Yemen: Crisis update – 10 November 2015

10 November 2015    International website of Médecins Sans Frontières (MSF)

Overview

• 15,587 war wounded treated since 19 March by MSF teams.
• More than 400 tonnes of medical supplies have been sent by MSF so far.
• It remains extremely difficult to move within the country to assess the needs and deploy assistance, due to fighting and airstrikes.
• MSF facility in Haydan, in Sa'ada governorate was bombed on 26 October. The Haydan hospital was the only remaining operational facility in the district, covering a population of nearly 20,000 people. MSF is running another health facility in Sa'ada governorate, the Al-Jumhori hospital in the main city of Sa’ada.
• MSF trucks are still unable to deliver essential medical aid to two hospitals in a besieged enclave of the city ofTaiz, in southern Yemen even after two months of negotiations with Houthis. The situation in Taiz is still tense with airstrikes, snipers and ground fighting. News says that the Saudi-led coalition is deploying ground troops to Taiz to control it.
• Large civilian populations remain in towns and villages in Taiz. Out of 20 major medical infrastructures in Taiz governorate, 14 are closed and the remaining hospitals are overloaded. And out of eight urban women and child health centres, six are totally closed and only one is functional but not running fully because of a lack of fuel. MSF started a new mother and child project  in one of the hospitals, and the first patient was seen on 7 November. Large civilian populations also remain in towns in Sa'ada and north Amran governorates, near the Saudi border. Many health facilities have been damaged or destroyed, medical staff have fled, and transport is extremely challenging due to high fuel prices and insecurity on the roads.
• The MSF Emergency surgical hospital in Aden started receiving an increased number of landmine and unexploded ordnance (UXO) victims especially children (more than 60 cases between the second week of August and late October).
• A fuel blockade is still crippling the country. It’s worth mentioning that fuel is available 24/7 on the black market. The standard price for 20 litres of fuel is 3000YR but its price in the black market varies between 9,000YR and 15,000YR. There is a huge strain on the general population when it comes to moving anywhere, and food and water costs have increased throughout the country. Hospitals also have inadequate provision of diesel to keep their generators running. Sana’a has remained without power consistently since early April. Populations who do not live in direct proximity to health structures no longer have any means of transport to access healthcare.
   

Project update

A total of 790 MSF staff are working in the country: 64 international staff and 726 Yemeni staff. In Yemen, MSF is working in Aden, Al-Dhale, Taiz, Sa'ada, Amran, Hajjah, Ibb and Sana’a.

ADEN

MSF is running an emergency surgical hospital in Sheikh Othman district, in the north of the city. Since the beginning of 2015, Mmore than 4,662 surgical interventions have been performed. Since 19 March, MSF has received 6,478 war wounded. MSF is also providing mental healthcare and physiotherapy in the hospital. MSF has been receiving more patients from Lahj and Abyan governorates recently. The number of victims of landmines and unexploded ordnance have been increasing since early August. MSF has received more than 60 victims, mostly children, and the number is increasing every day.

In the south of the city, on 20 April MSF started running an advanced emergency post. In the Crater Health Center, MSF staff are working 24/7 to provide trauma care. More than 1,232 wounded patients have been received in the emergency room. Between May and July, MSF ran mobile clinics in the health centres of Enma and in Al-Sha’b districts to provide outpatient care to surgical patients who could not access MSF hospital. More than 1,220 war wounded were provided with surgical follow-up consultations and wound dressings. As movement is easy now in the city, MSF is receiving these patients in its hospital in Aden but is still providing drugs and dressing materials to the health centres.

AMRAN

As the situation in North Amran governorate is relatively calm, many people fleeing from several areas in Yemen are taking refuge there. MSF has been providing general consultations in mobile clinics for internally displaced people. Since mid-May 2015, more than 14,515 general consultations have been provided. In addition, MSF has provided support in several locations where the displaced are gathered, and this support has included providing water tanks, non-food items and hygiene kits for more than 500 families located in 20 locations in Khamer. Activities have also included health promotion and cleaning the sewage system in the central market of Khamer. Support was given to a Ministry of Health measles vaccination campaign in Khamer in July.

In the Ministery of Health Al-Salam hospital, MSF is actively supporting life-saving services and is also supporting the Huth health centre with medication, oxygen, logistic equipment, human resources support, electricity and a referral system. Between 1 January and the end of August, MSF received  24,801 patients in the emergency rooms (more than 250 war wounded), performed 2,488 surgeries, aided 2,121 deliveries, admitted 2,578 adults the inpatient department and 2,478 children to the paediatric ward and neonatal unit, and provided 5,364 antenatal and postnatal consultations.

