Yemen and joint mission with UNICEF and World Food Programme

WHO Director-General, Dr Tedros's statement at the Member States briefing

Ambassador Ali Mohamed Saeed Majawar, distinguished Ambassadors and representatives, thank you for the opportunity today to brief you on my recent mission to Yemen and the health situation there.

It was not by chance that my first mission to a WHO country programme was to Yemen. The dire situation in Yemen explains my leadership priorities: we must strive to provide universal health care in the most fragile and complex settings, we must ensure health systems have the capacity to detect and respond to unplanned events and circumstances—particularly from infectious hazards, we must ensure that our WHO country offices have the capacities and skills to lead and to be accountable, predictable and professional.

This joint mission was the first of its kind—3 heads of agency going together to look at how we can strengthen our collective ability to ensure the provision of key social services to a population in desperate need in a highly complex and fragile setting. We visited hospitals and talked with the sick, their families and the health workers caring for them.

Two years of conflict have devastated the lives of ordinary people and left nearly 15 million without access to basic health care. 17 million people on the brink of famine. 16 million – that is equivalent to the populations of London and New York combined – with no access to clean water and sanitation. Children and other vulnerable populations always suffer most. Nearly 80 percent of Yemen’s children need immediate humanitarian assistance. At least 10,000 children have died in the past year from preventable diseases and nearly 2 million are acutely malnourished—making them more susceptible to diseases like cholera which in turn worsens malnutrition.

Of particular concern is the fragility of the health system. The ongoing cholera outbreak is a symptom of this weakened system. And cholera flourishes in a weakened health system. We are witnessing the second wave of an outbreak that first started in October 2016. From 27 April to 1 August, we have recorded 1921 deaths and more than 443,000 suspected cases. It has affected 22 out of the country’s 23 governorates. While there has been a downward trend in the number of cholera cases in recent weeks, the situation remains dire, the rainy season is coming, so we may see another spike in cases.

Together with UNICEF, we have set up more than 1000 diarrhoea treatment centres and oral rehydration corners. The delivery of food supplements, intravenous fluids and other medical supplies, including ambulances, is ongoing, as is the rebuilding of critical infrastructure – the rehabilitation of hospitals, district health centres and the water and sanitation network. WHO and UNICEF are also partnering to roll out a public awareness campaign –engaging 16,000 volunteers going door-to-door to explain to people how they can protect themselves, and how cholera is treatable. We are also working to attack cholera at its source and to significantly scale up the availability of clean water. Together we are achieving results: more than 99 per cent of people who are sick with suspected cholera and who can access health services are now surviving.

At the same time, Yemen suffers from a shortage of doctors and nurses to help treat and care for those who are ill. Some have fled the country. Yet many continue to come to work, even though they have not been paid for more than ten months. WHO and UNICEF are paying incentives, travel costs, overtime and other allowances where and when we can to help get them through this period but this is not a sustainable solution. Other challenges include the fact that more than 55% of all health facilities are closed or only partially functional, there are no doctors in 49 of 333 districts, the supply chain is hampered by restrictions on importations and logistics, as well as the limited amount of implementing partners and funding. And access to the most needy is an enormous challenge to the humanitarian response in Yemen.

Despite the many challenges, I saw dedicated and courageous people working hard, around the clock, to deliver services and to reach the most vulnerable. I saw first-hand the joint work of WHO, UNICEF and WFP in Yemen supporting the provision of social services in part thanks to a nascent partnership with the World Bank that has made available more than 200 million dollars for nutrition and health to fend off the collapse of social services while rebuilding capacities and infrastructure.

I visited the national Emergency Operations Centre for health that leads and coordinates the national and international efforts to provide services in this emergency setting. In the EOC, WHO, UNICEF and WFP are pooling our resources and making joint decisions on how best to use them to achieve maximum impact. We are setting up joint EOCs across the country, even in the most difficult areas to access. The Yemeni health authorities have told us that this new way of working, and of coordinating the efforts of international and national humanitarian and health partners, is making a real difference: they can now sense the presence, not of individual agencies working on their own, but of a unified humanitarian response effort.

Our joint mission resulted in our four main priorities for joint action and dialogue:

First, to accelerate the peace process to bring an immediate end to this conflict so that people can not only survive but thrive. WHO, UNICEF and partners are doing all that we can to save lives and support the health system. But without peace there will be no end to the suffering of the people. When we met Yemeni leaders -- in Aden and in Sana’a -- we called on them to give humanitarian workers access to areas affected by fighting and urged them to find a political solution to the conflict.

Second, in areas of continuing conflict, ensure civilian infrastructure such as water and sanitation and health facilities are always protected in accordance with International Humanitarian Law. Again in Aden and Sana’a, we called on the parties to respect international humanitarian law and to refrain from attacking civilian infrastructure.

Third, donors need to fulfill the pledges that were made at the high level event on Yemen in April and also provide funds for this crisis in a more flexible manner. Ensuring health workers are paid and given incentives to remain at their posts and continue to serve their communities. WHO’s component of the Humanitarian Response Plan is relatively well-funded; however the overall appeal is not.

Lastly, provide political, financial and technical support for longer-term recovery and development. The partnership between the World Bank, UNICEF and WHO on providing services while revitalizing the health sector provides a useful model. We need to re-build the country health and sanitation systems, so that we can prevent and better contain future health risks.

Today, I ask all of you to rally in solidarity with the people of Yemen and to do your utmost to help end their misery. We cannot allow a fragile state to become a failed one. We cannot allow it because of our humanity, we cannot allow it because of our public health goals, and we also cannot allow because of our collective aim for health security. Together, with your help, we can protect the health and well-being of the Yemeni people for years to come.