Overview

After 18 months of conflict, Yemen is a full-blown humanitarian emergency. After a short ebb in fighting due to the peace negotiations, airstrikes and ground fighting have fully resumed, with enormous consequences for the civilians. All armed actors involved in the conflict, including the Saudi-led coalition and the Houthis, are carrying out indiscriminate attacks without respect for civilians or civilian infrastructure such as hospitals. Airstrikes resumed again in July, triggering a disproportionately high level of civilian casualties. An airstrike in Haydan on 13 August killed 10 and seriously injured 28 children.

MSF health facilities alone were hit four times in a 10-month period. The last bombing, an airstrike on Abs hospital on 15 August, resulted in 19 deaths and 24 wounded, including an MSF staff member. MSF was forced to evacuate the teams from six hospitals in Northern Yemen, as the facilities are considered unsafe for both patients and staff, reducing access to quality health care for at least 200,000 people. The UN reports that over 600 health facilities in the country have stopped functioning due to damages or lack of staff/supplies, affecting access to healthcare for millions of people. Taiz city is one of the worst-affected areas of Yemen. With intense fighting – including daily shelling in the densely populated inner city – it has not seen any ceasefire since July 2015.

MSF health facilities hit by airstrikes/missiles

Four MSF-supported facilities and one ambulance were hit by airstrikes or missiles in a 10-month period:

• 15 August 2016 - Abs Hospital
• 10 January 2016 - Shiara hospital
• 2 December 2015 - Tent clinic in Al-Houban, Taiz
• 26 October 2015 - Haydan hospital

18 August 2016 evacuation

MSF withdrew its staff members from six medical facilities in Saada governorate (Haydan, Shiara, Al Gamhouri and Yasnim) and Hajjah governorate (Abs and Al Gamhouri) because it considered them unsafe for both patients and staff. As Saada, Haydan, Shiara, Abs, Yasnim, and Hajjah are hospitals run by the Ministry of Health (MoH), medical activities continue with their MoH staff and local volunteers. To allow the hospitals to continue to function, MSF continues to support them with medical supplies, fuel, food, water, diagnostics, and funding for staff and operations.

Hospital bombing details

Abs hospital,  Hajjah – 15 August, 2016 – 3.45pm

• Hospital: Abs rural hospital
• Location: Abs district, Hajjah governorate, northwestern Yemen
• Details: Aerial bomb hit the area where the emergency room is located and destroyed it along with other structural damage
• Death toll: 19, including one MSF staff member: Abdul Kareem al Hakeemi
• Injured: 24
• Status: 27 August - MoH resumed maternity and emergency services; 18 August - MSF evacuated staff

Abs Hospital was the main medical facility functioning in the western part of Hajjah governorate, serving more than 50,000 people in the area. Since MSF began supporting the hospital in July 2015, the facility has treated 11,020 patients in the emergency department, admitted 906 patients, assisted 1,394 deliveries and provided 15,730 mobile clinic consultations.

The hospital had a 14-bed emergency room, a maternity unit and a surgical unit, and was in the process of opening a nutritional unit. In the first weeks of August before the hospital was bombed, the staff saw an increase in war-wounded patients, mostly victims of recent clashes and the aerial bombing campaign in the area.

Shiara hospital  Razeh – 10 January, 2016 – 9.20am

• Hospital: Shiara hospital
• Location: Razeh district, Saada governorate
• Details: The missile/rocket hit a corridor leading from the main gate to the hospital buildings, with a metal fence alongside; the wounded were hit by shrapnel from the rocket, and also by shards of metal from the fence
• Death toll: Six killed, including three staff members
• Injured: Seven people were seriously injured, including two staff members; many others received shrapnel injuries           
• Status: For five months after the attack, the hospital was not fully functioning, so people did not have access to hospital care. Even at the time of the attack, the hospital could not offer a full range of services as it had previously been hit by a missile/rocket in September 2015 and the inpatient department and surgical department were destroyed. By July 2016, the MSF team resumed regular supervision visits, but had to halt these visits in August when the situation again became insecure following an escalation of airstrikes. However, MoH staff continue to provide health care services.