MSF has built a network of advanced medical posts in northern Amran and Sa’ada governorates setting up emergency rooms in local health centres, providing medical supplies and training in emergency care and the management of mass casualties, repairing and improving damaged structures, and running ambulance systems to surgical hospitals in Khamer and Sa’ada city. In July, MSF set up a referral system from three peripheral health centres in North Amran governorate. MSF is supporting the emergency rooms in Harf Sufyan, Al Ashah, Al Qaflah health centres with medications and is covering the costs of referring the patients to its hospitals ( Al-Salam, Al-Jumhori or Huth health centre) according to the patients’ conditions. MSF also  provides logistic support to these centres when necessary. In August, MSF received 4,447 patients in these health centres and referred more than 270 of them to Al-Jumhori hospital in Sa’ada to receive surgical care. MSF is supporting Huth and Khameer with four ambulances.

SA'ADA

Large civilian populations remain in towns and villages in Sa’ada and north Amran governorates, near the Saudi border, despite daily air strikes and significant destruction of infrastructure in the region. Many health facilities like Shiara medical centre have been damaged or destroyed, medical staff have fled, and finding transport is extremely challenging due to high fuel prices and insecurity on the roads.  A need was identified to improve access to life-saving care for those who live at a distance from the main referral centres. Since mid-May, MSF has been supporting the emergency room, operating theatre and maternity departments of Al Jumhori hospital in Sa'ada city. The MSF team works alongside Ministry of Health staff.

Since mid-May, MSF has treated 4,072 emergency cases (including 1,370 war wounded; in September 392 war wounded were taken in charge) and 702 patients have received surgical care (574 of these cases related to war surgery). In September, 209 patients received surgical care (including 177 war wounded patients). There were 250 deliveries in September. MSF has also facilitated 1,080 kidney dialysis sessions at Al-Jumhori Hospital in Sa'ada.

The MSF-supported health centre in Haydan was destroyed by air strikes on 26 October. This health centre had treated more than 3,200 patients between May and October, 30 per cent of whom were suffering from conflict-related trauma.

HAJJAH

Between August and the end of September, the MSF and Ministry of Health staff at Al-Jamoorhi hospital in Hajjah city treated 2,479 emergency cases (434 of them war wounded). MSF facilitated 1,020 kidney dialysis sessions for 30 patients.

In Beni Hassan, MSF is supporting  around 15,000 internally displaced people with water (240,000 litres a day). In May, non-food items were distributed to 805 families. Between May and July in Bani Hassan district, MSF provided 5,523 general consultations at its mobile clinics and the health centre in the district.

In July, following an air strike on Aahem market, 68 civilians wounded were stabilised at the Beni Hassan health centre supported by MSF and referred to the Hajjah and Hodeida hospitals. Then, MSF moved from Beni Hassam health centre to Abs hospital in July to extend its support to the displaced and the general population. Since that time until the end of September, 1,931 emergency cases were treated, and 107 patients were admitted to the inpatient department between July and the end of September.

Since May, MSF has done door-to-door identification of the internally displaced in Beni Hassan, Abs and Khamis. By the end of July, the total number of displaced was around 20,000, of which 16,500 were in Beni Hassan and 3,500 in Khamis. In August at the internally displaced sites, around Abs and Khamees, 3,532 children were screened for malnutrition and this showed an alarming increase in the emergency rate of malnutrition.

SANA’A

Since 26 March 2015, MSF has focused its support on the main hospitals in Sana’a, especially Al-Gomhoury and Al-Thawra hospitals which are receiving the majority of the wounded people from Sana’a and the rest of the country. More than 1,200 injured were benefiting from MSF first-aid kits.

Support in Sana’a, however, is not only limited to first-aid dressing items but also includes surgery and post-surgery materials, along with some blood transfusion and admission required items.

Since October, MSF has been supporting the emergency room of Al-Kuwait hospital with a regular supply of drugs and kits for mass-casualty situations. MSF also provided mass casualty training to more than 130 medical staff in the hospital. In October, an international MSF orthopaedic surgeon and anaesthetist were working in the hospital to support the operating theatre medical team, and an international emergency room nurse and special emergency doctor helped with the re-organisation of the emergency set-up in the hospital and put the mass casualty plan in place. MSF donated 3,000 blood bags to the National Blood Bank, which was affected by an air strike 200 metres away from the hospital.  

