Pandemic Preparedness Strategies with an Eye on Displaced Populations in Yemen: Efforts and Challenges on Hand

Currently, only 50% of Yemen’s healthcare facilities are completely functional, rendering efficient referral systems from the displacement camps difficult [118]. This is compounded by the increasing hostilities and political instability in Yemen. The turmoil has caused major highways to become inaccessible, along with increasing administrative impediments and the disruption of basic needs. If this continues, the displacement may extend into Marib Al Wadi and Hadramaut, where widespread desert landscapes and scarce humanitarian facilities will precipitate large-scale humanitarian responses [1311].

Adding to the misery, migrants and refugees do not have access to the free national healthcare services [108]. Healthcare discrimination, especially to refugees, continues to occur in the country [120]. The pandemic has further aggravated this situation. Refugees are being scapegoated as carriers, when they do not even have access to shelter, let alone basic healthcare [108]. As tribal conflict has become more frequent, more Yemenis have become internally displaced with a subsequent constraint in their access to healthcare [119].These conditions, in addition to the famine in Yemen, have forced migrants to seek help from smugglers, who had previously mistreated them despite the promise of a safe return home [108]. Hence, regulatory measures addressing discrimination are necessary; however, it is debatable whether the authorities would be able to enforce these in an already conflict-stricken country.

Yemen’s economy is highly dependent on the revenues of its limited oil and gas reserves; the COVID-19 outbreak and crash in global oil prices have forced the country to be more dependent on foreign aid. However, the donors’ domestic economies have limited their capacity to provide aid. As of December 2020, no donor has indicated a willingness to provide continuing support to Yemen [131]. IOM’s health program in the country still lacks USD 30M [108], compromising health assistance and its efficacy in certain locations. Access to healthcare for refugees across Yemen is already limited: in Marib, 84% of migrants are completely deprived of healthcare resources. Thus, this funding shortage is alarming as it can lead to increased mortality among refugees and IDPs, particularly in the setting of a COVID-19 outbreak [108]. Strengthening collaboration with foreign governments to increase political stability and ensure adequate funding is pivotal in this regard. For the long run, it is highly crucial for the GoY to diversify their income sources to ensure financial stability, and therefore coverage of fundamental domains such as healthcare.

Vaccination is another important challenge that the refugees around the world are facing. To date, 51 – or 57 percent of the 90 countries currently implementing national COVID-19 vaccination policies have included refugees in their plans. [142] Even though Yemen is expected to receive an initial supply of 2.3 million doses through COVAX [153], an initiative launched by WHO to make vaccine available to the world’s most vulnerable, it will take a long time to make the vaccine available to each and every Yemen refugee as more than half of the vaccine doses have been bought by high-income countries that are expected to be manufactured in 2021, even though they only account for 13% of the population. [164] It is impossible to stop the pandemic unless a minimum of 70 percent of the population has acquired immunity. [142] Hence, it is important to understand that it is not possible to break or sustainably slow the transmission of the virus if displaced people are excluded from the vaccine rolls plans. It will possess a high risk of continued transmission of the virus in these populations with spillovers into the general population.

Moreover, refugees have a higher mortality rate than the residents of the nation in which they have asylum. They are at higher risk of stress and infectious diseases because they often live in overcrowded camps with poor sanitation. There is no general agreement regarding the ethical basis for the rights of the migrants and the obligations of the host countries and of the international community. There is a lack of effective global governance for public health, despite UN Sustainable Development Goals principle of ‘leave no-one behind’ which is inclusive of migrants and refugees [17]2]. A strategy aimed at understanding the needs of the marginalised people during the COVID-19 pandemic and proposed solutions was published by WHO but it must be followed as well, taking into account the position of health determinants of refugees. [18]