Yemen hospitals between ‘the scourge" of war, international Organizations' "business"

Yemen – 24 December 2018: Our tour this time was in a number of Yemeni governorates. Our goal was to monitor the suffering of Yemenis in the health sector and convey the suffering of Yemenis in light of the lack of resources, if not their absence in most hospitals and health facilities.





"A cement room was changed to be an ICU of Thwra Hospital in Yemen"


After strict security procedures, and difficulty in allowing us to take photographs, we visited Al-Gamhouria General Hospital and the Basheib military hospital in Aden. We toured inside the two hospitals. The first thing we noticed was the large number of patients visiting them with different health complaints. The hospitals are trying to meet the needs of the patients with their limited resources and incomplete equipment. They rebuilt themselves after being sabotaged by the war. They suffered from a shortage of medical supplies, medicines and equipment, but they insisted on survival. Between the hammer of war looting and the anvil of the aid organizations that do not meet all the needs, these hospitals struggle to continue fulfilling their duty towards their patients.




Al-Gamhouria hospital queues

Queen Elizabeth the second did not know that the hospital, for which she laid the foundation stone 64 years ago, will become the theater of Houthi military operations. It is Al-Gamhouria General Hospital; Queen Elizabeth laid its foundation stone on 27 April 1954 during her visit to Aden for her honeymoon. She hoped the hospital would be a distinctive landmark in the governorate.






Al-Gamhouria is one of the most important hospitals in Yemen, which was looted and bombarded by Houthis in 2015. After liberation, officials tried to reequip it to fulfill its required role, but there are still challenges. Patients gather at the gates and in the corridors waiting for their turn or hoping to find a cure for their diseases. Among those waiting we met Umm Abdullah, 60 years, holding an envelope filled with many papers. He told us: "I have been to many hospitals. I suffer from kidney failure, and can’t find the needed resources for dialysis available all the time. Treatment in private hospitals is very expensive and beyond what I can afford. We are poor. I come from Al-Brega for the dialysis sessions and have to wait for hours and in the end I sometimes leave without having my session. My daughter also suffers from a heart condition, but her medicine is not available, and even if it’s available the poor like us can’t get it easily.”









“The medicine is not available," is what Zaynab, a mother of three children who suffers from cancer and needs chemotherapy, told us when we first met her. She rushed to talk to us hoping that we can help her find the cure for her pain. She described what she suffers from, saying, “I can’t sleep at night because of the pain. The treatment is not available. We come to the hospital and they help us as much as they can. But the chemotherapy is not available. I have 3 children and their father died in the war with a Houthi shell. I don’t work, but we sometimes receive subsidies from charitable organizations. Sometimes we can get a food basket once a week which is only one meal. We spend days hungry. Our conditions are worse because of my illness. I come to this hospital asking for treatment, and they refer me to other centers, but I don’t find the treatment there. I have to return here, but I still don’t find the treatment."




Fatma Mohammed, a patient at Al-Gamhouria Hospital, told us, “I am from Lahj and I came to Aden to receive treatment. Sometimes I come with my 8 years daughter, but we do not find the treatment, so we leave and come back. Treatment in private hospitals is expensive and we can’t afford it. Treatment here is rarely available, but we have patience and we are thankful to God that the hospitals are now open. During the war we couldn’t find a place to go, and when the Houthis were in control no one was able to come out of his house. There were two solutions, either you resort to herbal therapy or you die. The Houthis besieged the city and the roads. We used to witness our neighbors dying because we don’t have hospitals. Houthis controlled all of them. It is very difficult to leave the governorate to go to Aden. They only allow very severe cases to leave the governorate for treatment."





Broken devices and lack of oxygen

We left Zaynab and the queues of patients. Dr. Nasser Al-Markhi, head of the operations department, took us in a tour in the hospital departments to see the operating rooms. The operating rooms are not different from the normal rooms, as they have weak resources; the equipment is broken and rusty since the war has begun, and fixing them requires huge amounts of money. Patients are being operated on collapsing beds, and the number of beds is very limited compared to the huge number of patients. Doctors have only simple surgical instruments that they use to try to save patients' lives.










Dr. Naser explained that there are urgent needs, including surgery requirements, such as anesthetics, surgical threads, and surgical tools. He added, “We perform 20 to 30 surgeries daily, including serious cases caused by mines, rockets, mortars, and sniper bullets. Most cases come from the “security belt” front on the western coast. The most difficult case was that of a young man who was shot by a missile and he came to us with his bottom half stuck to the rocket. We face many difficult cases; we contacted international relief organizations working in Yemen to help us, but they did not respond.”




