As a UNICEF Immunization Specialist in Yemen, I was recently sent to Sa’ada, an area (or Governorate) already devastated by internal wars since 2004, further deteriorated by the ongoing conflict since March 2015 – the worst recorded in the region’s history. Government offices, religious institutions, residences and schools have all been indiscriminately targeted by the warring groups. I was one of a very few who got an opportunity see the war and its ruins up close and in critical detail. The sights I have seen are not bedtime stories and have left me in deep anguish.
Though this is one of the first international staff visits to Sa’ada in months, I had read much in the international press and felt an immense sense of urgency to see how badly the city of Sa’ada, with an estimated pre-war population of 50,000, had been affected by the conflict.
0820: We crossed the Al Azraqain checkpoints where soldiers – mostly very young boys – were standing holding guns. The sight of such young warriors was very disturbing. Despite getting all the clearances we were stopped and asked a few questions. It was a nervous moment for all of us. We passed an unorganized Internally Displaced Persons (IDPs) camp at Al Khamar. IDPs from Sa’ada are now sheltered at the Al Khamar camp.
1145: As we entered Sa’ada Governorate, we were greeted by a demolished building façade. Another passenger casually mentioned that it used to be a health facility. I began dreading the coming sights. As we passed the gates of the city itself, the sights left me completely desolate. Destroyed buildings, homes and marketplaces reflected the reality of Yemen today. This past seven months of war had left Sa’ada and its chances in ruins.
1235: We entered the UN compound with warm greetings from the various UN staffers. As I settled into the office, I noted the conversation was about victims not just from the city, but those affected the most – those trapped in the rural periphery and bordering districts, where even aid response was proving very tough. A friendly face ushered me to my accommodation. With a mattress, blanket, sheet and old pillow, I felt grateful for the simple luxuries of which a child in Sa’ada could barely dream.
0545: The first morning at the camp: air strikes and bombs woke me up to a new, rude reality. The room shook every time a bomb was dropped in the vicinity.
1010: Undaunted, we headed for the Governorate’s Health Office and met with the Director General. It was a day of shocks, to hear that since the conflict had escalated, 11 health staffers had been killed. So now, out of 600 of the team, only 200 were reporting for duty. The room had lost some of its daredevil spirit.
1100: No activities could be conducted in two districts of Sada’a and Al Dahaher, which meant a population of 45,000 remain deprived of any health services. Polio, measles and rubella immunization campaigns, working with other outreach activities, were being conducted in some areas, but the data was skewed and unfinished.
1215: We toured the city’s cold storage for the vaccines. It was heartening that the cold storage facility was fully functional and all vaccines were intact. Beside the main cold facility, the vaccines were also stored in non-commercial refrigerators, run on generators fuelled by UNICEF.
1545: After lunch we took a short tour around the city, in which “sights” meant desolation and buildings demolished by recent airstrikes. Nothing stood whole any longer. Government buildings like the education department, finance and agriculture were little more than rubble. Even mosques hadn’t been spared.
Day one proved to be a brusque eye opener. I could only appreciate the courage of these young men and women who were trying to cope with the madness that surrounded them. Truth is, the whole medical and aid system in this governorate was running on a threadbare capacity of 33 percent. My restless mind questioned alternatives to this situation. We desperately need to improve the referral system for patients and the solution to this was asking for the extraordinary. I dozed off chasing those answers only to be awakened once more to the sounds of war.
0830: We started early for the Al Jamhori hospital, only to find a sea of humanity rushing in and out of the main gate. We were told that this was one of the best referral hospitals in Sa’ada. Clearly this was true. It was heart-breaking to see so many malnourished children in one place. It appeared at first glance that almost every child in Sa’ada was malnourished. Most of them had not received vaccinations yet. For some, I could tell, it might be too late.
1015: We all had to brace and find cover as sounds of an explosion struck very near the hospital. Soon ambulances started bringing in patients injured in the airstrikes. In seconds, every bed in the emergency ward was filled with battered and injured people. The sights that greeted me in the next half hour are indescribable. Panic had gripped the relatives of those injured. There were blood-soaked faces everywhere.
