War does no one any good. It brings death, loss and struggle. For those who escape, survival becomes the first challenge. Then comes the harder task of rebuilding everything from scratch.
And one of the biggest struggles is often the medical system.
Yemen is facing that struggle now. Even before the latest Houthi escalation, the country’s hospitals were already under severe pressure. The fighting has pushed an already fragile health system closer to collapse.
From the deteriorating to the collapsed
Seven-year-old Tarek al-Salami sat in a diaper, his frail body weakened by malnutrition and diarrhoea. Under normal circumstances, he would have received treatment within days. But little is normal in Yemen anymore.
When Iran-backed Houthi rebels advanced this month, Tarek’s father carried him on foot from the southwestern city of Mokha. Two days later, they reached a hospital in the government-held city of Aden, about 270 kilometres (170 miles) away. But the hospital had no beds and was overwhelmed with wounded patients. The family eventually found a therapeutic feeding centre.
Tarek arrived in what the centre’s director, Dr Arwa Atef, described as an “acute crisis”. More than a week later, he finally began walking again.
“I swear to God, when I look at him, my heart breaks,” his father, Mohammed al-Salami, said. “He looks almost lifeless.”
Tarek’s story reflects the collapse of Yemen’s already fragile health system as fighting opens a new front in the Iran war. The Associated Press spoke with patients, medical workers and aid organisations across Yemen as medicines run short, medical staff flee and some health facilities are caught up in the fighting.
Some health centres are turning away pregnant women and other patients to focus on those wounded in the conflict. Vulnerable children are filling incubators and sharing beds. More than 130,000 people have been displaced as Iran-backed Houthis advance against government forces supported by Saudi Arabia.
The therapeutic feeding centre where Tarek and other children are recovering is struggling to cope with a surge in patients in a country where hunger was already widespread.
“We can't keep up with the situation,” Atef said.
Hospitals overwhelmed by the wounded
Most hospitals and primary health centres affected by the escalation closed during the first 48 hours before resuming services, according to the United Nations. But the Houthis have seized parts of the Red Sea coast, including key ports used for humanitarian aid.
“The areas with some of the highest health needs are increasingly difficult to reach,” the World Health Organisation said Friday.
Less than 10% of the affected health centres are fully equipped to provide the trauma care needed by wounded patients, according to WHO. With resources stretched thin, hospitals are being forced into painful choices over who can receive care.
Fewer facilities are now able to handle pregnancy-related emergencies, which were already contributing to the deaths of three Yemeni women every day before the latest escalation, said Francesco Galtieri of the United Nations Population Fund.
“Around 2,000 pregnant women are on the move,” he said, with more than 200 expected to give birth within the following week.
In some hospitals close to the fighting, maternity wards have been converted into emergency rooms, said Hashem Osseiran, a spokesperson for the International Committee of the Red Cross. Many facilities lack sufficient anaesthesia, oxygen and sterile surgical gloves.
At a hospital treating mothers and children in the government-held city of Marib, Dr Ahmed Modhesh said emergency maternity cases were increasing as other hospitals concentrated on treating the wounded.
But Martyr Mohamed Hayel Hospital lacks intensive care specialists and does not have enough generators to keep all departments operating during power cuts.
A midwife said the number of childbirths handled by the hospital had almost doubled to around 80. One woman arrived with an ectopic pregnancy and severe bleeding, but staff were able to carry out an emergency procedure that saved her life. The midwife spoke anonymously because she was not authorised to speak to the media.
Yemen’s health system was struggling before the war
Yemen’s hospitals were already dependent on limited government support and public donations before the latest escalation. Some facilities were unable to fully pay their staff.
“Now, we are in a very dangerous situation,” said Fahd al-Nazari, manager of the health office in Taiz province, which has received many of the newly displaced.
“Within a day or two, or a week at most, we might have to close down some facilities. In fact, some hospitals are already closed.”
Three of Taiz province’s 17 hospitals are no longer under government control. Hospitals across the province had received around 635 casualties, including 112 bodies, by Thursday after the Houthis captured Mokha, al-Nazari said. The casualties included civilians and combatants.
“We're exhausted receiving wounded people under these circumstances,” he said.
Medical supplies and fuel are also running low after key routes between Mokha and Taiz were largely cut off. Aid convoys have been forced onto mountainous roads that cannot easily accommodate large trucks.
Even before the latest escalation, public hospitals in Taiz province had only one MRI machine.
At the Yemeni-Swedish Maternity and Children’s Hospital in Taiz, incubators were full and two or three children were sharing beds in the emergency room, general manager Sami al-Sharabi said.
“I'm scared that the conflict would reach the hospital,” he said. “Any explosive that could hit us would destroy the hospital, as some parts of the building are already weak.”
Hospitals in Aden, where Yemen’s government is based, are also struggling. Doctors Without Borders said more than 60 wounded people had been admitted to Al-Gamhouria hospital within a week, many requiring urgent surgery or blood transfusions.
Rebels also seek treatment
A private hospital treating rebels in the Houthi-held city of Sanaa was overwhelmed with hundreds of wounded patients last week, according to two medical officials who spoke anonymously because of security concerns.
The overall number of Houthi fighters killed or wounded remains unclear. Few aid organisations operate in rebel-controlled areas, where the group has detained and harassed dozens of humanitarian workers.
Experts say the Houthis have also struggled to pay civil servants, including public-sector doctors, while diverting much of the tax revenue they collect to their military operations.
The ICRC, one of the few international agencies still operating in Sanaa, said last week that it had delivered 22 tonnes of urgently needed medical supplies to support overwhelmed hospitals.
There is little information on casualties among government forces. One government-allied group has said more than 1,500 of its fighters were wounded.
The shortage of medical workers is making the situation even harder. Some health professionals have fled the fighting, leaving hospitals with fewer staff.
In Mokha, Doctors Without Borders said its small team was continuing to work “despite the severe shortage of health professionals”. Emmanuel Massart, the organisation’s deputy coordinator of operations in Yemen, said three other hospitals in the city had closed for several days before reopening.
Resupplying those facilities remains difficult because of blocked roads, Massart said.
“We should not forget about Yemen,” he said. It “remains one of the worst humanitarian crises in the world.”
