On August 4, 2020, a devastating explosion occurred in the port of Lebanon’s capital city, Beirut. The explosion left over 200 people dead, 6,500 injured, and 300,000 displaced from their homes. The explosion destroyed and damaged health facilities in Beirut. Now, the ongoing economic and political crisis continues to leave the people of Lebanon facing daily hardship. MedGlobal’s Lebanon Program Manager, Dr. Tania Baban, and Lebanon Logistics and Procurement Coordinator, Radiah Saleh, answered questions about the situation ahead of the one year anniversary of the Beirut port explosion.

1. It’s been a year since the Beirut port explosion. Can you describe the impact of the explosion on the city and for people in Lebanon in general?

Radiah Saleh: The blast took place amidst a political, economic, and public health crisis. It escalated the lack of confidence in governmental institutions and the public sector in general. The people felt betrayed by their own government for storing such toxic material in the port which is located in Beirut’s hub and adjacent to residential areas. Health care institutions were overwhelmed and over flooded by patients due to the closing down of major hospitals that were destroyed in the blast. And with the rising cases of COVID patients, things were getting out of control.

Dr. Tania Baban:

The explosion happened at a time when the Lebanese people had already been emotionally and physically drained.

The humanitarian impact of the blast was and remains very daunting. Lebanon had already been facing an economic meltdown, an influx of refugees, and a new spike in COVID-19 cases. It came in the throes of the worst economic crisis in recent Lebanese history, which has only been exacerbated by the COVID-19 pandemic.

Around 33% of the country’s population lived at or below the poverty line September 2019 — that number is now estimated to be approximately 77%.

The country’s unemployment rate is now just above 50%. The  massive explosion in Beirut led to a more immediate emergency: more than 300,000 people were left homeless, and over 6,000 injured. These injuries come on top of the pandemic, placing additional stress on the country’s medical and healthcare resources as well as the population’s emotional breakdown.

2. The blast damaged major hospitals and destroyed primary health centers. Can you describe how people accessed health care directly after the explosion, and throughout the past year?

Radiah Saleh: Right after the explosion, emergency rooms were flooded with the injured and hospitals couldn’t accommodate the huge number of injuries. Some patients had to be treated in ambulances or outside hospital doors because hospitals were full and their staff outnumbered. 

Days after the explosion, COVID cases started skyrocketing due to the lack of measures and the chaos the country was going through. This is where MedGlobal saw it best to intervene to help ease the suffering of the Lebanese people in such unprecedented times. We started by distributing PPE material in the area that the blast took place in and then proceeded with the distribution of hygiene kits. We then set up a medical tent nearby the port area that offered first aid, medical assistance, and mental health consultations to more than 3,000 patients. Our work continued later on during the coming months to provide PPE and medications to several hospitals in the Beirut area and then expanded to distribute winterization and hygiene kits to refugee camps in Arsel, in addition to oxygen concentrators and medical equipment to hospitals in Beirut and the north of Lebanon. Our Elderly Program in collaboration with Lobnaneyon was a huge success due to the lack of home care in Lebanon, especially for the elderly.  We also received a lot of positive feedback for the implementation of the dental program in collaboration with MAPS in the north of Lebanon.

Dr. Tania Baban:

Lebanon is facing multiple overlapping emergencies that have had dire consequences.

The country’s ongoing economic crisis has made private healthcare prohibitively expensive, leaving more people reliant on the public health services. COVID-19 and the Beirut blast put additional strain on the already stretched public health system. As one healthcare official told the press the day after the explosion, “We need everything to hospitalize the victims, and there is an acute shortage of everything.”

The explosion destroyed three of the city’s main hospitals and damaged many other health facilities, forcing many patients to be evacuated and creating an increased demand for beds in other nearby facilities. Two more hospitals suffered severe damage, with one hospital managing to continue functioning by setting up a field hospital in its parking lot. Some medical supplies were already in short supply due to the coronavirus. Beirut had the highest concentration of confirmed cases of COVID-19 in the country. The port of Beirut also handled 80% of Lebanon’s medical imports, which meant that getting supplies into the country to where they were most needed involved contingency plans, such as delivering through the smaller port of Tripoli in the north (approximately 90 minutes away by car). Before the explosion, hospitals were already near capacity, coping with a spike in COVID cases. After the explosion, the situation deteriorated even more rapidly, with more than 300 new cases of COVID identified on a daily basis. It became harder for people to protect themselves from the virus while living in damaged homes without electricity and running water, or sharing shelters with other families. The health system was stretched to breaking point as medical facilities in the capital had to treat thousands of patients for severe burns and blast injuries. Many facilities reported an urgent need for more medications and medical equipment as well as medical staff to treat all those in need of care.

3. The mental health impact of the blast for many people in Lebanon will surely be long-lasting, and we know that anniversaries of traumatic events can sometimes reactivate particularly difficult thoughts and feelings for survivors. Can you describe some of the mental health and psychosocial support services that are available?

