Yemen Health Care Crisis: Challenges in Yemen During the COVID-19 Pandemic

Yemen suffers from a real health crisis due to the fragile health system and the continuing outbreaks of infectious diseases, such as diphtheria, dengue fever, and currently COVID-19 (1).

Healthcare facilities in Yemen are not ready as they lack the capacity to avoid the threat of a COVID-19 pandemic. Most health care units do not have enough intensive care units, beds, and isolation rooms. Also, there are huge deficits in essential medical supplies, testing capabilities, and protective personnel equipment. They also do not have enough plans to deal with the spread of COVID-19 (2).

There are many problems that the healthcare system faces, including:

• More than 50% of people do not have access to safe drinking water
• More than two million children and pregnant women suffer from acute malnutrition
• Lack of technical personnel necessary for field investigation or active monitoring
• Lack of a national strategy for the workforce to recruit epidemiologists
• The national laboratory system is primitive and depends on a small number of central laboratories such as the National Central Laboratory of Public Health in Sana’a and its four branches in the governorates of Aden, Taiz, Hadramawt, and Al-Hudaydah. The weaknesses of the laboratory system are not only limited to the number of national laboratories but also due to the lack of PCRs and reagents to detect COVID-19 cases, there are only six polymerase chain reaction (PCR) machines available in Yemen (11). Moreover, there are only 500 available ventilators in the whole country (12).
• Masks, gloves, and sanitizers are not sufficient to be spread among the citizens.

The spread of the COVID-19 pandemic will make matters worse and cause pressure on health facilities. Therefore, measures must be taken as soon as possible.

The fragmented authority system and armed gangs are among the most important difficulties facing the implementation of the International Health Regulations and related legislation and policies during disease outbreaks. The Yemeni government was unable to prepare sufficient sites for isolation at entry points into the country and was unable to meet the standards of the International Health Regulations in response to epidemics. Yemeni entry points have little to no technical capacity or systems in place to effectively deal with suspected infected travelers. Moreover, Yemen has a long coastal border, which regularly receives thousands of migrants and refugees from the Horn of Africa. And how the country can implement public health measures in response to migration movements across its porous borders and ports is not yet clear.

Yemen suffers from conflict, mismanagement, and a lack of a good relationship between the government and citizens. The government and the international community must act now more decisively (9).
Basic healthcare facilities are unapproachable to about 16.4 million individuals. The infectious and communicable diseases services are available only in 43% of health facilities, and maternal immunization coverage and immunization plans for children services are available in only 35% of functional health facilities.

The health care system in Yemen is not capable of tackling the outbreak like other middle and high-income countries. The massive insufficiency of the very basic and essential medicines, as well as health kits, makes the healthcare status of Yemen vulnerable and rely on the World Health Organization and other private and humanitarian organizations’ aid (10).

Health system functions, such as access to health care personnel and their capacity, are less than 40% (2). The vast majority (93.9%) believed that the healthcare system in Yemen does not have the resources and capabilities to face and manage a COVID-19 outbreak (3).
82.4% of healthcare workers rated the general alert level of their healthcare facilities as very bad or weak. They also mentioned the unavailability of equipment such as mechanical ventilation devices, diagnostic devices, ICU rooms and beds, and isolation rooms (3). Health care workers have assessed the general level of preparedness of the country’s health care facilities as very weak, poor, ill-equipped, and lacking the most basic facilities and resources to deal with a pandemic (2). Approximately 80% of the population in Yemen has achieved the largest humanitarian crisis worldwide. Therefore, it needs all kinds of humanitarian, medical and food aid (2).

Unstable daily life and armed conflicts have led to high rates of deaths, injuries, food shortages, and have exemplified the low efficiency of the health care system in Yemen. Few and insecure shelters, immigration, lack of medicine and food, lack of sanitary water, non-existing vaccines, and almost zero hygiene policies make the scene much worse. Also, the irregularity of giving salaries to the healthcare workers by the government and the attacks on healthcare workers because of the civil war contribute to worsening the condition even more.
Based on the most recent estimates of the Ministry of Public Health and Population in Yemen, COVID-19 may expand and infect 90% of Yemenis, and this is expected to cause even more deaths than air strikes (5).

Although recorded cases do not seem to be high, the alert of crisis is poor and healthcare workers may be at a high risk of catching the Corona Virus. This does not indicate that Yemen is ready for any upcoming pandemics in the future.

The health care system in Yemen is comprised of four level of facilities; health units, health centers, district or governorate hospitals, and referral hospitals. There are approximately 4207 public health facilities including 243 hospitals.The poverty and ongoing civil war since 2015 has affected the country very badly. Many healthcare related infrastures are in jeopardy making hygiene and sanitation systems even poorer(13)