"We have a severe shortage of Ventilators, oxygen and anesthetics. Also and the capacity of the beds is not enough. There are cases that we cannot receive because there are no places. We have been demanding an increase in the number of beds, but to no avail”, Eshraq Gameel, supervisor of the intensive care department, said.

Continuous Suffering

Dr. Ahmed Salem al-Jarba, Hospital Director, explained that this is the main hospital in Aden and serves five neighboring governorates. “We receive between 20 and 30 injured daily. Since the beginning of the war we receive annually from 1,600 to 1,800 injured, and the number of surgeries increased since 2015. Last year alone we performed about 11,330 surgeries; the largest proportion—around 60 percent—of the total number of operations being emergency operations,” he added.




Al-Jarba pointed out that Houthis transformed the health sector buildings and hospitals into military barracks. They targeted health centers, medical staffs, ambulances and paramedics, destroying 153 health facilities. Diseases and epidemics such as cholera and malaria spread in areas under their control, due to the damage in infrastructures which lead to lack of clean water and sanitation. Work stopped in Al-Gamhouria hospital from April to August 2015, and part of the hospital was destroyed and the other part was looted. After liberation we tried to reform it with the help of coalition forces and UAE Red Crescent, and without this aid, we would not have reopened the hospital.



"We are forced to work 24 hours a day and sometimes 60 injured arrive at the same time. In this case we stop receiving non-emergency cases. We only have 460 beds," he said, adding that there are contributions from international institutions and support from the King Salman Center for Relief and UAE Red Crescent.

“We still need modern equipment, for example we lack MRI equipment, CT scan, advanced devices in the field of surgery, and equipment for examination in medical laboratories,” Al-Jarba added.

Dr. Jarba explained that part of the medicine is provided by the government and another part comes from relief aid. However, there are basic needs that are not met by relief organizations such as anesthetics. He pointed out that the Yemeni Central Relief Committee distributes medicine. Each hospital gets a share regardless of the different needs. "We place high hopes on the King Salman Center, and the UAE Red Crescent as they provide great support to the health sector,” he added.

Dr. Jarba assessed the work of international organizations in Yemen, saying: "We are sad because they are not honest in conveying reality. There are a lot of exaggerations. For example, they are getting loans and lots of support to face cholera and they are telling the world that Yemen is infected, although the number of cases has not been so huge. The total number of cases treated here in the center of Aden is only 4460, a very small number compared to what these organizations declare. The rest were cases of watery diarrhea only. This center was closed because it is no longer needed, and yet these organizations still claim to the world that Yemeni people are suffering from cholera epidemic."

He noted that among these organizations are the World Health Organization (WHO) and UNICEF, adding, "They are not only falsifying statistics, but they are creating diseases that do not exist in reality to get million dollars in aid."

He revealed that the funds of these organizations are directed to trucks that spray mosquitoes, which only pushes it from one place to another without treating the disease or ending the crisis. Funds allocated for the treatment of diseases and for projects such as dengue fever control and fighting Malaya, are wasted, and 35 percent of the budget of these organizations goes to administrative expenses.

He added: "Their projects do not address the reality of Yemeni patients or the needs of hospitals. They impose grants and assistance on hospitals without consultation with us or attention to our demands. For example recently a delegation from the World Health Organization visited us to install solar panels on top of the dialysis center, after entering a global tender in this regard, although we do not need it”. Dr. Jarba called on donor countries to directly supervise the quality of the projects being implemented and the disbursement of financial resources.

Basheib hospital faces problems

Basheib Military Hospital in Al-Tawahi directorate receives the highest number of injured from the front. The director of the hospital, Salem Hassan al-Attas, told us the details of the problems the hospital faced during the Houthi siege of the area. He pointed out that Houthis used the hospital as a military barracks and prevented all supplies while the number of injured from the fronts was doubled.




He continued, “We were relying on the aid of the popular resistance by sea, and for fear of the lives of the injured we helped them to flee using boats to Brega. Houthis would kill any injured person they catch without mercy. Some did not endure the hardship of the trip and died during attempts to run away. The militias caught some injured young men while being transformed by hospital cars, killed some of them and took some as captives. They also attacked the hospital several times, destroyed all the equipment and generators, stole ambulances and searched for the injured and the members of the resistance. Also if they find patients they would take them. Then the hospital was closed until liberation and we opened a field hospital in Al-Mansoura area."


Dr. Salem talked about the hospital’s capacity, saying, "We continue to receive injured people from the fronts. Since the liberation of Aden till now, we have been working on restructuring the hospital. We have built some buildings and some parts are still being repaired. We have provided some equipment as much as we can because we are a governorate and the conditions are much better. Now we have 150 beds, and the number will rise to 360 beds after the reconstruction is finished. But there are still some needs such as a heart center and a radiology center because the Houthis destroyed the radiology devices, and the cost of a device now is 350 thousand dollars. There are some medicines that we need and also ambulances. We rely on the support of the state more than the relief organizations. We requested ambulances from some organizations, and we await the response."