Radiah Saleh: Mental health awareness has been a rising topic in Lebanon the past couple of years due to the socio-economic situation in the country and unstable political situation. The blast alongside the pandemic reinforced the need for such care. MedGlobal’s first initiative in this field was in the medical tent that was set up in collaboration with a local NGO. A psychiatrist was brought on board and there were daily consultations and follow ups for over 200 patients. We then collaborated with Embrace, a local NGO aiming to raise mental health awareness whose mission is ‘to ensure that mental health and access to care is positioned as a basic human right that must be met for all persons, through awareness, advocacy, and dignified mental health services across the spectrum of care.’ 

Dr. Tania Baban:

Lebanon’s recent history combined with this explosion created a mental health challenge for hundreds of thousands of Beirutis, including an estimated 100,000 children.

While many affected by the blast may not have sustained physical injuries, the long-term effects of explosions are shown to include post-traumatic stress disorder. Left untreated, PTSD from these experiences could lead to chronic conditions including anxiety, depression, or addiction, as well as negative coping mechanisms. These conditions can seriously limit a person’s potential or quality of life. Although the number may not be exact, many people were separated from their loved ones in the aftermath of the blast. Many, including children, witnessed first-hand the destruction of their homes, the death of family members, and hospitalization of close friends. Hundreds of people are still recovering from physical injuries a year after that ominous day. And those without physical wounds are suffering from the psychological effects of what happened. The people still need substantial emotional and psychological support to help us try to “come to terms” with the disaster and the suffering that we continue to see around us.

4. Now we are seeing economic collapse lead to another dire crisis throughout Lebanon. Can you describe the daily challenges people are facing?

Radiah Saleh: Despite the lack of trust in leadership in Lebanon, community solidarity still stands. This is evident in the rising number of volunteers in response to the explosion, either through physical labor or through donating to local NGOs. The main challenge is that people do not feel that the money allocated for recovery, coming from the outside, will be spent equally, transparently, and fairly. People are reluctant to invest in anything public because of the corruption rates. They are pessimistic about the future and the quality of life a couple of years from now.

There is a growing shortage in medicine and fuel to keep hospitals and generators running, in addition to the fact that most of our renowned doctors are leaving the country.

Some food items have become a luxury to most Lebanese because of the inflated prices and devaluation of the Lebanese currency. 

Dr. Tania Baban: The country now faces a growing shortage of medical supplies and essential medicines, such as those used to treat chronic diseases and mental health, leaving the most vulnerable people at risk. Lebanon also hosts the largest number of refugees per capita in the world, which means that many of the displaced people living here have already endured traumatic experiences. Since late 2019, Lebanon has been grappling with its worst economic crisis in decades, as well as social unrest and political turmoil. These overlapping crises, along with COVID and the blast, have exacerbated people’s vulnerability and pushed thousands into poverty. All this comes in addition to a protracted situation for displaced people. Now the cost of basic goods, including food, is more and more difficult to afford for many. Medical fees have also become prohibitive for vulnerable groups in the country, and this context is expected to worsen people’s health conditions and access to care. We have already started to witness signs of deterioration. Over the past year, we have observed an increase in vulnerability among patients. Many of them are experiencing financial issues related to the country’s economic situation, which for some are having an impact on their ability to properly follow their treatment. The toll on people’s psychological well-being is also noticeable and is a major concern.

5. What are the greatest needs you see now for the population in Lebanon? Among Lebanese, as well as Syrian and Palestinian refugees, migrants, and others?

Radiah Saleh: The ability to provide basic necessities to their families is the main concern to most Lebanese or refugees residing in Lebanon.

What once was a necessity is now a luxury to most.

Clean water, fuel, electricity, food, and medicine are very difficult to acquire. A basic standard of living has become so hard to maintain, causing distress, anxiety, and depression among many people. Unemployment rates are rising by the day and maintaining a safe space for families to live is becoming impossible. These truly are unprecedented times and every donation and helping hand makes a difference. MedGlobal and our field team in Lebanon are trying to reach as many vulnerable communities as possible with the limited resources we have, and praying for better days for this beautiful, once vibrant country. 

Dr. Tania Baban: For many people in Lebanon, whether they are Lebanese, refugees, or migrant workers, the current economic crisis and the deteriorating living conditions come on top of traumatic events and stressful experiences they have already had to face, such as conflict or displacement. These stress factors have contributed to disrupting people’s psychological well-being. Many people in Lebanon show symptoms related to emotional distress, depression, anxiety and hopelessness. As one blow follows another, people’s coping mechanisms are weakened and, for many, keeping their head above the water is becoming harder. The MedGlobal Lebanon team is trying to help as much as we can in such a complex context and we are committed to continuing to do so, but our capacities are also limited and we can’t respond to all the needs. It is disheartening to see people’s vulnerability increasing and more people requiring more and more medical support.

We have become a nation on edge with limited access to anything and everything: medical equipment and medications, fuel and electricity, food and water.

