Max Wirtz Yemen: Cholera in a time of War

In less than three months, the number of cholera cases recorded in Yemen has gone from zero to 500,000. That’s nearly double the number of people who contracted Ebola during the West African outbreak of 2014, but in half the length of time. Such is the exponential growth rate the waterborne disease has achieved since the country’s healthcare system was blasted into oblivion by the constant bombardment of the Saudi-led coalition.

The Director General of the WHO, Tedros Adhanom Ghebreyesus is right when he calls it “an insidious disease” that thrives in conditions of famine, poverty and conflict – all of which have ravaged the country, already the poorest in the Middle East, since Saudi-backed government forces set about crushing a Houthi rebel uprising. The WHO, joined by the World Food Program and UNICEF are now calling on all parties involved to “bring an end to the suffering – by bringing an end to the conflict.” But with so many regional and international interests enmeshed in the conflict and so little news coverage about it, what chance does Yemen have?

While Houthi animus towards the Yemeni government dates back to the 1990s, the most recent uprising stems from their opposition to the election of Abdrabbuh Mansur Hadi who ran as the sole candidate in 2012. Once elected, divisions grew further after Hadi put forward a plan to create a federal state of six regions, which runs counter to Houthi demands for greater autonomy in their northern Yemen stronghold. After a series of stunning victories in tribal areas, the Houthis allied themselves with forces supporting the ousted president Ali Abdullah Saleh, stormed the presidential palace in Sanaa and drove Hadi into exile in Saudi Arabia.

The conflict acquired a regional dimension when Riyadh, fearful of a Shia-affiliated group with possible links to Iran, joined the fray on the side of the exiled Hadi government. That’s when the airstrikes began, laying waste to the country’s infrastructure and breeding a cholera epidemic that at one point was adding 5,000 new cases a day.

The West’s cynical sale of weapons to the Saudi-led alliance has only compounded the cholera epidemic. The US and UK in particular have been furnishing Riyadh with logistical and tactical support for their airstrikes – some of which have targeted civilian infrastructure and were decried as war crimes by Human Rights Watch. “None of the forces in Yemen’s conflict seem to fear being held to account for violating the laws of war,” said Sarah Leah Whitson, Middle East director at Human Rights Watch. And yet both countries are ramping up their arms sales to the Kingdom.

All of these factors have made the work of humanitarian agencies trying to reach cholera victims all but impossible. Unlike during the Ebola outbreak where there were, thankfully, no airstrikes to contend with, NGOs, governments and the private sector were able to work together under public private partnerships to bring the epidemic under control. In Guinea, for example, which was one of the worst affected countries, Rusal, a mining operator that saw its workers threatened by the spread of the disease, ploughed resources into the country’s healthcare sector to halt it in its tracks. The company built a hospital to treat patients as well as diagnostic labs to work on researching new vaccines for the deadly virus. This summer, a vaccination program was put in place to test out a new vaccine that will see 2000 people receive the innoculation over the course of 2018.

Similarly, ArcelorMittal led a private-sector guided group in neighboring Liberia that counted more than 100 companies working together to bend the curve of the outbreak by pooling best practices and gathering information on the ground to help with the international effort to stop the virus. Others, like Facebook, Google and Microsoft were able to generate hundreds of millions of dollars in donations to help combat Ebola and support the healthcare capacity of the affected countries. These initiatives were crucial in ridding the region of Ebola.

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In stark contrast, a plan to disseminate one million cholera vaccines in Yemen, which was only one-third of what was needed, has been canceled because in the time it took for aid organizations to work out the logistics of running a vaccination campaign in a war-torn country, the number of people with the disease rose so much that it would no longer be effective. Since cholera is present in 91 percent of the country’s governorates, aid workers would have needed to reach extremely remote regions with the vaccine chilled at sub-zero temperatures all while avoiding hijack by rebel groups – an impossible task for a country lacking even basic electricity access.

The nature of the conflict means that the no holds barred private sector response that was key to halting Ebola in West Africa is simply not possible. Moreover, the country is in dire need of aid – $2.3 billion according to the UN – but only 40% of that amount has been received so far. In what can only be described as a morbid case of cognitive dissonance, Saudi Arabia claims to have spent $8.2 billion on aid to Yemen since April 2015 – to alleviate a crisis that Riyadh itself is perpetrating.

As NGOs have been saying: for the suffering to end the conflict has to end first, but much like with the conflict in Congo, it is Yemen’s remoteness that has doomed it to obscurity. Without a light being shone on the depredations suffered by the people of Yemen, the powers that be will continue pursuing the conflict through to its bitter conclusion. In the meantime, untold hardship will continue to be inflicted on the least deserving.