Making Health Care Accessible in Yemen: The Power of Mobile Health Teams

Making Health Care Accessible in Yemen: The Power of Mobile Health Teams

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.

Yemen: Medical Oxygen Crisis Amid COVID-19 Second Wave

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. 

Q&A with MedGlobal’s Yemen Program Manager on Health Crises & Famine

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.

Healthcare in Yemen’s Hard-to-Reach Areas: Supporting Hospitals in Taiz, Al Hudaydah, and Hadramaut

MedGlobal has worked in Yemen since 2017, providing health services and supporting 14 hospitals across 7 governorates. Since the outbreak of COVID-19, MedGlobal has scaled up its work in Yemen by providing PPE and critical medical equipment to health facilities responding to the COVID-19 crisis. During August and September, MedGlobal’s Program Manager for Yemen, Asma’a Dunia, traveled across the country to deliver medical assistance and coordinated with 7 health facilities in the Hadramaut, Taiz, and Al Hudaydah governorates. This medical support would not have been possible without the dedication and hard work of Asma’a, and the entire MedGlobal team is grateful for her leadership. Below are the details of that healthcare support. 

Health services are more critical than ever in Yemen, after more than 5 years of conflict has created one of the world’s worst humanitarian crises. Around 80% of Yemen’s population is in need of humanitarian aid, and less than half of all health facilities are fully functioning. At the same time that COVID-19 and other health crises are escalating, the UN has been forced to cut critical aid to 300 health centers across Yemen because of a lack of funding.

Map of MedGlobal projects in Yemen

Taiz Hospitals

“There was a dire need in this area. Many people had not received health support before.” 

– Asma’a Dunia, MedGlobal’s Yemen Program Manager

The Taiz governorate is on the frontlines of the armed conflict in Yemen. There are estimates that over 270,000 people are displaced in Taiz from the conflict. In August, MedGlobal identified immense medical needs in the area, as health facilities in the Al Mafa’afer district and Al Sheikh Al Shamayateen district had not previously received any support and were in dire need of assistance. MedGlobal is now working towards sustained support for the Al Nasham Rural Hospital in Al Mafa’afer district and Al Sheikh Khalifa Hospital in Al Shamayateen district. 

Al Mokha Isolation Unit

“MedGlobal provided 19 oxygen cylinders, which is really lifesaving for that isolation unit and the hospital itself.”

– Asma’a Dunia, MedGlobal’s Yemen Program Manager

The Al Mokha district on Yemen’s western coast has also become a core focus of MedGlobal’s work in Taiz governorate. The area is near the frontlines of fighting and thousands of people living there are entirely unable to access healthcare. Prior to MedGlobal’s involvement, there were no functioning hospitals screening for COVID-19. All suspected and confirmed cases were referred to Aden or Taiz city, a journey of 4 to 5 hours, forcing many infected people to remain at home as their health deteriorated. As part of MedGlobal’s response, we contributed to establishing a COVID-19 isolation unit in Al Mokha by providing medical equipment and supplies, including ICU and lab equipment, to allow the unit to start receiving critical cases. 

Hadramaut Hospitals

“In Marib governorate, the site of intense fighting, clashes at two different checkpoints delayed MedGlobal’s medical delivery to Hadramaut by two days.”

In Yemen’s largest governorate, Hadramaut, MedGlobal supports Al Hayah Hospital in Al Qaten district and Ghayel Bawazeer Hospital in Ghayel Bawazeer district. Traveling to the facilities from Aden, the current capital of the Yemeni government, is a dangerous journey of nearly 1,000 kilometers through heavily contested areas. In Marib governorate, the site of intense fighting, clashes at two different checkpoints delayed MedGlobal’s medical delivery by two days.

According to local medical staff, when the pandemic started, health workers lacked the protection needed and many were infected while providing treatment in health centers. The supplies MedGlobal provided for local hospitals in Hadramaut, such as the PPE, disinfectant, and medical equipment, is essential for protecting health workers and treating COVID-19 patients. 

Al Hudaydah 

Al Hudaydah governorate extends along Yemen’s western coast, and hosts an increasing number of displaced people as a result of the escalation of conflict in the area. Communities in Al Hudaydah are particularly vulnerable, and the acute malnutrition rate in Al Hudaydah exceeds the 15% WHO emergency threshold.

“The heartbreaking stories we see in the field are not easy to talk about.” 

– Asma’a Dunia, MedGlobal’s Yemen Program Manager

As the COVID-19 crisis escalated this summer, MedGlobal began to support the Al Waera Isolation Unit in Al Khawkha district and Hays General Hospital in Hays district. Our Program Manager Asma’a conveyed that traveling to the health facilities from Taiz governorate is increasingly difficult as the route is permanently damaged and difficult to traverse. The area is filled with military sites and there is a consistent lack of internet and communication networks, making coordination extremely difficult and time consuming. 

Hays district is surrounded by frontlines and access to the area is heavily restricted. The people living there face daily risks to their safety and healthcare access issues are common, even for health emergencies. For those who are able to leave the area to access healthcare, they need to travel more than 4 hours to reach the nearest health center. Hays General Hospital, which MedGlobal supports, has been targeted twice by attacks that inflicted significant damage. The hospital also suffers from constant shortages of equipment, supplies, and medications. MedGlobal’s delivery of PPE and equipment was crucial for the capacity of this hospital – however, significantly more support is needed for all of Yemen’s health facilities in the long-term for the health system to cope with both COVID-19 and the broader humanitarian crisis. 

