Ali Muhammad’s entire family are sick. In the months since his home district of Abs in northern Yemen was hit by a cholera outbreak, he has lost both parents and all six of his children have fallen ill.

“Cholera is everywhere,” he said, according to a testimony provided by Médecins Sans Frontières, who are caring for his eldest daughter at a cholera treatment centre in Abs. “The water is contaminated and I don’t drink it. We have tanks, but we don’t get water regularly. The situation cannot be worse.”

As the area grapples with both the cholera epidemic, which began to spread in April, and the impact of the country’s civil war, the life of the qat harvester has become harder and harder. “Everybody is sick and in rough shape, and their poor financial condition does not enable them to move from one health centre to another.

“My father got sick and although we hospitalised him, he passed away. My mother died as well. And I am just like many others.”

The Abs district was the scene of a deadly airstrike by the Saudi-led coalition last August that demolished a hospital supported by MSF, killing 19 people, including one of the aid agency’s staff members, and injuring 24.

Less than a year later, as the ongoing conflict hits an stalemate, creating the largest humanitarian crisis in the world, the MSF cholera treatment centre in Abs town alone is receiving more than 460 patients daily, which is more than anywhere else in the country.



A girl drinks water from a well that is allegedly contaminated with cholera. Photograph: Hani Mohammed/AP

The International Committee of the Red Cross warned on Monday that the cholera epidemic in Yemen was spiralling out of control, reaching a milestone of over 300,000 suspected cases. More than 1,600 people have died. Children account for nearly half of all suspected cholera cases in the country, according to the UN’s children agency.



Sana’a-based Taha Yaseen, from the Mwatana Organisation for Human Rights, said obstacles that stand in the way of controlling and containing cholera today in Yemen, include, but are not limited to, the ongoing war.



“During [the war] almost all health facilities and healthcare services reached a point of thorough collapse and thus are unable to respond to the increasing need to address fatal diseases and civilian victims. Many hospitals [have] shut down and many others were hit either by air or ground strikes, occupied by militias or used as military barracks,” he said.



“Most [people] cannot afford even the transportation from their countryside areas or displacements communities to the nearest medical centres to treat them for cholera,” he added.

MSF’s Roger Gutiérrez, who has just returned from a seven-month service in Abs, said the wards in the hospital there, the only public hospital in the area, were “bursting at the seams … what’s happening in Abs sums up the current state of Yemen”.

The district hosts more internally displaced people than anywhere else in the country but most health facilities are not functioning; there is a lack of staff and medical supplies are running short.

“When a plane flies overhead, many patients and staff feel that fear, that vulnerability. For seconds, everything stops,” he said, according to a testimony provided by MSF. “You see mothers disconnecting their children’s feeding tubes so they can run out of the hospital’s nutrition ward.”



Ayed Ali, a Yemeni caretaker based in the al-Sharq district of Hajjah governorate, said most people in the area drink from exposed wells and tanks, “no matter the water is clean or not”. “There are no salaries and no services,” he said, according to MSF. “Even public hospitals are down. There are no drugs. If you have money, you get treatment. Otherwise, you’ll die.”



The conflict in Yemen is between Houthi rebels controlling the capital Sana’a, who are allied with former president Ali Abdullah Saleh, who led the country from 1990 to 2012, and forces loyal to the ousted president, Abd-Rabbu Mansour Hadi. Since March 2015, Saudi Arabia has led a US-backed military intervention in Yemen, aimed at reinstating Hadi, who lives in exile in the Saudi capital, Riyadh, and countering advances of Iran-backed Houthis.

Adam Baron, aYemen expert, said: “The key thing to remember is that while combat deaths continue to get more attention, it is the indirect results of the conflict – things like the cholera outbreak, the hunger crisis and the rise of deaths from preventable disease – that remain the largest killers.”

While Houthis have taken some significant losses this year, Baron said the conflict had largely resulted in a continued stalemate on most key fronts. “By and large, the war in Yemen continues to flare,” he said. “Airstrikes and shelling continue as civilians continue to get caught in the crossfire. But even as the conflict proves to be the catalyst for the collapse of Yemen’s already weakened healthcare system, the country continues to get little attention. The worry is that this won’t change until it’s far too late.”

According to the World Health Organization, suspected cholera cases have been reported in 95.6% of Yemen governorates. Apart from Hajjah, the other three affected areas are Amanat al-Asimah, al-Hudaydah and Amran. Only 45% of health facilities in Yemen remain with limited functionality, the UN has said.