Shiara hospital is the main medical facility functioning in the town, located in the mountains where most of its 40,000 residents are living in caves to shelter from the bombs. The hospital serves about 120,000 people in the area. It has six inpatient beds for emergencies but only functions in the daytime because people do not want to drive to the hospital at night as their headlights could give them away and create risk of being bombed. Patients and medical staff  prefer not to stay overnight, as they know that hospitals are targets.

Medical teams have treated more than 8,500 since MSF began supporting the hospital in November 2015. The hospital has a six-bed emergency room, a maternity ward and a lab.

Haydan hospital Saada – 26 October, 2015 – 10.30pm

• Hospital: Haydan hospital (MSF-supported)
• Location: Haydan district, Saada province
• Details: Airstrikes occurred over a two-hour period, completely destroying the emergency and consultation rooms, maternity unit, and inpatient department
• Death toll: None; hospital staff and two patients managed to escape
• Injured: One staff member was slightly injured while escaping
• Status: Evacuated

Haydan hospital was the only functioning hospital in the Haydan area and served at least 200,000 people. It had inpatient and outpatient departments, a maternity ward, a lab and an emergency room. MSF began supporting the hospital in May 2015. On average, MSF was seeing 200 war-wounded patients per month in the emergency room.

Clinic in Al-Houban, Taiz – 2 December, 2015 – 11.10am

• Health facility: MSF clinic in hospital tent in area with high number of displaced people 
• Location: Taiz city, Al Houban neighbourhood, Taiz province
• Details: An airstrike occurred 22 metres from an MSF mobile tent clinic, which had closed 30 minutes earlier
• Death toll: This airstrike injured nine people within the proximity of the tent clinic, including an MSF health educator and an MSF guard; one wounded person died of his injuries the following day
• Status: The clinic closed after the airstrike as the population felt MSF’s presence caused the attack.

Ambulance serving Al Gomhoury hospital, Saada – 21 January, 2016 – 4.00pm

• Location: Dhayan, 20 kilometres north of Saada, Saada governorate
• Details: The ambulance was responding to an earlier bombing in Dhayan. Just as it arrived and people were gathering to assist the victims of the initial bombing, the same site was hit again with another airstrike, wounding many people. A third strike was then launched, hitting the ambulance and killing its driver and a health worker, and injuring two others.
• Death toll: 18 people; five of whom were dead on arrival at the hospital
• Injured: 36 people (who were then treated at Al Gomhoury hospital).

Current activities

MSF has been working in 11 hospitals and health centres in Yemen and providing support to another 18 hospitals or health centres in eight governorates: Taiz, Aden, Al-Dhale, Saada, Amran, Hajjah, Ibb and Sanaa. More than 2,000 MSF staff work in the country, including 90 international staff, making it one of MSF's largest missions in the world in terms of personnel. MSF is currently assessing how it can continue to work in Hajja and Sa’ada to serve the population in a manner that ensures an acceptable level of security for its staff following the airstrike on Abs hospital. In the meantime, MSF continues to support the six hospitals in Hajja and Sa’ada with medications, financial incentives for MoH staff and logistical support. MSF operations in Yemen have a budget of nearly 70 million euro per year.

Key MSF figures, March 2015-August 2016

• 49,473 war-wounded and victims of violence
• 23,137 surgeries performed in MSF facilities
• 112,140 medical consultations provided for displaced people in MSF mobile clinics
• 18,962 births assisted
• 267,188 patients seen in the emergency room
• More than 1,761 tonnes of medical supplies sent to Yemen.

MSF projects

Taiz

The situation in Taiz remains extremely critical, with some of the heaviest fighting in the country. MSF is running lifesaving medical activities on both sides of the frontlines in Taiz, Yemen’s third largest city, where most hospitals have closed due to the conflict. In Al Houban neighborhood, it runs a mother and child hospital, where 458 deliveries were recorded last month and over 400 severely malnourished children were admitted to the therapeutic feeding clinic. MSF also runs a trauma centre for war-wounded and trauma cases and manages referrals.