By Valerie Nguyen, MedGlobal Policy Intern

Over a year into the global pandemic, the rapid COVID-19 vaccine research and production proves hopeful in finally making steps toward ending the pandemic. However, COVID-19 still disproportionately impacts vulnerable populations without reliable access to the vaccine – leaving a massive number of people unprotected from the virus. The COVAX program was implemented as the vaccine pillar to the Access to COVID-19 Tools (ACT) Accelerator, a global collaboration between the World Health Organization and other global health agencies beginning in April 2020. COVAX established the Humanitarian Buffer to provide vaccines to vulnerable populations, particularly refugees, internally displaced persons (IDPs), stateless people, at-risk individuals, people facing humanitarian crises, and others who are unlikely to receive vaccines through a national vaccination strategy – essentially, the buffer is set up to act as a “last resort” for access to COVID-19 vaccines. The buffer was created to supplement and fill in gaps of existing national vaccination plans for populations who may fall through the cracks. The Inter-Agency Standing Committee (IASC) estimates there are approximately 167 million people at risk of exclusion from receiving a COVID-19 vaccine, almost half of whom are refugees, IDPs, or stateless people. An estimated 60 – 80 million people in areas outside the de facto control of national governments could be outside of reach, such as those in northwest Syria. The buffer intends to reach those in hard-to-reach areas, such as conflict areas and geographically isolated areas.

National governments participating in the COVAX program and humanitarian agencies can apply for the Humanitarian Buffer. National governments are required to demonstrate why the population of concern was not included in the national vaccination plan and provide evidence of attempts to cover this population. Similarly, humanitarian agencies are required to demonstrate that there is a clear gap in vaccine coverage and access for the population of concern, as well as the agency’s competency to deliver vaccines to the population in question.

The Humanitarian Buffer was intended to be agile and respond to dynamic situations, but it is not intended to cover vaccines for entire communities – leaving millions of people without access to a vaccine, and at risk of a COVID-19 outbreak. MedGlobal released the report “Vaccine Equity & Access in Crisis” detailing the widespread inaccessibility of COVID-19 vaccines in our countries of operation. This report highlights that forcibly displaced people experienced COVID-19 effects in over 100 countries, majority low or middle-income countries often operating with very limited health resources and medical providers. The report details the significant discrepancy of access to healthcare between wealthy and lower-income areas, especially for vulnerable populations located in conflict-affected or fragile states. Offering the Humanitarian Buffer under COVAX is a hopeful step to ensure marginalized populations in humanitarian settings are accounted for outside of national vaccination rollouts, but there are still many technical details that need to be ironed out – from burden of legal risk to the threat of insecure conditions – if the buffer will be utilized effectively in offering vaccines to the populations it was intended for.

By Emma Ackerman, MedGlobal Communications & Advocacy Intern

Trigger warning: descriptions of sexual violence.

Recent humanitarian crises and conflicts have resulted in record numbers of people forcibly displaced worldwide. There are currently an estimated 26 million refugees around the world, 50% of whom are women. Conflicts, crises, and resulting refugee movements have deeply gendered dimensions that place women, girls, and gender minorities at a disproportionately high risk for sexual and gender-based violence and discrimination while in conflict zones, on the move, and in refugee camps. 

Gender-based violence (GBV) happens on a broad spectrum, including forced and/ or child marriage, “survival sex,” sex trafficking, domestic violence, physical abuse, sexual harassment, and rape. According to a UNFPA Representative, “Gender-based violence… is one of the most pervasive human-rights abuses in the world.” Female refugees worldwide tell heartbreaking stories of unspeakable brutalization, oppression, loss of livelihood, and even identity in the quest for safety. 

In the context of conflict, sexual assault and GBV are often used as weapons of war. Women’s bodies, especially those of refugee women, have long been treated as battlegrounds. Recent reports condemn the unprecedented scale of systemic rape and other forms of GBV being used as a tool of political repression. Recent conflict in the Tigray region of Ethiopia has included harrowing accounts of sexual violence against Tigrayan women and girls. Thousands of people from the Tigray region have become displaced by the conflict and have fled to camps located on the border of Ethiopia and Sudan. An open letter organized by politicians from the UK and New Zealand, alongside human rights activists, calls on the UN Security Council to set up a tribunal to investigate allegations of sexual violence in Ethiopia’s Tigray region “as a war crime, a crime against humanity, or a constitutive act of genocide.” The heartbreaking accounts of sexual violence against Tigrayan women is shining a light on sexual violence during conflict more broadly – the letter continues, saying: “Failure by the international community to act would undo the progress made so far in eliminating sexual violence in conflict.” 

Refugee camps themselves come with their own security threats. A UN press release from January expresses grave concern over the rise in reported instances of sexual gender-based violence (SGBV) within refugee camps. According to interviews led by UN Women with community leaders and refugees, nearly all Rohingya women and girls living in the Cox’s Bazar refugee camps in Bangladesh has survived and/ or witnessed instances of sexual assault, rape, gang-rape, and murder during the ethnic cleansing and displacement in Myanmar. Survival sex is a common practice within refugee camps, particularly in Columbia, Sudan, Bangladesh, and Yemen, where women are forced to trade sex for food, water, and shelter in order to survive. Contraceptives are rarely used, putting medical centers under high demand for emergency contraceptives and tests for STIs, all of which are in short supply. Staggering numbers of women refugees bear the physical and mental scars of GBV and are in desperate need of health care and counseling services. Chronic pain, infertility, unwanted pregnancy, unsafe abortions, chronic incontinence, internal bleeding, STI’s, suicidality, post-traumatic stress, urinary fistulas, brain damage, mutilation, and even death are some of the most common impacts of sexual violence in refugee communities and conflict-affected areas. Refugee women often lack access to health facilities and are almost entirely reliant on services provided by UN agencies and humanitarian organizations such as MedGlobal. The chronic lack of women’s health services, poverty, and limited infrastructure in refugee communities makes health care extremely difficult to access, increasing risk of long-term repercussions. Due to social stigma of sexual assault, lack of reporting mechanisms, and fear of retaliation or deportation, refugee women rarely report cases of GBV. 

