NEW YORK — The number of confirmed COVID-19 cases remain relatively low in Yemen, but the virus is likely circulating, creating a “perfect storm” for catastrophic results in a country already facing the world’s largest humanitarian crisis, according to World Health Organization and humanitarian experts.
The coronavirus response comes at a time when routine humanitarian assistance to Yemen is under threat. The U.N. agencies operating there, including the World Food Programme, UNICEF, and WHO, are preparing to scale down three-fourths of their work in Yemen over the next five months due to lack of funding, according to the U.N. Office for the Coordination of Affairs.
“With 50% of the health facilities in Yemen not being functional, we are dealing with a very fragile health system that isn’t equipped to deal with a crisis of this size.”— Samah Hadid, director of advocacy, campaigns and media, Oxfam in Yemen
“Mark Lowcock recently amplified this very well in his Security Council briefing. He said the virus nowhere else on earth will spread faster, more widely, with deadlier consequences. That is because of the fragility of the health system and the vulnerability of the people,” explained Altaf Musani, head of the WHO mission in Yemen.
“Millions of people depend on humanitarian assistance every day. We have been flagging since the declaration of the pandemic that in this low-resource setting, it will be catastrophic once the virus is in full-blown transmission.”
Yemen had 26 confirmed cases of COVID as of Wednesday. WHO is conducting scenario planning based on several globally available models for the virus’ transmission — one in particular is produced by Britain’s Imperial College. It projects that without any mitigation, COVID-19 could infect 93% of the population, and kill approximately 65,000 people. With mitigation, 55% of the population could become infected, and 42,000 would die.
Hospital capacity, personal protective equipment, and testing are all in short supply in Yemen, Musani explained. The country requires 9.2 million COVID-19 tests, according to Musani. So far, the country has access to 6,700.
Meanwhile, more than 12 million people in Yemen have been receiving food assistance from the U.N. Because of “pipeline breaks” and a $1 billion funding gap, 8.5 million people in northern areas are now receiving half rations, according to OCHA spokesperson Zoe Paxton.
Nine million people receive health services at 189 hospitals and 200 primary health care centers. If funding from April is not received, more than 80% of the services will be reduced and could end by September.
“What COVID-19 is going to do is just aggravate the situation further — the lack of donor funding, the reduced aid, the loss in jobs. It’s a really scary and worrying situation,” said Sultana Begum, Yemen advocacy manager at the Norwegian Refugee Council.
“It's a perfect storm for everyone. We are starting to see price rises for food and other goods. We've got delays in terms of commercial and humanitarian goods coming into the country. And then on top of that, you've got a complicated situation where the aid money is running dry as well,” Begum continued.
U.N. malnutrition programs have started to reduce in Yemen, and cuts to health care programs are “imminent,” Paxton said. The U.N. cuts would also impact school lunches, child nutrition, trauma care, immunizations, and programs for internally displaced populations, among other areas of work.
Humanitarian funding gaps of this level are not unprecedented. But the total amount of donor pledges for Yemen, wrapped in a civil war for the last five years, have also decreased. The U.S. said it was suspending Yemen aid last month, totaling up to $200 million in losses for humanitarian assistance, Oxfam has said.
“What is different — and highly concerning — is that we have much less in pledges (basically fewer signals from donors that they intend to pay a certain amount),” Paxton told Devex via email.
“Last year at this time we had US $2.6 billion in pledges and paid contributions. This year, we’re around $900 million — of which $400 million has been paid and $500 million pledged by the Kingdom of Saudi Arabia,” she continued.
OCHA will host a pledging conference for Yemen in June.
U.S. funding cuts led WHO to eliminate its incentivization program for 10,000 health care workers, which provides them with a regular stipend, in the country’s north last month. There are concerns that these and other health workers will be reluctant to return to work, Musani said. There have also been instances of individual private and public hospitals closing over the last few months because of lack of COVID-19 preparedness.
“To further complicate matters, health care workers don’t have enough PPE [personal protective equipment] to protect themselves. Secondly, this is a new novel virus requiring additional training on clinical management of this. We must protect our first-line responders,” Musani said.
WHO has helped develop a national coronavirus response plan for the country, and has designated 38 hospitals for COVID-19 patients. It is exploring more than seven procurement lines for more PPE, according to Musani. And it has increased its public awareness campaigns on social media, television, and radio on mitigation strategies such as handwashing.
“With 50% of the health facilities in Yemen not being functional, we are dealing with a very fragile health system that isn’t equipped to deal with a crisis of this size,” Samah Hadid, director of advocacy, campaigns and media for Oxfam in Yemen, wrote in an email.
One challenge is enforcing recommended social distancing. While schools have closed in Yemen, many other facets of life, such as shopping in markets and stores, continue uninterrupted.
Many Yemeni people also cannot afford to stay home. The coronavirus is “number 4” of Yemeni people’s concerns, following food, other diseases, getting bombed and becoming displaced, according to Aaron Brent, Yemen country director of CARE International.
“Most Yemeni people are daily wage workers and there is no option for staying home. Even an imposed lockdown will not last long. It is impossible,” Brent said.
But public concern might grow as the number of cases spread across the country and into hospitals.
“Yemeni people are so used to every type of catastrophe they can imagine. This would not phase them. If we start seeing health facilities overwhelmed, I think panic would start to spread. What can they do? They have to keep going at it. Yemenis are so resilient I think they will find a way to face this, however they can,” Brent said.
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