Humanitarian crisis and cholera epidemic in Yemen: photos and graphics. A Brief History of Endless War

Cholera continues to spread in Yemen, with more than 390,000 suspected cases and more than 1,800 deaths since April 27.

WHO and partners are responding to this cholera outbreak in Yemen by working closely with UNICEF, local health authorities and others to treat sick people and prevent further spread of the disease.

Every person with cholera has a family, a story, hopes and dreams. In patient care centers, local health workers work tirelessly, often for free, to fight death and help patients fully recover from illness.

Fatima Shui sits between her 85-year-old mother and 22-year-old daughter, who are being treated for cholera at the overcrowded 22 May Hospital in Sana'a.

“We don’t even have money to get to the hospital. My husband works as a janitor, he is our only breadwinner, but for 8 months now he has not been paid a salary, says Fatima. “I am afraid that other members of our family will contract this disease.”

Dr. Adel El Elmani is the head of the diarrhea center at El Sabin Hospital in Sana'a. To cope with the influx of patients, he and his team often work 18-hour days.

For more than 10 months, more than 30,000 Yemeni health workers have not been paid. However, many of them, like Dr. El-Elmani, continue to treat patients and save lives.

WHO/S. Hassan

Eight-year-old Mohannad beat cholera after a three-day course of treatment at the diarrhea treatment center at El Sabin Hospital in Sana'a. Mohannad lost his mother and sister in a bomb blast near their home in Hajj. After that, she and her father left for Sana.

“Mohannad is all I have left in this life after the death of my wife and daughter. When he got cholera, I was afraid that he would follow his mother and sister,” says Mohannad's father.

A health worker takes care of 20-year-old Khadija Abdul-Karim. Khadija was forced to leave her home in the conflict-torn area of ​​Al-Waziya, Taiz. The girl barely makes ends meet, and the disease only exacerbates this situation.

In search of treatment, 53-year-old Abdu El-Nehmi had to go through a long and difficult path. Overcoming bumps and other obstacles on the road from his village in Bani Matar to Sana'a, his car broke down. All this time, in addition to diarrhea and vomiting, he suffered from pain in the kidneys.

“There is no health center in our area, and it takes 2-3 hours to get to the hospital in Sana'a,” he says.

To date, WHO, UNICEF and partners have supported the provision of 3,000 beds in 187 diarrhea centers and the equipping of 834 fully functioning oral rehydration therapy sites.

Nabila, Fatima, Amal, Khayat and Hend are nurses at Azal Health Center in Sana'a and devote their time to treating patients who present with severe dehydration.

“Every day we see seriously ill patients with complications, but the lives of most of them can be saved. It happens that a new severe patient arrives while we are busy with other patients,” says Nabila El-Olofi, one of the nurses working at the center.

"We don't get paid regularly, but our main 'earnings' are saved lives."

WHO and UNICEF also provide medical supplies and pay for labor, travel and overtime for health workers so they can continue to treat patients.

War has been raging in Yemen for several years now. It seems that everyone here is at war with everyone. Houthis (Shiites of the Zayed direction), supporters of ISIS and Al-Qaeda, the Muslim Brotherhood, allies of Saudi Arabia and Iran, the Yemeni army, troops from the Emirates and Saudi Arabia seize cities, bomb, threaten each other, swear allegiance and abandon the unions that have become unnecessary.

Yemen is very far away - on the very outskirts of the Arab Oikoumene. It is the poorest of the Arab countries. There is no oil and gas here, there is nothing at all but endless deserts, hunger and devastation.

Today, 8 million Yemenis are starving, and epidemics of cholera and diphtheria are raging in the country. On the territory of Yemen, the hands of the Yemenis themselves are fighting two regional giants - Saudi Arabia and Iran. They fight not for life, but for death.

Despite the remoteness of this conflict from Israel, this war is also projected onto our region, therefore, recently, the events in Yemen are increasingly mentioned in the statements of politicians, who, however, know about what is happening there only by hearsay. Sometimes, for one reason or another, politicians try to simplify the history of Yemen, or maybe they just don't know it. This is how the myth appeared that after the “Arab Spring”, hostile to Saudi Arabia, as well as to other Arab countries and Israel, Iran created a front of instability in Yemen with the help of its Shiite allies, the Houthis. And if only "to chop off Iran's hands" in Yemen, then order and peace will immediately be restored in this country. But, judging by the history of the 20th century, Yemen can only dream of peace.