COVID-19 has increased the vulnerability of women and girls while simultaneously limiting operations of many humanitarian aid organizations. From 2019-2020, sexual and gender-based violence against Venezuelan migrants in Columbia has increased by 41.5%. Within the times of COVID-19, the exacerbation and increase of sexual and gender-based violence is known by many humanitarian organizations as a “shadow pandemic.” Due to COVID-19 lockdowns, many mechanisms intended to report sexual and gender-based violence and provide victim support services are no longer accessible. Lockdowns have made it significantly more difficult for victims to escape from perpetrators and seek outside assistance. Additionally, prioritization of COVID treatment and medical support has drawn attention and funds from other important areas of health, specifically those impacting women. Leaders of women-led humanitarian organizations tell how vital sexual & reproductive health services, maternal health, and immunizations have become overlooked. There is a need for international humanitarian organizations to prioritize women’s health and experiences of refugee women in their response to refugee crises. 

Humanitarian aid responses should center the needs and priorities of refugee women and promote healing in an inclusive, intersectional, and culturally competent manner. Team Zamzam is a group of 16 Sudanese women who have provided free counseling and medical advocacy services to over 1,000 women and girls struggling with trauma from sexual violence since September 2020. They are a remarkable example of the power of mental health & psychosocial support led by affected communities. Refugee women’s perspectives are also critical in identifying strategies for reducing and preventing GBV in refugee camps. For example, in the Dadaab refugee camp, rape was reduced by 45% after stocking houses with firewood rather than having women go out to collect it on a daily basis. Further steps need to be taken in order to close the chasm between resolution and reality of stopping gender-based violence in refugee communities and conflict-affected areas.

As Lebanon continues to grapple with devastating economic and health crises, elderly residents of Beirut face dire challenges. The lack of strong social support networks and retirement plans have created massive gaps in health coverage for Beirut’s elder population. Many elderly residents live alone and suffer from physical disabilities that make it difficult for them to travel and access services. Among the elderly, there are many who are unregistered refugees facing additional hurdles to accessing care due to their legal status. Lebanon’s inability to finance the import of medical supplies has also led to severe shortages of medications needed to treat chronic conditions.  

The Beirut port explosion on August 4th, 2020, has further exacerbated the health crisis by injuring more than 6,500 people and displacing 300,000 residents. The blast also damaged six major hospitals, half of which were completely incapacitated, and damaged or destroyed 23 primary health centers. Hundreds of elderly residents are currently living in extreme poverty without food or shelter. According to UN Women, mental health hotlines reported a significant increase in calls from elderly people contemplating suicide following the traumatic blast and econimic collapse. To address the crisis, MedGlobal launched an initiative to provide at-home medical care visits for elderly patients who have minimal or no access to healthcare, with support from the Stirling Foundation.

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“The elderly people here were very affected by the blast and are also affected by the economic crisis and COVID-19 pandemic. There are multiple financial, security, and health problems facing these people.”

Dr. Elie Stefan, Saint George Hospital University Medical Center

MedGlobal is partnering with Loubnaniyoun, a local NGO, to hire a geriatrician and nurse to conduct home health visits to elderly patients. The program focuses on low-income residents of Beirut over the age of 60 with physical difficulties or impairments that prevent easy access to health facilities. The program prioritizes patients with chronic conditions and those who are not currently receiving support from other organizations. Program staff have provided health exams, imaging and lab services, medications, psychosocial support services, and follow-up visits. The program has reached over 330 patients. MedGlobal will additionally provide training to young volunteers on how to work with elderly people and respond to their needs. 

“Since our daily Beirut blast activities and assistance program, we met many elderly people in need of somebody to help take care of their health. Either left alone or with poor children to take care of them, their health is put aside since the primary needs are to eat and afford a minimum standard of living. But the surprise of Loubnaniyoun’s team was tremendous as we are measuring the impact of this project. Through this project the elderly are given the chance to have a medical checkup and assessment, to do blood or radiology tests, and to be treated professionally. All this would not have been done without this program: we are actually saving lives. This huge impact is thanks to your NGO MedGlobal’s help and funds; we are able to give 335 elderly people a chance to take care of their health, which is the most important thing in life.”

Nadine Saidy Daher, President of Loubnaniyoun

“The elderly are an integral part of our society. Loneliness, negligence, chronic illness and lack of access to medical care are conditions they too often face. Given our limited resources in Lebanon, particularly the absence of an elderly healthcare system and social security safety nets, elderly people are facing greater demands and challenges. This program has not only helped them with their physical ailments, but has also given them hope for a better future, one where they are cared for and not left alone.”