Dr. Salem pointed out that there is also the crisis of irregular salaries of doctors and many are working for free, because of the human commitment, as Yemen is in a war condition. He stressed that international organizations are making strong propaganda claiming that there is a spread of some pandemics to obtain grants. This propaganda is repeated in Western media. He continued, “We are surprised by the reports that are presented, while they are sometimes different from reality."


International organizations deny

In his response to the accusations against his organization, the head of health operations at the World Health Organization (WHO) office in Aden, Dr. Omar Zain, denied the validity of the accusations that (WHO) claims the existence of diseases that do not in reality exist to get money from donors. He stressed that (WHO) is an international organization and not a personal one. He added that if it not been were not for the intervention of the organization, the cholera would have increased in Yemen. He pointed out that there is a mechanism to control the disbursements of donors’ money through an independent supervisor between the organization and the donor.

He referred to the continuation of agreements related to cholera, despite the decline in the infection rate, saying: “First it is the donor who determines the health program in which the money is to be spend, either for primary services, hospital support or structural support of the health system. Secondly we directed big support to address this epidemic when it was widespread. We did that through opening treatment centers and support hospitals. We cannot completely stop allocating budgets for the epidemic, as there is still the possibility of its return since the causes of the disease are present. The rainy season is about to come, which helps in the transmission and spread of the epidemic. Also, more than 50 percent of the population does not get clean water, and we also have sewage problems and problems because of the overcrowding of the displaced,"

On the programs dedicated to malaria and dengue fever, Dr. Zein said, “It is not true that it these programs are directed to awareness and training only, but there are also laboratory tests for the infected to monitor the infection rates, and the spray the impact of the remaining for 3 months, and there is a therapeutic part of the injured, both endemic diseases appear according to seasons, To another in Yemen according to the mosquito carrier, and in any case we need a proactive plan for any new pandemic of the epidemic."

He talked about the lack of some necessary devices and medicines such as anesthetics, and the low level of readiness of operating rooms, saying: "We do not deny that there is a shortage of equipment, but hospitals’ needs are huge, and there is no entity in the world that can cover all of them, even in developed countries; donors cannot cover all the needs of hospitals."

He added that there is a new program implemented by the World Bank this year, in cooperation with the legitimate government. The program includes support for hospitals in directorates, especially those serving more than one directorate. The program is implemented with the participation of hospitals’ representatives, who presented their requests.

UNICEF, through its office in Aden, confirmed that it is providing support through health, education, water, sanitation, hygiene and protection programs. It explained to Egypt Today that in 2017, in cooperation with the Ministries of Education and Health, it had trained 6,000 teachers to implement activities in response to the cholera outbreak in schools. The activities target 2.4 million students. UNICEF also provided 6.8 million people with water and sanitation services.

UNICEF added that the organization contributed to the second national polio campaign, and the receiving of vaccines continued through 2940 health centers in Yemen. More than 404,400 children benefited from psychological support services and the organization supported 1.4 million children in Yemen through the rehabilitation of schools.

The UNICEF office continued that Yemenis suffer -because of the ongoing conflict- of severe shortages of humanitarian, basic and service items in the areas of sanitation, water, education and health. More than half of Yemen's population does not have access to safe water, 11 percent of schools are destroyed or out of service, 25 percent of the students are out of schools. There are more than one million people suffering from cholera, in addition to outbreaks of diphtheria, acute watery diarrhea. There are also more than 1.8 million severely malnourished children. The office pointed out that there are programs to meet these humanitarian needs.





The organization confirmed that it has a permanent presence in five offices throughout Yemen. It conducts regular visits to its projects’ sites. It also has a network of local partners and regular monitoring mechanisms to deliver humanitarian assistance on a daily basis, including the use of independent third-party monitoring throughout the country.

Concerning the volume of aid directed to Yemenis, the organization revealed, “In 2017, the annual needs were estimated at $339 million, 61 percent of this amount was received, and in 2018 UNICEF needs an estimated $350 million, and 5 percent of this amount was received so far."




People complained that the organization is dealing with the Houthi side in delivering aid to the beneficiaries, because Houthis are not reliable. They add that this is clear as children die of starvation in different regions as in Hodaidah. The organization responded saying that it works in Yemen to secure the needs of children and to deliver services to them wherever they are regardless of the side in control in the regions they deliver aid to.

