled areas, lawmakers and activists say. On May 12, six senators asked Trump administration officials to clarify what assistance they had allowed to continue for humanitarian reasons and whether that included material to counter the coronavirus like personal protective equipment and ventilators, as well as details about where in the country the $225 million is going.
The Houthis have now agreed to partially change their approach to aid, according to the U.N. Humanitarian groups also wrote a joint missive urging a more generous U.S. response, which congressional staffers are using to pressure the Trump administration, said Hassan El-Tayyab of the Friends National Committee on Legislation.
At a U.N. fundraising event for Yemen on June 2, the U.S. did not announce further funding. Another top supporter of the Saudi-led campaign in the country, Britain, promised more than $200 million, while fellow backer France pledged less than $10 million.
The UAE, which continues to fund allies in Yemen despite officially withdrawing from the country’s civil war, offered no support, either. (The country says it has previously donated over $6 billion.)
The event ultimately raised $1.35 billion ― far less than the $3.2 billion a similar drive raised last year.
Saudi Arabia offered a fresh $300 million. The kingdom has continued its blockade of much of the country, which slows down vital imports like medicine and spare parts for equipment such as ventilators, and only paused its fight with the Houthis for a few weeks, recently resuming airstrikes that have become notorious for killing civilians.
In April, during that brief halt in fighting, UAE-backed separatists clashed with Saudi-backed forces and began a campaign to take over southern regions that continued for nearly two months.
“The country urgently needs a nationwide ceasefire and it has to be agreed by all warring sides,” said Abdulwasea Mohammed, the policy lead in Yemen for the charity Oxfam.
The Houthis are scrambling to ensure the coronavirus outbreak does not threaten their rule or weaken their ability to withstand the U.S.’s partners in Yemen. As deaths mount in the crowded areas under their control, grave-diggers and guards at cemeteries have been instructed to say the dead are “unidentified bodies from the war,” The Associated Press revealed, and authorities rarely tell families whether it was the virus that claimed their loved ones.
Burials are being spread throughout graveyards to avoid drawing attention to how many are taking place, residents told the AP, and health workers are being harassed and facing delays in getting permits, The Lancet reported. “The authorities are trying to hide but every day there are more dead bodies and it is out of control,” a worker told the medical journal.
By making it hard to speak openly about the virus ― to the extent of refusing to release statistics on COVID-19 cases ― the Houthis have created an environment in which paranoia and disinformation can thrive. Many living under Houthi rule now believe they have told health workers to give patients lethal “mercy” injections.
“Whoever spreads this rumor is a criminal with every meaning of this term,” Jumaan said. The conspiracy theory both endangers medical professionals and makes sick people less likely to seek treatment, she noted.
A doctor in the port city of Hodeidah recently told Jumaan a story that showed how those claims had affected the situation: A patient who entered a hospital with coronavirus symptoms brought armed escorts who told medical staff that if he died, they would be killed.
The Houthis’ key foreign ally, Iran, is struggling with its own resurgent coronavirus outbreak; after it supplied the militants with weapons for years, Tehran has said little about helping them face the pandemic.
Meanwhile, the militia is inflaming the conflict. As Houthi officials suppress the truth about the toll of COVID-19, they are suggesting that the U.S. is benefiting from the outbreak. Last week, they said they launched one of their biggest missile strikes on Saudi Arabia since the beginning of the civil war ― and promised more to come.
Confronting A New Challenge
A deadly and far-reaching initial wave of COVID-19 is now indisputable in Yemen, aid groups and experts say.
Measures to limit infection like lockdowns are only partially enforced, and most Yemenis cannot afford to stay home because of their dependence on meager daily earnings, Oxfam’s Mohammed said.
The systems that are supposed to inhibit the crisis are breaking down. Some of the 59 isolation units established by the WHO are admitting more people than they can safely handle and running low on personal protective equipment, Mohammed told HuffPost.
Authorities have turned the first quarantine facilities for people entering Yemen ― primarily migrants from the Horn of Africa seeking to travel onward ― into a “breeding ground” for the virus with policies like putting more than six people in each room, Jumaan of the Yemen Relief and Reconstruction Foundation said. Those detainees, many of them infected, were not stopped from leaving for activities like shopping, which is how some began to buy medicine from Jumaan’s nephew, a pharmacist in the area. He soon infected his entire household, including his elderly parents.
Medical “facilities are already overwhelmed,” Tamuna Sabadze of the International Rescue Committee, which operates an isolation facility and a network of clinics in southern Yemen, wrote in an email.
“Suspected COVID-19 patients are being turned away … while people with other illnesses are being turned away from clinics which have been designated COVID-19 only,” Sabadze continued. “Doctors and nurses do not have sufficient PPE to continue treating the increase in patients with COVID-19 symptoms, and the severe lack of testing means COVID-19 is spreading undetected.”
Some health care workers are staying home because of the shortage in gear, she added. The virus has already killed dozens of them, local unions told the AP.
“Trump’s decision to end funding for the WHO worsened a funding crunch for the body, which began to wind down payments to thousands of Yemeni health workers and support for nearly 200 hospitals.”
And for many Yemenis, medical care is not an option. “People who do get to the hospitals represent a drop of the total number who actually die from COVID,” Jumaan told HuffPost.
Along with inflation and poverty produced by the blockade by anti-Houthi forces, the collapse in normal governance has ended health care subsidies and made treatment significantly more expensive, respiratory specialist Hakeem Al-Jawfy recently told Science magazine.
Even when infected Yemenis do receive clinical attention, their chances of survival are often low after years of living in increasingly desperate conditions. In the southern port of Aden, mortality rates among people infected with COVID-19 are among the highest in the world, United Nations Secretary-General Antonio Guterres said earlier this month. The city saw more than triple its normal death rate for the month of May, according to research that an adviser to the local government shared with The New York Times.
Dwindling international aid will make the health care system weaker. It also threatens more basic programs that could help with the outbreak. Funding cuts could end water and sanitation services for 6 million people, including 3 million children, within days, said Muhammed of Oxfam, which runs hygiene and water programs, including in camps for the hundreds of thousands of Yemenis displaced by the war. Large parts of major cities may also soon lose access to water, he added.
Despite shortages and tough odds, many Yemenis are trying to put up a strong fight against the virus. A number of graduates from an epidemiology training program supported by the U.S. Centers for Disease Control and Prevention are now in top posts in health policy, said Jumaan, who initiated the program in 2010. Hundreds of rapid-response teams developed with U.N. help to tackle cholera are attempting to trace COVID-19, Altaf Musani, the head of the WHO office in Yemen, told Science.
Jumaan is in frequent contact with medical staff across the country, particularly in laboratory settings, through WhatsApp groups she set up to coordinate sharing medical supplies and other aid.
“The camaraderie is much stronger now,” she said, describing discussions about how to improvise personal protective equipment and to share essential equipment across the lines of the conflict to prevent shortages.
“It’s been extremely heartwarming … even though these technical people are under different political powers, they don’t really give a damn,” Jumaan added.
But in a situation as dangerous as Yemen’s predicament has become, even solidarity and specialized skills are not always enough.
In a separate training program Jumaan runs now, one young trainee has lost two brothers to the virus. Fourteen days after the death of her second brother, the trainee developed COVID-19 herself. “I told the trainer just leave her alone,” Jumaan said. “This is not important anymore.”