Dr. Tania Baban, MedGlobal Program Manager in Lebanon

In conjunction with home visits, MedGlobal has provided PPE, medications, and other medical supplies to 13 primary health centers in Beirut to support emergency and primary medical response services. The program has impacted over 10,000 people directly. MedGlobal has been active in Lebanon since early 2018, providing primary and surgical care and mental health services to Syrian refugees and vulnerable Lebanese patients. Since August 2020, following the devastating explosion in the port of Beirut, MedGlobal has been responding to the health needs of vulnerable Beirut residents.

By Andrew Moran, MedGlobal Policy & Advocacy Intern

Last week, President Biden announced that the United States’ annual refugee admissions cap would be raised to 62,500, up from a historic low of 15,000. However, the White House has expressed doubt that the program will be able to fully scale up admissions by the end of the year. The reduction in admissions to the US reflects the international state of refugee resettlement. In 2020, the number of refugees resettled around the world fell to the lowest level in two decades amid the COVID-19 pandemic and closing of national borders. Fewer than 15,500 refugees were resettled between January and September, well under the global quota of 50,000. Though continuing to resettle refugees is a critical component of refugee crisis response efforts, it is at least as important – especially during the pandemic – to support refugees and host communities where they are, and invest in refugee-led initiatives. 

Nearly three in four refugees are hosted in neighboring countries, many of which are low and middle-income countries with limited ability to manage humanitarian crises. As a consequence, millions of refugees live in overcrowded camps with scarce resources that are ill-suited for long-term displacement. In Bangladesh, more than 900,000 Rohingya refugees are living in severely congested camps in Cox’s Bazar, including nearly 630,000 refugees in a single camp. As highlighted in MedGlobal’s report In the Eye of the Cyclone, hundreds of thousands of people are housed in areas prone to flooding and landslides during the monsoon season. Large fires have also plagued the camps in recent months. Poor living conditions in refugee camps, both in Bangladesh and around the world, have left refugees at risk of catastrophic outbreaks of COVID-19. As the resources of host countries are stretched thin and non-citizens are increasingly deprioritized, surging assistance to camps and host communities is vital to ensure the needs of refugees are met. 

Lebanon is another country where comprehensive support for refugees and local host communities is incredibly difficult. Lebanon is the country with the highest number of refugees per capita in the world. More than one million Syrian refugees are dispersed among cities, villages, and informal settlements. An estimated 80% of Syrians are unregistered and 90% live in extreme poverty. NGOs like MedGlobal support health programming and clinics that provide free medical services for refugees, but national initiatives are required to ensure all needs are met.

Support for refugee-led initiatives is another critically important component of global refugee responses, helping to bring agency and decision-making back to refugees themselves. While organizations led by refugees have often played key roles in their communities, the COVID-19 pandemic has compelled them to take on increased responsibilities as government programs were rolled back and many NGOs reduced operations. In Kenya’s Kampala refugee camp, one of the largest in the world, Young African Refugees for Integral Development (YARID) is a model of a refugee-led organization that has stepped up to deliver food and other items to vulnerable refugees and share guidelines for limiting the spread of COVID-19. These refugee organizations are instrumental in enhancing self-reliance for refugees and creating opportunities for their own communities.

Caring for refugees – who have been displaced by persecution and conflict – is a universal responsibility. As the world continues to grapple with COVID-19, scaling up support for refugees has never been more vital. The deterioration of economies and health systems has caused historic and existential crises for entire regions, and disproportionately impacted refugees and other vulnerable communities. Only through surging assistance to host communities and refugee-led initiatives can we hope to avoid even greater tragedy, and shift power into the hands of affected populations.

By Andrew Moran, MedGlobal Policy & Advocacy Intern

The COVID-19 pandemic has generated international focus on the critical role vaccines play in managing outbreaks and saving lives. The global effort to develop new vaccines was accelerated by massive public and private funding and international partnerships that resulted in multiple vaccines in record time. However, the successful rollout of vaccination campaigns have been marred by barriers to access and widespread vaccine skepticism. In Pakistan, Sudan, and Yemen, long-running efforts to eradicate polio highlight these challenges and provide a critical framework for navigating mass vaccination campaigns.

According to the World Health Organization, more than one billion children received vaccinations over the past decade. These immunizations are estimated to save between four and five million people each year and have led to the near eradication of incurable diseases like polio. However, even momentary lapses in immunizations – caused by conflict, economic crisis, mass displacement, or competing health priorities – can leave entire regions vulnerable to outbreaks of previously controlled diseases. 

In Pakistan, one of the few remaining countries where polio is endemic, vaccination campaigns were halted for four months due to the COVID-19 pandemic. This had a devastating impact on the fight against polio at a time when new polio cases were surging. In 2018, there were just 12 reported cases of wild polio. A year later, there were at least 144 new cases and more than 80 cases were reported in 2020. The surge in cases is attributed to the spread of conspiracy theories surrounding vaccines and attacks against health workers that disrupted campaigns. Despite facing new hurdles imposed by COVID-19, health officials in Pakistan worked with communities to combat misinformation and carried out six campaigns in 2020. In January 2021, Pakistan mobilized 285,000 health workers to vaccinate 40 million children. 