Dance on the heads of snakes

Unlike the Syrian war, which has been at the epicenter of world attention for seven years, the headlines from Yemen are in the background. Only in the days of the “Arab Spring”, when Yemeni students and female students, elderly people and children stood together on Tarir Square (Arabic, “change, change”), demanding changes, Yemen was interesting. However, the transition from the autocracy of President Ali Abdullah Saleh, who was in power for almost 33 years, to democracy did not work out. Instead of democracy, a civil war broke out in a divided and impoverished Yemen.

The ousted president quickly joined the Houthis, the Shia rebels who, back in the 2000s, raised an uprising against his regime and were defeated. It is worth remembering that in the nineties, Saleh worked closely with the local branch of the Muslim Brotherhood, the Sunni radical movement Islah. Maneuvering from radical Sunnis to radical Shiites, Salah tried to maintain power at any cost.

In October 2017, the former president said in an interview that “governing Yemen is like dancing on the heads of snakes.” By this point, Saleh had become disillusioned with his Houthi allies and announced that he was going over to the side of the anti-Houthi coalition, which seriously increased its chances of victory. On December 4, 2017, the car of the former president, who perfectly mastered the art of dancing on the heads of snakes, was fired from a grenade launcher by his recent allies, who did not forgive the betrayal.

A Brief History of Endless War

In a few sentences you cannot tell about thousands of years of history, but it is worth recalling that after the Islamic conquest, Yemen (or rather, the northern part of modern Yemen) enjoyed independence for several centuries, until the Egyptian invasion in the 11th century. However, even after the conquest, Yemen was a vassal sultanate, retaining a significant measure of autonomy. The Ottoman conquest in the 17th century put an end to this, in the 18th-19th centuries independent Shiite Zaydi dynasties arose on the territory of Yemen, then the country again passed into the hands of the Ottoman Turks. In 1918, northern Yemen, predominantly populated by Zaidi Shiites, became an independent country with a theocratic monarchist regime - the so-called "1000-year-old imamate" is being restored, while southern Yemen, inhabited mainly by Sunni Muslims, remained a British protectorate until 1967 .

In 1962, a coup took place in northern Yemen - one of the putschists was the young lieutenant Ali Abdullah Saleh, the future president of Yemen. For eight years, the royalists fought the Republicans, and in the meantime, the young southern Yemen became pro-Soviet. Until 1990, the two sides fought fiercely with each other, the situation was further complicated by numerous tribal conflicts. After unification in 1990, only four years of peace passed, after which a civil war broke out.

By 2011, everyone was unhappy with the situation. Shiites in the north complained that the central government forced Sunni Islam on them and did not invest enough in the development of northern provinces such as Saada (today the capital of the Houthi rebels). The southerners were not happy with the unification either; anti-government sentiment, in the end, led to the fact that al-Qaeda militants settled in the south (today they control several cities and regions).

Al-Qaeda in Yemen is fighting against everyone - blowing up Shiite mosques and government offices. The Houthis opposed President Saleh, but having no access to power after the new president, Mansour abd al-Hadi, took office, they embarked on the warpath. In response to claims regarding cooperation with Iran, they replied that the Yemeni regime was also resorting to the help of a foreign power, Saudi Arabia.

From the Yemeni Shiite perspective, for three decades the West has collaborated with an autocratic president who shamelessly robbed his citizens while the ruling elite basked in luxury. For moderate Sunnis, the rise of Iranian influence is like death. At the same time, a significant part of the citizens of Yemen do not support anyone and do not trust anyone, and only watch with horror how some armed bandits replace others in their provinces, cities and villages.

If not for oil

Despite its geopolitical remoteness from the traditional centers of the Arab world, Yemen is the guarantor of unimpeded oil supplies through the Bab al-Mandeb Strait, one of the main tanker routes that cross the Suez Canal. Blocking the Bab al-Mandeb Strait will block the way for tankers from the Persian Gulf to the Mediterranean Sea, and will also close the shortest route from North Africa to Asia. If not for this circumstance, and also if not for the growing influence of Iran on what is happening in the country, it is unlikely that the tragic events in Yemen would have aroused at least some interest outside the Arab world.

