The Yemen Civil War and its Effects on Civilians

BY KRISTI WHARTON

In a country plagued by civilian casualties, potential famine, and a cholera outbreak, the Yemeni civil war rages on between the Houthi rebels and government forces, with the citizens of Yemen stuck in the middle. The Houthis goal is to end government corruption, and to end Western influence, while ultimately creating a modern democracy. The war between the rebels and the government would go on to compromise the safety of the people of Yemen through famine, disease outbreak, and a dilapidated health care system.

In 2011, towards the end of Yemeni President Saleh’s reign, the Houthi rebels initiated several rebellions against the leader. Beginning in February of that year, the revolution in Egypt sparked a series of protests against the current president . In March, President Saleh offered to step down from his position, but the Houthi rebels and their supporters rejected the offer, and the protests continued for several months until June, when opposition forces launched a missile into the presidential palace. The severely injured president, suffering from a collapsed lung and burns on over 40% of his body, was taken to Saudi Arabia for three subsequent months to receive treatment. Shortly after his return, he signed over his executive power to Vice President Abdu Rabu Mandur Hadi, still retaining the presidential title until the official handover ceremony in February of 2012.¹ This transition of power was meant to serve as a source of stability, easing the country’s political turmoil. However, because Mr. Hadi failed to solve many of the issues at hand, the unrest was not resolved.

Throughout the beginning of his presidency, Mr. Hadi struggled with many aspects of the presidential position. He failed to address a separatist movement in the south, attacks by al-Qaeda, and did little to improve the problems of unemployment and food insecurity. The situation was not improved by the loyalty many military officers still showed to the former president, Mr. Saleh. Capitalizing on the new president’s weaknesses, Houthi rebels took control over the Saada province in northwest Yemen. In September 2014, the rebels entered the capital city of Sanaa, setting up roadblocks and street camps. Just a few months later, the Houthis surrounded the presidential palace, forcing Mr. Hadi to flee abroad in March 2015.² These events culminated in a war that would result in civilian casualties, famine, disease outbreaks, and a health care system too weak to adequately address these issues. 

By March of 2017, upwards of 7,600 people had been killed, and another 42,000 injured. Of these, nearly 5,000 deaths and 8,000 injuries were civilians.² Dr. Tankred Stoebe, former president of Doctors Without Borders (also referred to as MSF – Medicins Sans Frontieres), said that they saw more than 800 casualties a month at the hospital he worked at in Taiz. The majority of them were women and children. In February 2016, the doctors at Al-Jumhori, a hospital in Saada, were presented with one of these tragic cases.  A young woman arrived at the hospital with 60% of her body covered in burns. Her home, located in the Razeh district of the Saada province, had been hit by an air strike. Because travel was highly dangerous at the time of the attack, her family had to wait a week before bringing her to the nearby health facility. Her injuries were too severe for the clinic to handle, so they transported her to Al-Jumhori five hours away. By the time she got there, she was septic and suffering from severe organ failure. “We did what we could,” said Dr. Mariela Carrara, a doctor working with MSF, “but there was no hope.”

Some people made it to the hospital in time for a more promising outcome. During Dr. Carrara’s first couple of days, a young couple was rushed into the hospital. Their home had been hit by an air strike and although the husband had suffered only minor injuries, the wife was missing almost all of the soft tissue in both of her arms. The doctors quickly got to work and began preparing to amputate. Explaining that the couple had already lost their four children, the husband pleaded that they try to save her arms. The doctors successfully treated the wounds, and the woman would later recover enough to return to the hospital to thank Dr. Carrara.³

Even though not all victims are able to make it to health facilities, relief workers in the area strive to treat as many patients as possible.  Workers at MSF facilities work 16 hour days, taking breaks in the basement of the facilities where they sleep on shared mattresses. The danger of the immediate area means they cannot leave the facility, and they must always be ready for incoming patients. Workers have said that they know patients are coming in when they feel the ground shake. The air strikes are deadly, and in cases where they are not fatal, they leave victims in critical conditions with severe injuries. In addition, the frequency and unpredictability of air strikes make people question the safety of the facilities. The risk of travelling to health care facilities, and the lack of definite safety while there, discourage people from seeking health care altogether, making the injuries even deadlier.³

Increasing restrictions on food and fuel imports pose yet another problem for the civilians of Yemen. Yemen grows little of its own food – around 90% of the country’s food supply is imported. Currently, however, the country’s northern ports are controlled by the Houthis, and the southern ports by government forces. Due to widespread government corruption, much of the food and other necessities coming into the country through these ports do not ever even make it to the citizens most in need.⁸ This, combined with the dangers of travelling, makes it difficult for people to access adequate food supplies needed for their families. As a result, more than 17 million people are currently considered food insecure, and 6.8 million considered severely food insecure. In addition, approximately 3.3 million children and women who are either pregnant or breast feeding are acutely malnourished. Some young mothers face malnutrition so severe that they are no longer able to breast feed, leaving their babies without proper nutrients as well. Additionally, 462,000 Yemeni children under the age of five face severe acute malnutrition.⁴ 