Pakistan’s experience running polio vaccination campaigns has already proved invaluable in its effort to manage the COVID-19 pandemic. In addition to repurposing existing infrastructure and surveillance networks to carry out vaccinations and monitor outbreaks, Pakistan also benefits enormously from the trust built with communities over previous campaigns. Key partnerships with community leaders, sports associations, media organizations, and religious leaders played an essential role in overcoming vaccine hesitancy for polio and will remain vital for COVID-19 and all other future immunization campaigns. 

Outbreaks of vaccine-derived polio, a consequence of low vaccination rates, have also occurred recently in Sudan and Yemen. Both countries recorded their last cases of wild polio in the 2000s, but are now vulnerable to its return. In 2019, Sudan carried out a national vaccine campaign for polio and measles. At the time, no cases of polio had been reported in over a decade. However, the outbreak of COVID-19, combined with mass displacements, an economic crisis, and weak health system, led to disruptions in immunizations and the emergence of 46 new cases of polio. In conflict-affected Yemen, 15 cases of polio were also detected in the northwest after immunization campaigns were stalled for more than two years. In response to the outbreaks, both countries partnered with the UN to carry out vaccination campaigns. As Sudan and Yemen begin their COVID-19 campaigns, they can rely on lessons learned and pre-existing partnerships to inform and bolster their work. 

The rapid development of the COVID-19 vaccine relied on decades of research, investment, and partnerships; the same global engagement is required to ensure everyone has access to it. While services providing direct access to vaccines, such as MedGlobal’s Mobile Teams in Yemen, are critical to boosting immunization campaigns, ensuring continuous access to medical services is just as important. In many cases, vaccine hesitancy stems from a lack of basic health services. Communities that are historically underserved or ignored may be more susceptible to rumors and misinformation when vaccines suddenly appear. As MedGlobal continues to engage with communities in Pakistan, Sudan, Yemen, and other countries around the world, we are working to invest in long-term, sustainable health care to build trust and address both current and future health needs. 

By Andrew Moran, MedGlobal Policy & Advocacy Intern

Earth Day 2021 marks the 51st anniversary of the modern environmental movement, a movement that now spans the globe with more than one billion people participating each year. Addressing the continued destruction of the environment and the rapidly changing climate have never been more critical. In every country MedGlobal operates, we see the devastating impact of a warming globe. The populations we serve are increasingly victims of extreme weather events, face food and water insecurity, and suffer from outbreaks of disease, all of which can be linked to climate change. While the shifting climate poses a risk to all people, the threat to displaced persons and other vulnerable groups is often existential. 

Climate change has already created and exacerbated massive humanitarian crises around the world. MedGlobal’s field teams in Bangladesh, Yemen, and Sudan are increasingly forced to manage the challenges of widespread, climate-linked flooding. In MedGlobal’s report on the Rohingya refugee crisis in Bangladesh In the Eye of the Cyclone, our team warns that the nearly one million refugees in Cox’s Bazar live in low-lying areas that are prone to flooding and mudslides. In Yemen, where violence and multiple crises have left 80% of the population in need of humanitarian aid, more than 300,000 people lost their homes due to flooding last year. This last year, Sudan saw record-breaking floods. MedGlobal’s Sudan Program Manager Abduelsamad Abdalla Ahmed reported on the widespread flooding that left half a million people homeless, saying:

“The floods in Sudan are the worst they’ve been in thirty years. Not only are the floods displacing and killing people, but we are very worried about an outbreak of diseases. The situation is out of control.”

In addition to the immediate effects of climate change, the long-term impact of the warming globe may drastically reduce habitability of entire regions, causing unprecedented global displacement. As climate change continues to worsen, more intense storm seasons are predicted to make once-in-a-century flooding ten times more common. In the next decade, rising temperatures are also expected to cause a 5% drop in global crop yields, pushing 100 million into poverty. Within the next 80 years, tropical areas and parts of the Middle East may become completely uninhabitable during summer months. Millions of people have already become climate refugees and it is estimated that by 2050, more than one billion people will suffer displacement due to these pressures. 

Another critical element of climate change that directly impacts health systems, it contributes to the outbreak of deadly diseases. Several diseases, including cholera, dengue fever, chikungunya, Zika virus, and West Nile virus, are expected to worsen due to climate change. For certain disease vectors, such as mosquitos, increased flooding leads to population growth and rising temperatures allows them to expand their range. This means that communities already battling the diseases face more severe outbreaks and some diseases may spread to new areas where local health systems lack experience managing them. For diseases like malaria, warmer temperatures also increase the rate of reproduction for the disease causing parasite, making it more transmissible. 

Since 2017, massive flooding in Yemen has contributed to over 2.1 million cases of cholera. Dr. Nahla Arishi, a pediatrician in Aden, noted in MedGlobal’s report A Tipping Point for Yemen’s Health System that flooding has hindered the COVID-19 response as many Yemenis misdiagnose their coronavirus symptoms as flood-related diseases. As Yemen approaches the beginning of its rainy season, new cases of cholera have already emerged and a new outbreak may occur. 