MSF also implemented the strategy of putting pre-positioned materials in the hospitals so they could be used in case MSF couldn’t reach the hospital in time with the supplies. In September in Sana'a, kits for 50  war wounded in the emergency room, operating theatre and inpatient department were given to each of the following five hospitals: Yemeni German hospital, 22nd of May teaching hospital, Omarah hospital, Mohamed Al Durrah hospital and Sheikh Zayed maternity hospital. MSF donated dialysis session materials to the Kidney Centre at the Al-Jumhori hospital in Sana’a to cover more than 3,070 dialysis sessions.

HIV PROJECT

Since 2010, a project to provide support to HIV-positive patients has been running in several locations across the country. In March 2015, the project launched a contingency plan to provide antiretroviral (ARV) drugs, services and psychological support to patients around the whole country. By the end of August, 1,327 HIV patients had received ARVs, 775 patients had received drugs for opportunistic infections, 650  patients had received laboratory reagents, and 300 patients had received mental health support.

AL-DHALE

MSF provides life-saving healthcare services in the Ministry of Health Al-Nasser hospital in Al-Dhale district, in southwestern Yemen. The support includes emergency room (24/7), surgery, post-operative care, sterilization, laboratory, infection control, healthcare waste management and referrals. MSF suspended it’s work in Al Dhale hospital for three weeks in October due to some security incidents, but resumed work  on 7 November.

In addition, MSF is supporting Al-Azarik health centre in the emergency room, and with antenatal care, postnatal care, family planning, normal deliveries, routine vaccination, nutrition and referrals to Al-Nasser hospital.

In Qataba, MSF supports the emergency room (24/7), observation room, outpatient department nutrition, and stabilisaion and referrals of war wounded brought in from the MOH Al-Salam health clinic.

Since March, MSF projects in Al-Dhale have received 36,710 emergency patients, with more than 2,029 war wounded people among them.

TAIZ

Since the beginning of May 2015, MSF has been providing emergency medication and surgical supplies to Al-Jumhori, Al-Thawra, Al-Rawdah, Military and Al-Qa’idah hospitals, which have been receiving people affected by violence in the recent and ongoing conflict. During the period, MSF set up and equipped three extra emergency rooms at Al-Rawdah hospital to allow for extra space for handling mass casualties, while also continuing to support the hospital’s emergency room with supplies and staffing. MSF has four medical doctors and one nurse working in the emergency room of Al-Rawdah hospital, and covers the salaries of 27 hospital staff who are working in the emergency rooms to ensure a 24/7 presence. Since 15 May 2015, Al-Rawdah hospital has received a total of 3,821 war wounded patients, of which 308 died. MSF started a hospital-to-hospital referral system with two ambulances, and this initiative is to be increased depending on the need.

On 25 October, despite weeks of intense negotiations with Houthi officials, MSF was blocked from delivering  stocks of essential medical supplies (chest tubes, anaesthetic drugs, IV fluid, sutures and antibiotics) to two hospitals in a besieged enclave of the city of Taiz, in southern Yemen. MSF’s trucks were stopped at Houthi checkpoints and denied access to the area. The hospitals in this besieged area are seeing large numbers of patients with war wounds.

Given the assessed needs, MSF started setting up an office in Taiz in June 2015 to ensure continued support during this crisis period. MSF started a mother and child healthcare project, with a 150-bed capacity for obstetrics and gynaecology and paediatrics focusing on children under five. The first patient was admitted on 7 November. An MSF team consisting of four international staff and eight Yemeni staff is on the ground to carry out further needs assessments whenever necessary.

In late October, MSF teams started screening 2,269 children for malnutrition in the besieged area in Taiz.The first round of analysis showed some concerning results. The final analysis is still in progress.

IBB

MSF has donated medical and surgical materials to Al-Thawra and Al-Qa’idah hospitals in Ibb governorate. MSF is also considering one-off donations of food supplies to centralised kitchens for internally displaced people, that are based in seven schools in Al-Qa’idah city. In September, MSF donated kits for 40 wounded to Yareem hospital and Al Thawra hospital.

MEDICAL DONATIONS

MSF has made donations of medical supplies to hospitals in Sana’a, Aden, Saadah, Abyan, Taiz and Lahj, Marib, Al-Baydha governorates since the start of the conflict. Beside the 400 tonnes MSF brought into the country, MSF purchased another 21 tonnes of medical supplies locally. Dialysis supply counts for 14 tonnes, and 3,650 litres of oxygen were given to various hospitals.

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