COVID-19 and the Vulnerable: Avoiding a Greater Crisis

This blog post was written by Andrew Moran, Policy and Advocacy Intern at MedGlobal. Andrew has a BA in Political Science from Yale University. This post reflects his personal opinions. 

As countries around the world experience massive spikes in COVID-19 cases, poor and marginalized groups suffer disproportionately. Among them, refugees, asylum seekers, migrants, and internally displaced persons are especially vulnerable to the effects of the pandemic. These groups are regularly excluded from national and local safety nets and health services and have become frequent targets of blame and abuse, including by the governments they rely on. It is crucial, now more than ever, to protect and care for the nearly 80 million forcibly displaced people in the world. Otherwise, in addition to avoidable deaths and a prolonged pandemic, xenophobia and discrimination towards them may become further entrenched.

Throughout history, refugees and migrants have been repeatedly scapegoated for disease, sometimes to distract from the failure of those in power to respond to crises, or simply to demonize them and justify their mistreatment. Agencies like the WHO explicitly discourage using the names of geographic locations or groups of people when referring to diseases. However, this has not stopped the proliferation of controversial nicknames for COVID-19. Indeed, the negative consequences and stigmatization of groups, which the WHO warns against, can be intentionally fostered to serve political purposes. The novelty of COVID-19 intensifies the effects of malicious branding by providing the unique opportunity to define the disease to an audience with few preconceived notions of it. 

Some governments have used efforts to contain COVID-19 as justification for the implementation of harmful policies that target vulnerable groups. Tellingly, policies of evicting people from their homes and selectively locking down overcrowded camps are in direct opposition to health guidelines. Unfortunately, if not intentionally, the denunciation of refugees and migrants as carriers of disease can become a self-fulfilling prophecy when they are forced into overcrowded camps with inadequate access to food, water, sanitation, and health care. These circumstances create the ideal conditions for the rapid spread of COVID-19, which could go unnoticed due to limited testing. The eventual emergence of large clusters of cases in camps may be used to further incite fear or even violence against displaced persons. 

Understanding how even responsible COVID-19 policies can negatively impact displaced populations is also critical for preventing unintended harm. One action many countries have taken in response to the pandemic is to close national borders and restrict movement internally. While this is often necessary to prevent and slow the spread of COVID-19, it can also have the effect of trapping people in dangerous situations. Violence, poverty, and hunger, all of which can force people to flee their homes, are not subsiding during the pandemic, but are being exacerbated by it. This year alone, an additional 71 million people are projected to fall into extreme poverty and 83 to 132 million more people are at risk of undernourishment. Understanding these pressures and surging responses to alleviate the burden on local communities is essential to avoid forced migration. In cases where illegal migration does occur, it is important to find alternatives to mass detention centers to avoid creating COVID-19 clusters, which would defeat the purpose of the restrictions in the first place. 

Failing to care for the needs of vulnerable populations is not only a humanitarian issue, but also goes against the interests of host countries. Addressing stigmas around disease and barriers to accessing basic necessities is vital in avoiding a worsening health crisis. Including displaced peoples in response plans has never been more urgent. Burden sharing is also critical as 84% of all displaced people are hosted in developing countries with limited basic health services. However, as need is mounting, funding for humanitarian aid programs is dropping as donors respond to contracting economies. Reversing this trend now is crucial to prevent crises from intensifying and inevitably costing more in lives and resources to address in the future. Even if a COVID-19 vaccine is developed and made universally acceptable, the humanitarian disasters created and exacerbated by failing to act quickly and comprehensively could last multiple lifetimes.

Press Release: MedGlobal Distributes Critical Medical Supplies in Sana’a, Yemen

Washington, DC – MedGlobal is proud to distribute critical medical supplies and equipment to a hospital and quarantine center in Sana’a, Yemen. In 2020, the number of people in Yemen in acute need has increased by 27% compared to last year. Based on the growing needs of the population, MedGlobal is committed to the expansion of our health response in Yemen and ensuring that we are able to support civilians across multiple government-held and de facto authority-held regions of Yemen. 

Beginning on Thursday, May 14, MedGlobal distributed medical supplies and equipment, including beds and cardiac equipment, to the Al-Kuwait Hospital in Sana’a, which is currently functioning as the capitol’s quarantine center, alongside our partner Life Foundation. This is the first health response MedGlobal has led in a de facto authority-held area of Yemen. 

MedGlobal is committed to reaching civilians with critical health care and humanitarian assistance based on need and under humanitarian principles. According to UNOCHA, an estimated 80% percent of the population in Yemen, or more than 24 million people, is in need of humanitarian or protection assistance, including 14.3 million in acute need. MedGlobal is proud to be able to serve civilians in both government-held and de facto authority-held areas with health services. 

Since the COVID-19 pandemic began, MedGlobal has been adapting its health and humanitarian response in Yemen and other countries with vulnerable populations to meet evolving needs. Beginning in April 2020, MedGlobal has supported local hospitals in Marib, Al-Hudaydah, Taiz, Hadramout, and now Sana’a with medicine, equipment, ultrasound machines, and hospital beds. MedGlobal has previously provided training for dozens of health workers in Yemen on critically needed maternal and child health technology, including the use of point-of-care ultrasounds and ‘Helping Babies Breathe’ resuscitation technique to reduce neonatal mortality.

MedGlobal is working with urgency to provide critically needed medical supplies to health workers and patients in Yemen, particularly during the important month of Ramadan. Join us in supporting vulnerable communities in Yemen at this critical moment.

For media inquiries, contact MedGlobal’s Advocacy Advisor Kat Fallon at [email protected]