The emergence of new diseases is another major issue that environmental destruction has accelerated. 2020 saw a sharp increase in deforestation, partially due to fires in the Amazon that were fueled by the worst droughts in 40 years. In addition to contributing to climate change, the destruction of habitat forces wild animals into closer contact with domesticated animals and humans. The increased interaction creates opportunities for diseases to jump from one species to another. According to USAID, up to 75% of all emerging and re-emerging diseases that affect humans originated in animals. Unless steps are taken to reduce habitat destruction, the frequency of new diseases may increase and catastrophic pandemics like COVID-19 may become much more common. 

While the world grapples with solutions to the environmental crisis, low- and middle-income countries continue to pay the greatest cost. Many of these countries have been the first to experience climate-linked emergencies and lack the resources, infrastructure, and health systems to adequately respond to them. As the needs of citizens are prioritized, the needs of refugees and migrants are often neglected or ignored. In these settings, MedGlobal engages with the worst humanitarian crises to address disparities in healthcare access. As we continue to meet the challenges of a changing planet, we must continue adapt our operations, invest in climate resistant infrastructure, and develop extensive response networks to ensure long-term, sustainable health services for the most vulnerable populations. 

In Yemen, millions of people lack access to health care. Less than half of the country’s health facilities are fully functional, though after six years of violent conflict, more than 80% of the population is in need of humanitarian assistance. Healthcare needs are spiking due to COVID-19, widespread acute malnutrition, poverty, and other effects of the conflict, though reductions in funding have forced the UN to suspend aid to 300 health centers across Yemen. 

Access to healthcare is most critical for rural, remote, and poverty-affected communities. To address this growing health crisis, MedGlobal is launching a Mobile Teams program to bring health care to communities in need. These Mobile Teams will deliver primary health services to underserved, hard-to-reach areas in the Al Shamayateen and Al Mozea districts of Taiz governorate. The area’s mountainous terrain and lack of serviceable roads poses significant challenges to healthcare delivery. The cost of transportation, especially for frequent trips to health centers, is an insurmountable barrier that forces isolated populations living on top of mountains to walk upwards of four hours to reach the nearest health facility. 

The ongoing conflict – for which Taiz has become a frontline – adds additional hurdles to access and exacerbates health needs. The region has the highest recorded number of landmines and 2,300 civilians have been killed since fighting began, the worst civilian death toll of any governorate. In 2019 alone, seven health facilities were attacked in this region, impacting access to health services for more than 32,500 households. 

MedGlobal’s three Mobile Teams, each composed of a team leader, nurse, midwife, and medical assistant, will coordinate with four health facilities in these districts to ensure widespread coverage and continuity of care. The teams will provide access to consultations, lab work, medications, and follow-up care to households that have difficulty accessing health services. Each month, the teams are expected to reach 500 patients with services including maternal and child health, nutrition, immunizations, and community health education. 

While other NGOs have deployed mobile medical teams in other regions of Taiz in the past, funding cuts have forced many programs to cease operations. Restoring and sustaining access to health services is especially crucial as Yemen begins to enter its rainy season. Several cases of cholera have already been reported in Al Mozea and there are currently no treatment services available. Taiz also hosts a large population of internally displaced persons, many of whom have missed out on measles and polio vaccinations, who will be a core focus of the Mobile Teams’ work. 

In the future, MedGlobal plans to establish additional teams in Taiz governorate and expand the program to Aden governorate as well. MedGlobal has worked in Yemen since 2017, providing health services and supporting 25 hospitals across six governorates. In response to the outbreak of COVID-19, MedGlobal scaled up its work and began providing PPE and critical medical equipment to hospitals, rural health facilities, and isolation centers treating COVID-19 patients. Our Yemen team is expanding to ensure that critical health care is accessible and available to those most in need.

Since late February, there has been a sharp increase in COVID-19 cases in Yemen. As of April 4, there have been 4,701 confirmed cases in Yemen – though this is undoubtedly a drastic underestimate of the real number. Out of the total confirmed cases, 54% of the total have been reported in the last six weeks, since February 22. The true number of people with COVID-19 in the country is impossible to determine due to limited testing, lack of access to health care, stigma, and complete lack of documentation in northern Yemen, all significantly hindering response efforts. This steep rise in COVID-19 comes as impending famine threatens to push the humanitarian and health crises in Yemen over the edge.

With COVID-19 patients overwhelming hospitals, Yemen is now experiencing a medical oxygen crisis. On March 19, Yemen’s Health and Population Minister warned that the intensive care units of quarantine centers had reached capacity and had run out of oxygen cylinders and intensive care equipment. A health emergency has been declared in response to the second wave surge of new cases. MedGlobal’s Yemen Program Manager, Dr. Mohammed Abass, said:

“The situation is really getting worse every day with the increasing number of cases of COVID and the death rate, especially in Aden and Taiz. Fears are increasing that the second wave of the pandemic will be more severe than the first wave. There are expectations that the number of cases will rise, especially with the beginning of the month of Ramadan coming soon, when it is custom or tradition to have frequent visits. There will be an even greater need for medical oxygen.”