In the enclaved city centre, MSF supports Al Jomhouri hospital for maternity services, Yemeni Swedish hospital for paediatrics, Al Thawra hospital for medical and surgical emergencies, and Al Rawdah hospital for emergency care for war-wounded. MSF has treated over 10,000 war-wounded cases in Taiz since July 2015, including 934 war-wounded in August 2016 alone. Most of the wounded are coming from the city centre, where many civilians are caught in the middle of intense fighting, struggling for food and survival. The patients MSF sees in Taiz suffer mainly from injuries due to airstrikes, blasts, shellings, gunshots, snipers and, more recently, landmines. Movement in and out of the city remains restricted and dangerous for civilians and humanitarian actors. MSF is also providing medications to the emergency room and emergency operating theatre supplies to Khalifa hospital in Al-Turba in Taiz.

Saada (evacuated)

MSF withdrew its staff members from Al-Jumhori, Haydan and Shiara hospitals on 18 August because it considered them unsafe for both patients and staff after the bombing of Abs hospital on 15 August. These three hospitals in Saada are run by the MoH, so medical activities continue with their staff and local volunteers. MSF continues to support these hospitals remotely.

Before the withdrawal of staff, MSF treated people with injuries from landmines and unexploded ordnance and other injuries, including road traffic accident injuries. They provided treatment to people in the maternity, surgical, and inpatient departments, as well as mental and physiotheraphy support. In addition, MSF provided assistance in the emergency room and in the maternity department of Shiara Hospital, which was hit by a missile/rocket in January 2016. Before the withdrawal of staff, MSF made weekly visits to supervise these activities and organised referrals to Al-Jumhori reference hospital in Saada city.

The Haydan health centre had resumed activities after rebuilding following an airstrike on 26 October 2015. Besides Haydan, MSF was also supporting the emergency rooms and referral systems in Noshoor and Yasnim health centres.

Hajjah (evacuated)

MSF withdrew its staff from Abs and Al-Gamhouri hospitals on 18 August  because it considered them unsafe for both patients and staff. As Abs hospital is run by the MoH, a minimum of medical activities continue with remote support from MSF, despite the level of destruction of the hospital.

The population served by the hospitals lived in displaced persons sites around Abs district. Through a system of mobile clinics, MSF teams provided basic medical care and also monitored the nutrition situation. Mental health services were provided in the hospital as well as in the mobile clinics that served the population in and around the IDP camps.

In Hajjah town, MSF supported the main public referral hospital in the governorate with emergency room and surgical services. MSF supported the intensive care unit and post-operation wards since August 2015, and maternity services since July 2016. Because transportation costs are very high, MSF supported a referral system and an ambulance to bring patients from other parts of the governorate to the hospital.

Al Dhale

Al Dhale governorate is located on the old border between northern and southern Yemen. Besides being affected by the current conflict, it is also affected by ongoing tensions over the old border. The governorate has front lines on three sides between pro-Hadi forces and pro-Houthi forces (Hamak, Taiz, Moreis/Damt). These areas saw intense levels of fighting in August from armed clashes, snipers, shelling and rockets. Shelling along the frontline hit civilian homes and cars. There was an increase in civilian causalities as armed actors targeted villages. In one incident, seven children between four and six years old were seriously wounded by shelling. They were admitted to the Al Dhale hospital, where two of them died.

MSF works in partnership with the hospital in Al Dhale and district health centres in Al Azariq and Qatabah, running emergency rooms, outpatient consultations, surgeries, inpatient services, patient referrals, paediatrics, nutrition programmes and maternity services. Following an increase in the number of war-wounded in the area, MSF began supporting the emergency room of the health centre in Damth, the only MSF location under Houthi control in the governorate. So far this year, 838 major surgeries were performed, over 1,100 war-wounded were treated and nearly 60,000 outpatient and emergency room consultations were carried out.

Aden

Aden is currently controlled by southern resistance forces, backed by the Saudi-led coalition. MSF is running an emergency surgical hospital in Sheikh Othman district in the north of the city. The hospital provides free medical care in an emergency room, inpatient ward and operating theatre, and provides mental health and physiotherapy consultations. MSF is still seeing victims of landmines and unexploded ordnance coming from Aden, Taiz, Lahj and Al Dhale.