However, it is worth noting that even now the famine and devastation in Yemen are extremely sparingly covered by the international media. On the pages of newspapers or television screens, horrific photographs of living skeletons occasionally appear - starving Yemeni children, as well as mountains of corpses as a result of a cholera epidemic. However, thanks to the inflation of death and suffering - the Syrian war, ISIS, terrorist attacks in Europe and the United States - everything goes on as usual and does not arouse emotions among the powers that be. But fears about how oil and petroleum products will be delivered help to ensure that Saudi Arabia, which led the campaign in Yemen in 2015, received an unconditional mandate to act in this country, despite the fact that the Saudi kingdom is undeniably an interested party. .

Victory in battle but not in war

Today, after the defection and assassination of former President Saleh, it appears that government forces, backed by the Saudi alliance, have made tangible gains for the first time and pushed back their Houthi enemies. It is quite possible that in a few months they will be completely driven back to the north, and possibly completely defeated. But the Yemeni war, alas, will not end there. After the defeat of the Houthis, al-Qaeda and IS will inevitably get stronger (both groups operate in the south of the country) - after all, their common enemy will be defeated. As for the Yemeni Shiites, who are not at all a foreign element, but make up over 45 percent of the population, they will continue to grumble, and for a moment they will again take up arms if they again remain without their share of the meager Yemeni pie. And Iran will always be there to take what lies badly.

Despite the huge difference between Yemen and Lebanon, it is worth noting that the Lebanese Hezbollah (and the Amal movement before it) took advantage of the growing discontent in south Lebanon, populated predominantly by Shiites. It was this group of the population that had the least political rights and no access to the state budget. While Lebanon, often referred to as the Switzerland of the Middle East, was feasting, the Lebanese Shiites watched this celebration of life from the sidelines. The result of many years of removal from power and ignoring the adversity was the growth in popularity of fundamentalist movements such as Hezbollah. Of course, in this case, too, Iran took advantage of the situation for its own purposes.

It is possible that after the Houthis are suppressed, or at least driven out of the central cities of Yemen to the north, the attention of the Saudi anti-Iranian coalition may be switched to Lebanon. The recent drama around the resignation and return of Prime Minister Saad al-Din al-Hariri was a clear hint that Riyadh has not come to terms with the dominance of Hezbollah in the land of cedars. After losing the battle in Syria, will the Saudis try to change the situation in Lebanon? If so, then, firstly, Lebanon will soon resemble Yemen - in terms of destruction and civilian deaths; secondly, Israel will certainly be drawn into this war by Hezbollah and Iran; and thirdly, just as in Yemen, the causes of the conflict will not be eliminated, which means that after some time everything will return to normal.

Only the creation of a more or less balanced system that will satisfy the needs of all religious and tribal groups, the correct formula for the division of power, social justice on the one hand, and on the other, the cessation of the intervention of foreign powers, can put an end to the senseless, like all wars, conflict in Yemen . The failure of the ruling Arab regimes to provide all these conditions led to revolutions and coups in 2011-2012. The causes of the "Arab Spring" have not yet been eliminated. And this means that not only Yemen, but also other Arab countries, are still in the zone of instability, the end of which is not yet in sight.

Ksenia Svetlova, member of the Knesset - especially for the "Details" website

More than 500 people have already died from the cholera epidemic in the Democratic Republic of the Congo, as well as in Nigeria, the World Health Organization (WHO) said.

Outbreaks of waterborne diseases occur regularly in the Congo, mainly due to poor sanitation and lack of access to clean drinking water. But this year's cholera epidemic, which has already affected at least 10 urban areas, including the capital Kinshasa, is particularly alarming as some 1.4 million people have been forcibly displaced in the central Kasai region. According to WHO officials, at least 528 people have already died from this disease, and the epidemic has spread to 20 of Congo's 26 provinces. “The risk of spread remains very high in the Grand Casai region, where deteriorating sanitation and safety conditions further increase vulnerability to the epidemic,” the WHO said in a statement.

So far, health officials have recorded more than 24,000 suspected cases this year, and have averaged more than 1,500 new cases per week since the end of July. This month, WHO sent a team of experts, including epidemiologists and public health specialists, to the Congo to contain the spread of the disease.

