Yemen health system faces collapse as funding declines: World Bank

Yemen’s health care system is facing existential threats, including institutional collapse, in large part because of the yearslong conflict, according to a policy note released this week by the World Bank. One of the key issues is the country's heavy reliance on external financing, which is quickly drying up.

Donor support to the country ramped up significantly as the conflict broke out in 2014 and leading up to 2019, but then it saw a sharp contraction. Arab countries have dropped off some of their support in recent years, and the United Kingdom cut funding. The World Bank noted that starting in early 2020, with the COVID-19 pandemic and global economic decline, funding from other sources also took hits.

External financing for health peaked at $605 million in 2018. It then fell to $370 million the next year and has continued its precipitous fall.

The current appeal for Yemen from the United Nations Office for the Coordination of Humanitarian Affairs is only 54% funded, with the United States as the top donor, accounting for nearly a quarter of the $2.1 billion in total funding to date. Other key contributors include Saudi Arabia and the United Arab Emirates — both involved in the war — as well as European donors.

“The conflict has led to the virtual collapse of basic social services, including Yemen’s fragile health care system,” according to the report.

By the beginning of 2020, aid was reaching about 1.7 million fewer people per month on average, as U.N. programs were suddenly forced to downsize. According to the U.S. Agency for International Development, 19.7 million people lack access to health services, with the country’s maternal mortality rate among the worst in the region.

The COVID-19 pandemic hit a country already struggling with outbreaks of infectious diseases over the past several years. Cholera has been an ongoing concern since 2016, and measles has become a growing threat as well. The World Bank also noted outbreaks of diphtheria and dengue, with vaccination rates against infectious diseases exceedingly low.

Yemen is ranked 193 out of 195 countries for its capacity to manage an epidemic. Only 51% of the country’s health facilities are fully functional, according to a report by the International Rescue Committee from last year, released at the onset of the pandemic.

“The COVID-19 outbreak, flooding, locust infestation and climate-related hazards have further compounded the impacts of the conflict,” the World Bank report found.

The conflict also includes attacks on health infrastructure, with the report citing a study that counted 120 attacks on health facilities and medical personnel over a period of nearly four years.

The situation in the country has caught the eye of USAID Administrator Samantha Power, who told a panel discussion this week that a combination of increased funding and better access would be required. She warned of crippling restrictions on the movement of imports, coupled with rising food prices.

“The fact is that much more funding is needed to keep Yemen from the brink,” Power said.

David Beasley, the head of the World Food Programme, told the same panel that his organization was set to run out of supplies next month.

“We've got to get the support we need, particularly in the next six months, because our supply chain — we run out in about October,” Beasley said.

Earlier this year, WFP was among the U.N. agencies warning that 400,000 children under 5 could die of starvation this year. Some 2.3 million Yemeni children in that age group were projected to suffer from acute malnutrition, an increase of 22% from 2020.

“We need for those who made pledges to write the checks so that we can put food in the mouths of children throughout Yemen,” Beasley said during the panel discussion, urging donors to step up.

However, he also warned that humanitarian aid is like trying to “stick a finger in the dike.” He said parties to Yemen’s conflict need to negotiate an end to the fighting, which has ravaged the country for seven years.