While visiting an area of Yemen where major aid agencies can no longer operate, reporter Nawal al-Maghafi encountered a severely malnourished boy. He was eighteen months old, but weighed about as much as a six-month old baby, and could not walk or talk. He was lactose intolerant, so his body could not digest normal milk. Before the war, the formula he needed was readily available. Since the war has continued to decimate basic supplies, it has become very difficult to get his formula, exacerbating his now life-threatening condition. Nearby, a four-year old boy was brought to the hospital with diarrhea and a fever. He was diagnosed with an infection that his body could not fight off because he was malnourished, but all he needed was an antibiotic. However, due to lack of medical supplies in hospitals, the doctors could not give him the medicine he needed. He died shortly after being admitted.  “Poverty has always affected Yemen, but now there’s a risk of losing an entire generation,” explained Nawal al-Maghafi.² 

Lowered immune systems as a result of malnutrition is also a growing problem. Although a major problem among children, the issue is also becoming more prevalent in adults. Cholera is spreading across the country at dangerous rates, leaving nearly 2,000 dead and infecting close to 800,000 people.⁴ Just a few years ago, the disease was nearly eradicated in Yemen, but now is infecting an average of 5,000 people each day.⁵ As a result of the war, millions of citizens have been cut off from clean water. In addition, waste collection has ceased in major cities. The worsening hygiene and sanitation conditions have left thousands to become infected.⁶ One of these victims was presented to Dr. Stoebe, when he was working in an emergency room. A family came in with a pregnant mother who had cholera. When she arrived at the hospital she was already very sick and required immediate IV fluids. Shortly after, she began experiencing cramps. The following day, her baby was born prematurely. The baby required ventilation for an hour and a half, and remained unstable for several days. Eventually, mother and child were able to be reunited. “It was just pure luck that we could save both mother and child,” said Dr. Stoebe.⁴ Had it not been so hard for them to get to a health facility, they likely would have avoided the health risks altogether.

By November of 2016, only 45% of the country’s 3,500 health facilities were functioning. MSF was providing healthcare in twelve hospitals and supporting eighteen other healthcare facilities throughout the country at the start of the war in March 2015.⁷ By February of 2016, three MSF healthcare facilities and one ambulance had been hit by air strikes. These attacks alone left eight dead and hundreds of thousands deprived of access to emergency medical care.³ Now, even those within close proximity of hospitals perceive the medical facilities as unsafe, and often are afraid to attempt the journey until it is too late. 

The 30,000 government health employees who occupy these facilities and are essential in the fight against the cholera epidemic, have not seen payment in nearly a year.⁵ Dr. Stoebe stresses the importance of the issue: “We are having really a lot of trouble getting enough resources coming into Yemen, enough doctors, nurses, sort of [need] international aid workers to help out because the local system is on the brink of collapse.”⁴ 

Health employees are not the only workers affected by the war. One man, a teacher with a pregnant wife and five children, reveals that although he retains his job as a teacher, he has not received payment in eight months. As a result, his family is faced with hunger and the threat of eviction. All over Yemen, college graduates and other highly educated people find themselves no longer receiving a salary or unemployed altogether. In addition, there are little to no jobs in the private sector as a result of the rapidly deteriorating economic situation, leaving many of these people without work.⁸ 

Despite the abysmal state of the war-torn country, there are several groups working in Yemen to fight the various hardships the country faces from the war. MSF helps to treat tens of thousands of injuries resulting from the war. Throughout the country, they have 1,600 staff members.  In 2016 alone, more than 32,900 patients received treatment in MSF facilities for wounds resulting from intentional physical violence.⁷ Mona Relief is an organization fighting against the current hunger crisis in the area. They currently have 380 people working in Yemen delivering food baskets to families in need. These baskets can each feed a family of six for up to a month. Despite the noble work of the organization, more aid is needed: this group alone only assists three million of the seventeen million people suffering from hunger.⁸ The World Health Organization (WHO) and its partners are also working to put an end to the cholera epidemic. They have been setting up cholera treatment clinics, rehabilitating the dilapidated health facilities, and delivering medical supplies to the area. Currently, data shows that more than 99% of people with suspected cholera who can access health services are surviving. However, the WHO also reports an estimate of nearly fifteen million people that are unable to get basic healthcare. The country’s healthcare crisis is far from over. 

While these efforts are improving the lives of millions of people, they are not enough to get Yemen back on its feet. The country needs a political resolution. There will be no end to civilian casualties until fighting and air strikes cease. Additionally, unless the ports are opened up and food can be transported throughout the country again, the country will be pushed into famine. The cholera epidemic will continue until the living and sanitation conditions improve. All of these issues have one common solution: an end to the civil war. Given the current state in which Houthi rebels control the northern region and government forces are in control of the south, it is difficult to imagine a resolution in the near future. With the help of international organizations, however, food distribution and health facilities and supplies can help put an end to many of the hardships that plague Yemen.

Kristi Wharton is a sophomore in Branford college majoring in History of Science, Medicine, and Public Health. You can contact her at kristi.wharton@yale.edu. 

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References:

1. Ali Abdullah Saleh Fast Facts. (2017, March 19). Retrieved October 31, 2017, from http://www.cnn.com/2013/07/08/world/meast/ali-abdullah-saleh-fast-facts/index.html
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9. R. (2016, August 30). At Least 10,000 Killed In Yemen Civil War. Retrieved October 31, 2017, from https://www.huffingtonpost.com/entry/at-least-10000-killed-in-yemen-civil-war_us_57c58703e4b0664f13ca63e4