1100: We met with Director General of the Hospital and he requested our support to strengthen the Intensive Care Unit (ICU), with provisions like fuel, human resource, supply of medicines and other equipment to keep his facility running. He stressed the need to strengthen coordination between various hospital organizations to meet the growing demands of the crisis.
1215: By noon we had reached the Atohila Health Unit, but it had closed. The number of health units which have been unable to stay open or functional is distressing.
1000: Reviewing the data of campaigns and other immunization activities in Sa’ada, I realised just how low the coverage area had been in the last polio, measles and rubella immunization campaign and how much work needed to be done. Tetanus coverage had also been reportedly very low compared to the reach of the other Governorates. A bad start to the day.
1330: Lunch with key Government partners, local media and NGOs: a fantastic opportunity to interact with all the local stakeholders and get a real-time check on the situation in Sa’ada.
Day 4 |
0830: We left early for Haydan in a UNHCR vehicle. A mountainous stretch and then we passed through the best and most expensive orchards of Khat, in Yemen.
1030: At Haydan, the locals were so afraid of becoming airstrike targets that they requested we hide the vehicle. The Director of the hospital welcomed us and we toured some of the hospital. Emergency and immunization services were only operational in some bigger hospitals. We met 2 midwives who informed us that women had stopped coming for delivery, fearing an airstrike.
1200: The staff showed us underground areas covered with sand which they had built to protect themselves during attacks. These were part bunker/part tunnel from which they conducted deliveries to parts of the hospital. Children were being vaccinated, but not to all necessary standards.
1255: On our way back to our hidden vehicles, we were shown a house which had been hit by an air strike yesterday, killing 2 adults and 10 children, with 2 more seriously injured children in the hospital. Haydan was leaving me with an eerie sensation of déjà vu. One hospital, with too many victims, too little aid and no clear resolution in sight.
1000: We reached Majaz health centre which is jointly run by WHO and UNICEF. Many patients and displaced populations who came from other war affected areas of Sa’ada live in areas near this health facility.
1100: We joined a mobile health team and swept through Sa’ada’s famous pomegranates orchard to reach Al Hariba (meaning “fighters village”). This was turning out to be a good day as the health team shared some excellent district performance reports. The local IDPs, who seemed very happy with the volunteers, requested visits from the mobile team and sought help in securing safe water.
0900: Due to the increased fighting, our security officer ensured that we left safely at 0900 hours.
As we passed the final checkpoint of Sa’ana, my thoughts lingered on the desperate situation of the IDPs and the children we had found lining the hospital hallways at Haydan yesterday, and many like them with even worse fates.
Today, only 5-7 percent of pregnant and women in need of medical attention have received vaccination against tetanus. Malnutrition is rampant and severe in most of the areas along my journey. Since March 2015, international staff movement in and out of Sa’ada has been completely stopped. On this return to Sa’ada I was keen to get a grasp on the reality of the new situation. My task was cut out for me. Sa’ada’s infrastructure is crippled, coupled with a shortage of human resources, no electricity with a strong dependence on fuel and a lack of access to basic health services, especially vaccination for infants, have simply multiplied the problems for its inhabitants.
Out of 143 health facilities, only 55 (38 percent) are functional. Safe access to quality health services has been completely paralysed. Schools in the entire area remain closed. Hundreds of thousands are displaced from their homes. Even as I returned to Sana’a, I was sent very disturbing news that Haydan rural hospital had been badly damaged in an air strike following our visit. It had been the last standing and functional edifice providing much needed psychological and medical care facilities to women and children in the area. It was almost as if this news had pulled down the curtains on the last glimmer of hope for all those who had a chance for vaccinations and health care in Sa’ada.
It may already be too late for many a malnourished child here, but I am hopeful that UNICEF will find resources and networks to rebuild a mobile health care centre in the area for the survival of children and mothers in the coming days of conflict.
Dr. Bilal Ahmed is an Immunization Specialist at UNICEF Yemen