Only half of Yemen’s healthcare facilities are fully functional, and nearly all lack basic supplies to sufficiently treat patients. Six years of conflict, economic collapse, and the destruction of health infrastructure has left Yemen struggling to manage multiple epidemics. Acute malnutrition threatens over half of children under five in Yemen, many who are at risk of dying if they do not receive immediate treatment. At the same time, reductions in humanitarian funding have led to a roll back in humanitarian aid programs in Yemen, which included cutting oxygen shipments to health facilities. In response to growing needs, MedGlobal provided 139 oxygen cylinders to several health facilities across Yemen in 2020 and plans to scale up this work in 2021. Many of the 25 health facilities MedGlobal has supported in Yemen face enormous barriers to accessing medical supplies, and face chronic shortages of equipment, medication, and medical oxygen. Oxygen is a critical part of the emergency response to COVID-19.

Around the world, the COVID-19 pandemic has placed immense pressure on health systems. Access to medical oxygen has become a global concern as demand has spiked. Roughly one in five people suffering from COVID-19 require oxygen therapy, including more than 500,000 patients in low- and middle-income countries (LMIC). However, half of all hospitals in LMICs lack reliable access to medical oxygen. 

While Yemen’s efforts to contain the spread of COVID-19 has been bolstered by the arrival of its first batch of 360,000 doses of vaccines through the COVAX program, the health system will continue to struggle to manage the crisis. The 1.9 million doses that Yemen expects to receive by the end of 2021 are a fraction of what it needs to vaccinate its population of 30 million. Unless support is dramatically increased for emergency and long-term phases, the broader health crises will continue to affect the population – from acute malnutrition to a maternal mortality crisis. Without consistent access to basic health care – such as reliable, long-term access to medical oxygen, to literally help those in need breathe – the outlook is bleak. 

The humanitarian situation in Yemen is dire, with 80% of the population in need of humanitarian assistance and the country on the brink of famine. At the same time, humanitarian funding commitments have been decreasing by global donors. MedGlobal has worked in Yemen since 2017, providing health and nutrition support to hospitals and communities in the most hard-to-reach areas. Our Yemen Program Manager, Dr. Mohammed Abass, recently answered questions about the humanitarian crisis in Yemen.

1) How would you describe the current humanitarian situation in Yemen? 

Yemen is truly experiencing one of the largest humanitarian crises in the world. The vast majority of people are in desperate need of humanitarian assistance. The hunger crisis is worsening all of the time. Our country is now headed into a large-scale famine. 

Many Yemenis are dealing with daily threats to their security, and many have faced protracted displacement and are unable to access basic services. Six years of fighting and violence has collapsed Yemen’s economy and destroyed housing and infrastructure serving millions of people. Over the past 18 months, flooding has devastated communities in the south and contributed to the spread of diseases, including cholera, dengue, malaria, and diphtheria. COVID-19 has of course made everything worse. When COVID-19 was first detected last March, all of Yemen’s other crises made it impossible to focus on containing or managing the spread. No one knows how many people have had the virus or how many have died. 

More than half of health facilities have been damaged by the conflict or lack the staff, medical supplies, or fuel to function. Challenges to importing supplies mean that many health facilities lack basic things like masks and gloves. Supplies that we need for treating COVID-19 patients, like oxygen, are even harder to get. And many health workers are working without being paid. 

2) Yemen has been on the brink of famine for several years. What is different about the situation now?

Yemen’s economy collapsed since the conflict began. Most Yemenis are hungry and unable to secure food for themselves. A third of the population has barely enough income to buy food, and even small rises in prices can prevent families from being able to buy food for weeks or months. The few companies that supply our markets are dealing with restrictions on imports and taxation. Importing food into northern Yemen is even harder due to air and sea blockades.

The cuts to humanitarian funding have also led to reductions in food assistance by humanitarian organizations. In the spring of 2020, there were big cuts to emergency food aid going to millions of people in the north. Monthly rations to families have been stretched to a single delivery every two months. These are just a few of the factors contributing to an increase in malnutrition and starvation, especially for children. A quarter of the population in Yemen, including more than two million children and one million pregnant and lactating women, are suffering from malnutrition. 

3) How are ordinary Yemenis dealing with the multiple health crises? Are certain needs prioritized over others?

The hunger and malnutrition crisis is getting worse day by day. Yemeni families are right now depending on meagre humanitarian assistance to supplement income from a few working family members or from a small business. Families in rural and hard-to-reach communities are often entirely dependent on humanitarian support and some agriculture. People are just trying to get by. 

Other health issues are also causing crises. Three years ago, Yemen experienced the worst cholera outbreak in modern history. For the last three years, cholera prevention and control services have taken priority. Of course, the outbreak of COVID-19 worsened the situation for many Yemenis. But major public health interventions receive limited focus.

4) What are some of the biggest needs in your opinion? 

Some of the greatest needs we see at the moment include:

• Food assistance and unconditional cash grants for families who are displaced. Support for those facing hunger and famine is critical for their survival.
• Nutrition support, especially for young babies. We need to reduce acute malnutrition among highly vulnerable populations.
• Water sanitation and hygiene (WASH) interventions to prevent future outbreaks of water-borne diseases.
• Maternal and child health care. This is lacking across Yemen.
• Strengthening health systems and infrastructure, especially through providing training and motivation for health workers especially in rural and hard-to-reach communities.