A medical doctor and nurse conduct weekly visits to Aden central prison to provide primary healthcare services. An average of 50 consultations are provided every week.

Training is part of regular activities in the hospital and MSF provides on-the-job training to MoH doctors and nurses. Since the start of the project in February, 14 doctors and nurses have been trained. An official training programme ran for three days in early July, supported by the David Nott Foundation and validated by the Royal College of Surgeons of England. Around 40 surgeons attending the course from the MSF hospital, other hospitals in Aden, and hospitals in Lahj, Abyan, Lawder and Shabwa.

MSF provided 700 blood screening test kits to the national blood bank in Aden to restart their blood donation activities.

Lahj

MSF has been supporting Ibn Khaldoun hospital in Lahj with regular donations of medical supplies since December 2015 and Al-Razi hospital in Abyan since February 2016. The support includes medications for the emergency room and emergency operating theatre supplies for Lawadar and Al-Razi hospitals in Abyan.

Amran

The situation in North Amran governorate is relatively calm; as a result, people are fleeing conflict to settle in this area. MSF has been providing general consultations to displaced people through mobile clinics.

MSF is supporting Al-Salam hospital and Huth health centre, providing healthcare, donations of medicines, oxygen, logistical equipment, electricity, human resources and supporting the referral system. In a number of other health structures in Amran governorate, MSF is providing medical supplies, training personnel in emergency care, repairing and improving damaged structures, and running ambulance and referral systems.

In January, MSF treated nearly 150 patients for scabies. After medical teams treated around 2,000 people for scabies in May, a mass treatment campaign was conducted in Khamer and Huth.

Ibb

In mid-2015, MSF initiated medical and humanitarian operations in Ibb governorate, the most densely populated region in the country, which borders two active frontlines in the war.

Since early 2016, MSF has supported the emergency department of Ibb Governorate’s largest central hospital, the most important referral medical facility in the region with a catchment population of two and a half million people. The objective is to increase free access good quality emergency health care and to improve the hospital’s capacity to manage a large influx of wounded (mass casualty management). Our staff are seeing 600 to 850 patients per week in the emergency room; 15 to 20 per cent of cases have suffered violent trauma.

On the southern border with the Taiz governorate, close to one of the country’s violent frontline, MSF rehabilitated and is supporting a general hospital that was previously inoperable. The focus has been on ensuring access to good quality emergency health care, improving the hospital’s mass casualty management, and providing lifesaving surgeries and inpatient hospitalization for severe medical conditions. The hospital’s catchment population is estimated to be five hundred thousand people.

On average each month, MSF medical teams provide around 600 emergency room consultations, 120 lifesaving surgeries and inpatient care for more than 100 severe medical cases. Violent and accidental trauma represents more than 50 per cent of the cases seen at the hospital.

Sana’a

MSF continues to support the emergency room in Al-Kuwait hospital in Sana’a. In addition, MSF is supporting war wounded patients and donating emergency supplies to Al-Jumhouri and Al-Thawra hospitals. Medical kits for treating war-wounded patients are also distributed in the Arhab, Hamdan and Jihnanah districts near Sana'a. MSF is also supporting the mother and child hospital Al Sabeen in Sana’a.

MSF´s support to the MoH HIV programme in Saana continues as normal, with 97 per cent of the programme’s 1,300 patients receiving lifesaving antiretroviral treatment despite the tensions and violence in the city. These patients come not only from Sana’a, but from several governorates in Yemen. MSF has regularly provided blood testing kits to the National Blood Bank in Sana’a since September 2015.

Since October 2015, MSF has supported dialysis treatment centres in Sana’a, Hajja and Mahweet, and recently began supporting the dialysis centre in Taiz, which treats around 650 patients with kidney failure. These patients were at risk of death as the dialysis treatment centres were badly affected by a lack of supplies and had reduced their sessions per patient from three to two. MSF is supporting these centres until November 2016, but needs to identify international organizations that are willing support these centres as MSF is focusing on providing life-saving healthcare to war-wounded and victims of violence victims in 10 Yemeni governorates. MSF brought in 240 tonnes of medical supplies for this activity alone at cost of 1.8 million euro over six months.