Cholera in Nigeria

Thirty-five people have died from cholera in northeastern Nigeria, local health officials said.

"The number of deaths has already reached 35, and the total number of cases suspected of having cholera now stands at 1,283," Borno State Department of Health said in a statement. Most of the infections and deaths from cholera have been in the Muna Garage camp on the outskirts of Borno's capital city of Maiduguri, which is home to about 20,000 people who have fled the conflict with the Nigerian radical Islamist organization Boko Haram.

Previously, 775 infections and three deaths have been reported in a sprawling camp where internally displaced persons (IDPs) live in makeshift housing, relying on humanitarian aid and public water wells. Waterborne diseases are a constant threat due to the lack of proper sanitation for camp residents, especially during the current rainy season when poor drainage causes infected stagnant pools to form.

The Nigerian government, domestic and international aid agencies providing shelter, food, clean water and health care for IDPs are now working to contain the cholera outbreak. But it has already spread to the city of Dikva, located 90 kilometers east of Maiduguri, where 438 cases have already been reported.

Cholera in Yemen

Earlier, MedNews has already written about the rapid spread of cholera in Yemen. According to WHO, to date, the number of suspected cholera since the beginning of the outbreak in April this year amounted to 612 thousand 703 people, 2048 people died from the disease. The number of cases continues to grow, increasing daily by 3,000 people, however, in the whole country, the spread of the disease is declining. The provinces of Al-Khodeidah, Amanat al-Azimah, Hajja and Amran are called the most affected.

The WHO notes that the current cholera epidemic in Yemen is the largest in the world and is spreading rapidly due to the almost complete destruction of medical infrastructure, lack of hygiene and clean water.

For the past two years in Yemen - one of the poorest Arab countries - an armed conflict continues between government forces and Shiite Houthi rebels. The protracted hostility between the two political forces led to an acute shortage of food and medicine. Experts call the current crisis in Yemen unprecedented in its scope.

According to the UN Office for the Coordination of Humanitarian Affairs, more than 18 million people in the country are in need of humanitarian assistance, about 10 million of them are in critical condition.

According to UN estimates, Yemen is now experiencing the largest humanitarian crisis in the history of mankind. It was caused by a blockade imposed by a coalition led by Saudi Arabia.

The blockade, which exacerbated the humanitarian crisis in the country, also contributed to the spread of the cholera outbreak that began in April 2017.

If the patient is given the necessary assistance in time, the disease will quickly recede. However, in Yemen, the situation is complicated by the fact that at the moment only half of the institutions that can save the sick are functioning.

Moreover, due to the blockade, it is impossible to transport patients to the capital's medical institutions, where they receive qualified assistance.

Cholera has already claimed the lives of more than 2,000 people. More than half a million are infected.

Children starving from malnutrition are especially vulnerable. Among them, the risk of disease increases three times.

According to the charity Save the Children, more than a million children in Yemen are at risk, 200,000 of them are at risk of starvation.

According to local doctors, Yemen is literally "losing its future."

In addition to severe shortages of food, drinking water and essential medical care, the Yemeni population is also suffering from bombing attacks by both Saudi Arabia and rebels, leaving many homeless.

Opponents in the conflict are government forces led by Yemeni President Abd Rabbu Mansour Hadi on the one hand, and Shiite Houthis, along with the opposition that supports the country's previous president, Ali Abdullah Saleh, on the other.

A coalition of states led by Saudi Arabia actively supports the government forces.

During the conflict, the Al-Qaeda terrorist group managed to capture the southern part of Yemen, starting active hostilities in the city of Aden, until it was driven out by the Yemeni armed forces with the support of the United States and the United Arab Emirates.

The tragedy of Yemen is entirely the product of human strength and political ambition. It could have been prevented or at least mitigated if there was political will on the part of the warring parties, which, in turn, would have saved the lives of thousands of civilians and the future of the entire state.

Last Friday, the International Committee of the Red Cross reported that a full-fledged humanitarian catastrophe had come to Yemen: a cholera epidemic amid war, devastation in health care and economic collapse. The 300,000 cases predicted in June were reached this past weekend.

For 10 weeks of the epidemic, approximately 1,700 thousand people in Yemen from cholera. About 300 thousand people are currently sick. The increase in cases is nearly 7,000 a day, according to ICRC regional director Robert Mardini.

