Yemen’s economy and health systems rank among the least developed in the world. Overstretched health facilities struggle to provide even the most basic services to the country’s 34.24 million people. For most-vulnerable Yemeni households, daily survival can be reduced to a desperate choice between needed medicines or a next meal.
Free medicines and healthcare services are prerequisites for many Yemenis to embark on often arduous journeys to hard-to-reach health facilities. This constitutes a dire predicament driven by the context of Yemen’s ongoing armed conflict and complex human crisis – considered today to be among the world’s worst.
Malika Ali, an internally-displaced person (IDP) from Hodeida, is a mother and grandmother of a growing and impoverished family. The family’s sole source of income is daily-wage labor.
“We can only afford one meal a day – it’s either lunch or dinner. We have no regular salaries. I am a widow, and I must work for my children,” Malika says. “For carrying rocks on their backs, my sons may earn around 2,000 rials a day (approximately US$3.50), or sometimes nothing!”
According to the International Monetary Fund (IMF) World Economic Outlook for 2022, Yemenis earn an average income of US$871.5 per capita GDP (gross domestic product) – leaving too many unable to cover the costs of daily meals, if ever health services.
Mercifully, Malika’s family can access a partially functioning public health facility for free care and medicines that aid their daily survival.
“I have been coming to Ras Al-Ara hospital when I am sick, for almost seven years now,” Malika explains. “My daughter has also come here for pregnancy check-ups and needed medication – now her child comes for vaccinations.”
Difficult journeys to health facilities
For many Yemenis, reaching a functioning healthcare facility may require traveling on long, rough, dangerous and potentially violent roads, especially for women and girls. Best case scenario, they pool their meagre monies together with those of other patients to share a rented vehicle. Hitchhiking (getting free rides in passing vehicles) is a more risky undertaking of often-last resort. According to the UN Humanitarian Needs Assessment for 2023, over 42 percent of Yemenis face a minimum one-hour road trip to reach the nearest public hospital, be it partially or fully functional.
Asma’a Ali, a four-month pregnant Yemeni woman and mother of two, understands too well that free medicines and services are the only possibility for herself and her family to receive any healthcare.
“Transportation is difficult to reach this hospital. Sometimes we hitchhike and sometimes there is simply no way to get here,” she says. “But the services are free – exams, sonograms, and medications – all of them! This is the only place where we can be helped – we can never afford to travel to Aden [the nearest city], or to anywhere else.”
One doctor’s childhood dream fulfilled
Dr. Baria Awadh is an obstetrician-gynecologist at the Ras Al-Ara hospital in south Yemen who is more than fully achieving a purpose-driven dream, dating back to her childhood.
“Since I was a little kid, I always wanted to be a doctor,” she explains. “My father is a fisherman and he always used to bring us here on summer breaks, to pass our time while he was out at sea. This [rural] area had no health facilities back then. Now I am proud to be the only doctor here, because it means that women in this area no longer must deliver their babies at home, or travel to other hospitals in Aden – a 180-kilometer journey from here.”
According to a 2013 national survey by the Yemeni Ministry of Public Health and Population (MoPHP) on lifesaving reproductive maternal and new-born health services, only 45 percent of births in Yemen were assisted by a trained provider, with less than one-third of these deliveries taking place at a health facility.
“This is the only hospital in this village,” says Dr. Awadh. “Not only that, it is the only hospital on this entire coastline that provides basic health services.”
“My goal was to train in this facility and then move to another hospital in Aden – then I came to realize that I should stay here instead of going there. It is here where I can serve more people than at any other hospital…so I have stayed.”
Dr. Awadh continues: “General health has improved, and mortality among mothers and children is now below one percent! Funding provided by KSrelief has enabled 75 percent of all services that we provide. Previously, we could only meet about one-fifth of overall health care needs.”
“Now we provide services to everybody, including internally displaced persons [IDPs] and African immigrants. A simple thank you and the gratitude that I can see in their faces are enough to make anybody happy. Just knowing that you can help others makes all the difference!”
Expensive dialysis treatments save lives for free
The 2023 UN Humanitarian Needs Assessment states that almost 50 percent of health facilities are either partially functioning or non-functioning due to shortages of staff, funds, electricity, medicines, supplies and equipment.
“Dialysis medications alone can cost patients around 300,000 rials (around US$540) every month, and they are needed non-stop,” says Dr. Zahr Alawi, a nephrologist and internal medicine specialist at the Seyoun Dialysis Center in Hadramout governorate. “Last year only, we had around 190 new dialysis cases, and demands are now rapidly increasing. Costs of consumable items are very expensive, yet here and at our pharmacy, we are able to provide examinations and expensive medications – all for free.”
Detecting disease outbreaks in hours, not days
Yemen is among the world’s countries, along with others such as Somalia, South Sudan and Afghanistan, that face highest risks of infectious diseases, with new disease outbreaks expected this year.
Dr. Nahed Salem is the Molecular Biology Unit Chief at Aden Central Laboratory, where Yemen’s first COVID-19 case was detected and announced in April 2020. She explains that her laboratory has been able to reduce the detection time for disease outbreaks from several days to just three hours.
“WHO has been the main supporter of this Unit – from Day One!,” she says. “We receive full support for everything from capacity-building to medical solutions and equipment. This support allows us to provide vital health care services to patients at no cost – including for renal failure and cancer patients. The only time when we have to refer patients is when medical solutions are not available.”
Strengthening the Health System and Operational Support to the Life-Saving Response in Yemen (EHS2) is the second ongoing phase of a World Health Organization (WHO) project funded by King Salman Humanitarian Aid and Relief Centre (KSrelief). The US$11.2 million project is supporting Yemen’s Ministry of Health and Population (MoPHP) to improve public access to secondary care, including reproductive, maternal health, and non-communicable disease (NCD) healthcare services in targeted districts and inter-district hospitals, while also improving epidemic response mechanisms with surveillance and prevention measures.
Story: Shatha Al-Eryani & Kevin Cook, WHO-Yemen
Photos: © WHO / Comra Films