“I pray to Allah that you may return soon.” When your wonderful team says this to you while looking up at the sky and putting their hands on their hearts, it means you have managed to touch the soul of the project.
We are in the city of Al-Mokha, in the hospital of Doctors Without Borders. When you set foot in this hospital, you realize that you have found a jewel in a country entirely destroyed by war. Devastated streets, houses demolished by the fury of the bombs, dwellings half rebuilt, men walking in the main streets with Kalashnikovs hanging on their shoulders, not even a trace of women to be seen.
The hospital is operating for the benefit of the direct and indirect victims of the fierce armed conflict that has been tearing through the country for more than six years. It is the only hospital on Yemen’s west coast that provides emergency surgical care to the civilian population, victims of war-related violence. Patients come mainly from the areas close to the front lines of the Taiz governorate (Mawza, Dhubab, al-Wazi’iyah) and from the southern one of al-Hudaydah (Khawkah, Hays, at-Tuhayta, ad-Durayhimi, Bait al-Faqih), areas controlled by the Saudi-led coalition, where access to care is very unequal.
Indiscriminate fighting and active hostilities in densely populated areas continue to be a major cause of death for Yemeni civilians. Rural districts have been hit hard, with over 60% of the civilian casualties, most of which are in the al-Hudaydah governorate, at-Tuhayta and Hays districts and Taiz governorate. In these areas, access to humanitarian assistance is severely limited.
Despite the UN-brokered ceasefire in al-Hudaydah, the number of incidents with civilian victims in the governorate has increased. When front lines are dynamic and shifting, the impact of war on civilians is often significantly greater than when front lines are static.
The conflict in Taiz governorate is paradigmatic. Regional rivalries between the Gulf states and Iran and untrammeled local competition for power and influence have grown and played off each other, spreading like wildfire across Yemen. To some extent, the local clashes are a direct result of broader regional dynamics. Pursuing a more proactive foreign policy in recent years, the UAE has vowed to combat political Islam—represented in Yemen by the multifaceted al-Islah party—in all its forms, throughout the region and beyond.
After the town of al-Mafraq, more than 40 km from al-Mokha, along a road marked with blue dots on Google Maps, there is suddenly a gap in the main road, marking the proximity to the front line. We are less than a mile away from the fighting.
On that stretch of road is where snipers are positioned. We continue on a dirt road detour that lengthens the route. The gap is marked by a mound of dirt on which a plastic pipe is planted. All the local drivers know that this sign means detour. From that point on, only the mountains stand between the battlefields, the roads and the houses. We pass through 12 checkpoints, going through the same queue for checks, and after two hours we arrive in the district of al-Wazi’iyah, in the governorate of Taiz.
The landscape is different here compared to Yemen’s arid, windy and sultry west coast. At the foot of the mountains, with the water of the Wadi Rasyan, the color green is everywhere, with acacias and palms. We pass through small villages. We meet a pharmacist who, after years of study and sacrifice, now drives a truck delivering tea to the city of Aden: “There are no other job opportunities,” he tells us.
Some health facilities have been supported by Save the Children, the Yemen Humanitarian Fund and Unicef for years. No more support has come in since August. In the villages of al-Khoba and al-Khuraif, the stories are the same. Salaries for staff have not arrived, medicines and laboratory reagents are running out. We ask what’s going to happen to them. We are told that in all likelihood, they will receive government support eventually, but in the meantime the flow of patients is decreasing towards zero. Civilian movements are minimized due to the proximity to the front line, military checkpoints and completely destroyed roads. The result is that treatments are delayed in a highly concerning manner, with rampant chronicity of otherwise curable diseases.
Healthcare personnel are offering some services for a fee, such as ultrasounds during pregnancy, laboratory tests and microscopic examinations. Some health districts have private pharmacies, whose candy-colored drugs are unmistakably “made in China.” The escalation of the conflict, the deterioration of the economic situation, food insecurity and poor nutritional conditions are signs of an imminent collapse.
About 20 million people in Yemen, out of a total population of 24 million, are in need of some form of humanitarian assistance and protection. Since 2015, the conflict has forced 4 million people to flee their homes, making the country the fourth-largest crisis in the world in terms of internally displaced persons.
The total number of reported victims is estimated at over 230,000, mainly in the cities of Taiz, Aden, Sana’a and Sa’adah. UN agencies and major non-governmental organizations have repeatedly expressed concern about human rights violations, urging a halt to indiscriminate bombing.
According to the latest statement released by the United Nations Office for the Coordination of Humanitarian Affairs, more than 16 million Yemenis, two-thirds of the population, are in need of humanitarian assistance. Among them, more than 12 million are in dire need. Meanwhile, preventable diseases have become pervasive, and morbidity and mortality are increasing exponentially. There are 15 million civilians without access to basic health care, 400,000 children in need of psychosocial support and 75,000 who have contracted diseases that can be eradicated with regular rounds of vaccination.
The conflict has devastated the health services. According to the World Health Organization, more than half of the 5,000 health facilities in Yemen are not functioning or are partially functioning, in 22 governorates. Thousands of health professionals are underutilized due to the destruction of health facilities, lack of medicines and inaccessibility on the part of the population. According to the Health Resources and Services Availability Monitoring System (HeRAMS) dataset for 2020, among Yemen’s 333 districts, 18% have no doctors at all. But one tiny spark of life continues to fight the last desperate battle, in the Doctors Without Borders hospital.
In Al-Mokha, there are always noises: car horns, sirens, gunshots, anti-aircraft artillery tests, fireworks. At first it all seems like one big din, with everything blurring together, but then you start to recognize exactly what everything is. Sounds of grenades. Then sirens. And you already know you have to run to put on your abaya and jump into the car that will take you to the hospital. The air always smells of smoke, gunpowder and sand.
