A pandemic in a war-torn country

Humanitarian organisations held their breath hoping the pandemic would not reach the country.

When the first case of COVID-19 was confirmed in Yemen on 10th April 2020, the country’s healthcare system was already overwhelmed. Vital medical supplies such as ventilators, oxygen cylinders, and protective equipment were in short supply.

Many doctors still receive little to no salary. Access to information and training for medical staff remains a major challenge, along with the ‘brain drain’ of trained professionals fleeing the war. Much of the international aid has been cut as the conflict has continued.

According to the WHO COVID-19 Dashboard, in November 2020, the country had reported a total number of 2,072 COVID-19 cases with 604 deaths. The case fatality rate of 29.2% is over ten times the global average of 2.4%. 

Addressing the knowledge gap

Since last August, UK-Med has been operating in Yemen to support the country’s COVID-19 response.

We responded to a call from the WHO to assist with system support, capacity building and clinical care. UK-Med put together a team of 10 that combined the expertise of national and international staff, including a national Logistician and Team Lead.

“I have seen that there is a gap, especially in IPC (infection prevention and control),” says Dr. Fredrick, UK-Med’s Medical Coordinator for Yemen.

“You can see there is quite a big knowledge gap with staff and that their emergency departments and laboratories are not organised, given the immense strain that is being placed on these facilities.”

Without effective measures like IPC, infectious outbreaks like coronavirus and cholera are devastating.

The UK-Med team provided hospital assessments, supported the development of training materials and delivered critical care training for 100 healthcare workers running critical care facilities from different governorates, including doctors, nurses and anaesthetists.

Because COVID-19 is a respiratory virus, it requires specialist training to adequately treat patients and keep both staff and patients safe.

The training topics and materials that the team have provided for national staff includes management of COVID-19 cases, airway management, infusion pumps, prone positioning and triage (IPC/PPEs), all of which is critical for treating COVID-19 patients and help prepare staff for future surges.

When flights in and out of Yemen were banned to stop the spread of the virus last March, it brought to attention the precariousness of a health system solely reliant on international relief teams. The recruitment and training of national staff is therefore even more essential to ensure longevity and sustainability of our work and help rebuild the local health system.  

Logistical challenges and hurdles 

After almost seven years of conflict, working in the country is incredibly difficult. Progress has been slow and often met with hurdles such as security risks, lack of resources, staff payment and stilted coordination of COVID-19 activities. Even BLS (basic life support) training is challenged by a shortage of mannequins for sessions.

The tight border control between North and South Yemen and road travel limits have affected the breadth of the team’s work. “For security reasons, our movements are quite limited,” Fred explains.

The country experiences regular internet blackouts and calls to staff are frequently cut off. The delays and logistical challenges that our team face in countries experiencing conflict are a significant hurdle, with the team having to pause its programmes while we wait to hear back about applications for registration and funding.

What the future holds 

Although coronavirus remained thankfully low throughout the summer and into the New Year, a wave of cases has hit the country from the start of February 2021, along with another surge in malnutrition cases, leaving the healthcare system in a critically dangerous position.

One bright spot has been the delivery of 360,000 doses of the vaccine last month, however, like many other countries in the world, misinformation and scepticism around the vaccine remain a major issue. Future work by UK-Med would include RCCE (risk communication and community engagement) support, which has been key in our other COVID-19 interventions.

“The ministry wanted us to stay longer, because the country now is facing the second wave,” Fred says.

“But for this mission, we have no option than leave, because we are here on the invitation of the WHO, so we have no option now rather than leave unless we get the registration and become an independent NGO.

“Those are the challenges we’re dealing with here.”

The Health Ministries, hospital directors and partner NGOs are keen for UK-Med to remain in-country as we address a vital gap in the international response. We are currently both seeking registration and reaching out to donors with our proposal for how we can support health services in the country.

It’s vital that we maintain a small presence in the country. If you are able to, please support us with a gift today and help us get on the ground in countries like Yemen, providing urgent training and support.