Malnutrition in Yemen is a health issue that predates the beginning of the current conflict. But in the Hajjah governorate and its surrounding areas, in northwestern Yemen, the nearly seven-year long war has exacerbated malnutrition. This is particularly the case among children under five years old, with Médecins Sans Frontières (MSF) data showing an alarming rise in cases in 2021.

“A nearly seven-year long conflict has badly affected the country’s economy and weakened an already fragile healthcare system,” says Nicholas Papachrysostomou, MSF head of mission in Yemen. “The situation is worsening with every passing day.”

The Inpatient Therapeutic Feeding Centre (ITFC) in Abs Hospital has been running at more than 100 per cent capacity since the beginning of 2021. A total of 3,377 patients were admitted between January and November 2021, while our teams received 76 per cent more children suffering from severe malnutrition coupled with medical complications – mainly respiratory tract infections and acute diarrhoea – compared to the same period last year.

Most concerning are the children who return to the MSF-supported ITFC in Abs Hospital. These children deteriorate again after already having been treated, often because they have not been able to access follow-up care or because there are shortages of therapeutic food. This can become a vicious cycle as children are treated repeatedly for malnutrition, while its underlying causes relating to the crisis remain unaddressed.

The causes of malnutrition in children go beyond a simple lack of food. “Malnutrition in Yemen has been at times attributed to famine, which gives the impression that the country doesn’t have enough food for its people,” says Papachrysostomou. “However, the issue of malnutrition here is more complex than a simple scarcity of food. Our concern is that people are unable to afford to buy food that otherwise exists.”

Many Yemenis are either unpaid for their work or have lost their livelihoods due to the conflict. On top of this, the depreciation of the Yemeni currency coupled with high prices of food, fuel and other necessities has eroded people’s buying power<p>According to WFP, the cost of a food basket has risen by around 30 per cent in areas under the Sana&rsquo;a based authorities and about 90 per cent in areas under the Internationally Recognized Government of Yemen in 2021.&nbsp;</p>.

Abs and surrounding areas currently host around 55,650 households displaced due to the conflict; most of them rely on humanitarian aid for survival. As a result, many families struggle to afford the right quantity and quality of food for their children. 

Poor health and breastfeeding practices further aggravate the situation. Our teams in the ITFC at Abs Hospital observed that out of all malnourished children admitted in 2021, around 33 per cent were aged between one and six months. An almost non-existent general healthcare system has made access to healthcare very difficult, if not impossible, for many pregnant women, mothers and newborn children. And an undernourished mother is more likely to give birth to an underweight child. 

Many of the severely malnourished children we see can be treated at an outpatient facility without requiring hospitalisation. However, people do not always find outpatient-feeding centres close to their homes, especially in more remote areas. Consequently, a child suffering from moderate malnutrition remains untreated for too long, and can end up with a more severe condition requiring hospitalisation.

“Due to a very weak system of general healthcare services in Hajjah governorate, patients often travel long distances and arrive in critical condition at our facility in Abs Hospital,” says Papachrysostomou.

“Humanitarian groups must prioritise mother and child healthcare, and support the health system to make general healthcare services more functional. An improved healthcare system can help mothers and children receive care at an early stage in order to prevent a health condition becoming more severe,” he says.  

While the health system needs attention, responding to all basic needs is the only way forward to address the issue of malnutrition. This includes expanding food distribution in areas badly affected by malnutrition and increasing community awareness on the correct hygiene and breastfeeding practices, as well as the early identification of malnutrition symptoms.

At the same time, the financial situation of people affected by the conflict needs to be addressed through economic and infrastructural change as well as livelihood support. Most importantly, the warring parties must ensure that the cost of conflict does not fall on those least able to bear it. Without these changes, malnutrition cases among children under five are likely to continue rising both in number and severity.