Injured and sick people talk about their suffering

Inside the Basheib hospital we spoke with Ahmed El-Asawi, an emergency battalion soldier who was injured by shrapnel in the muscles, back and thigh along with 35 soldiers, in the bombing of the anti-terrorism center in Aden in the region of Guldemir. He said, "We were sitting in our shift as we do every day in front of the center, and a car was parking in the vicinity of the center. We did not expect it was a booby trap and suddenly it exploded, and then a second car came quickly and also exploded. Terrorist bombings often happen in the governorate, but this is the first time I live one myself."



He added that doctors are trying to provide what they can but medicines and painkillers are lacking.

"We were gathered to demand our unpaid salaries," said Abdel-Aleem Mohsen of the Presidential Guard, who was wounded in the same accident. "In the meantime, a car exploded and a second car exploded after five seconds in the middle of the group of people standing there. We crawled on the ground to find someone to save us; bodies of my colleagues were next to me, and injured people were bleeding, then I lost consciousness."

Munif Mohammed Nassif, one of those who were injured in the terrorist attack, showed us a fragment extracted from his body, saying: “I was injured in the spinal cord, and unfortunately there are not enough resources for my treatment here. The explosion resulted in shrapnel and gunpowder; all flew in our faces that we could not see, and then fire broke out. I wish there could be a treatment for me, so I can be well and healthy as before."

Colonel Mohammed Hussein, who was wounded in the war, said: “We were wounded in the Al-Qal'a area in Ma'ala. We were a group in the front, and the Houthis attacked us with a tank and RPGs. My eyes were hurt." He explained that in this period, five committees were established to follow up the war zones to record their needs and provide them. He continued, “I say to Houthis: Fear God and leave people without hurting them. Yemenis have suffered enough."

"We suffered from the Houthis' siege. For several days we could not go out even to buy bread. Our children could not go to schools. When someone is sick, he is either treated with the available resources in the house, or he dies,” said Khalil al-Saadi, one of the people we met at the hospital. He also talked about his suffering to get cardiovascular drugs. He confirmed that he fainted several times, and almost died because he had no medicine and the hospital had limited capabilities.

"We need cardiac cauterization equipment, but we do not have it. I suffer from a heart condition, and they refer me to a private hospital, which is very expensive, so I have to stay in the house without treatment," said Mohammed A-Ghouri, a patient at the hospital.





Al Thawra hospital in Taiz

The health situation in Taiz governorate is different from the rest of Yemen. The health sector has been destroyed by 80 percent, according to the governorate data. It has only 4 hospitals and one medical staff. According to the governor, after the Houthi destruction, only three hospitals remained, the most important of which is Al-Thawra hospital. We found that this hospital has fewer capabilities than others, and part of it is destroyed by the Houthi bombing.










Also, the intensive care unit is a cement building outside the hospital building. We entered the intensive care and found patients sleeping in the hospital corridors. The beds are stacked in the rooms with no air conditioners for ventilation. We approached one of the patients, who told us that his name was Muhammad Abdullah, and he was injured in the front. He added that he has been treated for more than months without any progress. He is injured in the leg and needs many surgeries, but Al Thawra hospital is not equipped for them, in addition to the lack of required drugs and sedatives. One of the doctors told us, "Many soldiers and civilians die in the emergency room because of the lack of operating rooms, the lack of mechanisms to rescue them, and the lack of medicines."

Deteriorated condition in Ibn Khaldun in Lahj

In Lahj governorate, there is a hospital named Ibn Khaldun; a simple building from the outside. When we entered, we noticed the lack of ventilation devices and the limited number of beds. You could hardly find medical equipment, which reflects a deteriorated health situation in Lahj. This was confirmed by a number of citizens with whom we met in the street. "We either find smuggled bad quality medicines, or expensive medicines that the ordinary citizens cannot afford," Abdel Basset Hashmi told us.





Sana'a hospitals are weeping

The health situation in Sana'a is the worst, according to a doctor who works in a hospital in Sana'a, who refused to be named, fearing the brutality of the Houthis. He stressed that the hospitals have become mere buildings without services, cadres or medical devices, as the Houthis took over the budget and saved the remaining part for their soldiers. As for the civilian and children patients, they have no share in the medical service. There are increasing numbers of deaths, and hospitals cannot accommodate the huge number of casualties coming from the fronts. He referred to the outbreak of epidemics due to the accumulation of garbage and contaminated water and the lack of medicines.




Abdel Wahed Saif, one of the patients who received treatment in Sana'a and then managed to travel to Aden, says: “I lost my leg due to negligence in Sana'a hospitals. I was shot, and I stayed for a week without treatment, lying on the ground in the hospital. Then I felt as if knives were cutting my leg. I was screaming of pain. As a result my leg was amputated, and I came to Aden to continue my treatment.”

This article is part of a series of articles on Yemen by Eman Hanna. Hanna has taken a 30-day trip to monitor the suffering of the people in Yemen during the war.