• - acute intestinal infection, characterized by damage to the small intestine, vomiting, rapid loss of fluid from the body with the development of varying degrees of dehydration up to death. Mortality in the absence of treatment can reach 50%.

The WHO notes that the cholera epidemic in Yemen is currently spreading to 21 of the 22 mufahaz (regions) of the country, where more than half of the medical facilities have been destroyed. The most affected areas are Amanat al-Azimah, al-Hodeidah, Hajja and Amran. They account for 132,265 cases. Cholera is spread by feces that enter food or water in areas that have been particularly hard hit by the war.

Earlier, the UN Children's Fund said that the number of cases of cholera in Yemen by the end of August could increase to 300 thousand people. Unfortunately, this threshold was already overcome last weekend.

Why did the epidemic occur?

The hostilities that have been going on in Yemen since 2014, of course, have become the trigger of the epidemic. In three years, the infrastructure of the state was almost completely destroyed. The destruction of water supply and sewage systems played a huge role in the spread of the epidemic. According to the UN, 14.5 million people in Yemen currently lack access to clean water, which is especially important for the spread of the epidemic. In the ruins of houses, waste and garbage accumulate, which no one takes out anywhere. Hospitals have been bombed, there are no medicines, and 30,000 health care workers have not been paid since the fall of 2016. Most importantly, more than half of the population is malnourished, which means that a weakened body cannot resist the disease, and the incidence is growing. This is especially true for children.

In fact, 1,700 cholera deaths out of 300,000 cases is a very small percentage, which means that health care has not yet collapsed. If cholera is not treated, up to half of those who become ill die from dehydration and failure of internal organs, that is, mortality could be a hundred times higher.

Saudi Arabia has already allocated $67 million to fight the cholera epidemic, part of the funds will go to purchase the necessary medicines and the salaries of medical workers.

Causes of the conflict

The war has been going on since 2014 (although in fact there have been regular civil wars in Yemen, the previous one happened in 1994). And Saudi Arabia, in general, is one of the main culprits of the current devastation. As a result of the uprising of the Hussites, Shiites from the north of the country, who advocated the creation of a theocratic monarchy, an imamate, instead of the current moderate dictatorship, the capital fell and the country's president fled. After that, Saudi Arabia gathered a coalition and began bombing the country and military invasion. But a quick effective operation did not work out, but millions of refugees, destroyed houses and a humanitarian catastrophe turned out. True, they would have coped without it: in addition to the Shiite Houthis, who want to establish a theocracy in the country, local parts of Al-Qaeda, “moderate” Sunni groups, government troops, separatists from the south of the country and various influential field commanders are still participating in the war. Here is a detailed breakdown of the situation.

In such a war, regular garbage collection and water supply still become a utopia and, therefore, cholera is inevitable in a hot climate (in a cold one, it would rather be tuberculosis and typhus).

humanitarian catastrophe

As a result of prolonged hostilities, Yemen was almost completely destroyed. Water pipes and sewerage systems do not work, there is not enough food and drinking water, millions of people have lost their homes, tens of thousands of civilians have died. Now, on top of everything else, an epidemic of cholera has been added, which threatens to claim hundreds of thousands of lives before the end of summer.

“More than 2 million people have left their homes and live in completely inappropriate conditions. The provision of medical care to the population has practically ceased. 60% of people are starving. About 7 million people basically do not know if they will have food tomorrow or not. The provision of food and medicine is almost entirely dependent on imports. Now the supply of wheat has fallen sharply. About a week ago I visited the port of Hodeidah. There are no courts there. And this directly affects the humanitarian situation. In this regard, we call for the free delivery of food, medical supplies and drugs to the population,” said George Khoury, head of the office of the World Organization for the Coordination of Humanitarian Affairs in Yemen.

Why is it important?

Yemen is an ideal example of how a state can collapse as a result of civil war and intervention, after which medieval diseases that have been very close all this time will return. But Yemen was very poor from the very beginning, half the country lived on less than two dollars a day (the official UN poverty scale), and the state there was initially weak. But nevertheless: until 2014, the garbage was taken out and the water supply worked in the cities, and there was no cholera, at least in such quantities.