Vaccines

Special Report: In a hospital ward in Yemen, the collapse of a nation

ADEN (Reuters) – Nahla Arishi, chief pediatrician at the al-Sadaqa hospital in this Yemeni port city, had not seen diphtheria in her 20-year career. Then, late last month, a three-year-old girl with high fever was rushed to Arishi’s ward. Her neck was swollen, and she gasped for air through a lump of tissue in her throat. Eight days later, she died.

Soon after, a 10-month-old boy with similar symptoms died less than 24 hours after arriving at the hospital.

Two five-year-old cousins were admitted; only one survived.

A 45-day-old boy, his neck swollen and bruised, lasted a few hours. His last breath was through an oxygen mask.

One morning in early December, 16-month-old Sameh arrived at the hospital carried by his aunt and delirious with fever. Arishi immediately recognized a new case of diphtheria. “Put on your mask,” she ordered the aunt.

Sameh’s father, a fighter in Yemen’s three-year war, rushed in, grabbed his son, yanked off the baby’s shoes and threw them on the floor. “Sameh is the light of the house,” he wailed, feeling the boy’s feverish brow and body.

This is the emergency ward to a nation. After three years of warfare, cholera and hunger, Yemen faces a new battle: In the past four months, doctors across the country have recorded at least 380 cases of diphtheria, a bacterial disease that last appeared here in 1992.

Arishi, like her country around her, is struggling to cope. Every month, she and her team drip-feed dozens of Yemen’s half a million severely malnourished children. Her ward has also treated hundreds of the one million people infected by cholera.

This spring, Arishi and her colleagues reopened an abandoned wing of al-Sadaqa hospital, fenced it with chicken wire and created a makeshift cholera treatment center. Now, they are converting part of that center into a diphtheria ward, cordoning off isolation units by barring hallway doors.

But with rusty oxygen tanks and only two functional ventilators in a different part of the hospital – and with the expectation that the cholera epidemic will worsen in coming months — her triage upon triage is no longer working.

“We’re getting more patients but we can’t deal with them. We don’t have supplies. We don’t have money,” said Arishi, “This war has got to end.”

For the past three years, Yemen has been the combat zone of a struggle for regional supremacy between Saudi Arabia and Iran. Riyadh and some of its Arab allies jumped into Yemen’s civil war in 2015 to help quell an uprising by the Houthis, an Islamic political-religious movement backed by Iran. In addition to airstrikes, Riyadh – with U.S. and U.N. backing – has positioned ships in Yemeni waters as a way to stop arms reaching Houthi militia.

But the blockade has ended up isolating a country that was already the poorest in the Middle East. Vital provisions – food, medicine, fuel, medical equipment, batteries, solar panels and more – are not getting through. Humanitarian shipments of food and medicine have mostly been allowed into the country. Yet Saudi-led forces have severely delayed aid shipments or closed ports outright, especially in northern Yemen where fighting and the humanitarian crisis are most acute.

The war and blockade have also thwarted Yemen’s vaccination programs.

Seven years ago, 80 percent of children were fully immunized with three doses of diphtheria, whooping cough and tetanus vaccine, or DTP as the combined shot is called, according to Zaher Sahloul, a critical-care specialist who cofounded a nonprofit called MedGlobal. Now, he says, that has dropped to 60 percent.

Poor record keeping means there are discrepancies in data related to vaccine coverage. Yemen’s Ministry of Health says 85 percent of Yemeni children have been immunized against diphtheria, whooping cough, tetanus, Hepatitis B and bacterial influenza since the beginning of the conflict, a mere two percentage point drop from pre-war years.

In late November, the U.N.’s World Health Organization (WHO) sent a shipment of diphtheria antitoxins – designed to treat those already infected – and vaccines to the capital Sanaa. The vaccines were delayed by the Saudi blockade for a week, the WHO said.

In July, the Geneva-based International Coordinating Group on Vaccine Provision earmarked a million cholera vaccines for Yemen. An initial shipment of 500,000 doses was sent to the African Horn country of Djibouti, and was ready to send on to Sanaa. But the WHO and local authorities in Sanaa decided together to scrap the vaccination plan, citing logistical and technical issues.

“Yemen needs a Marshall Plan,” said Sahloul, who was visiting al-Sadaqa’s treatment center in December. “It is difficult to foresee an optimistic scenario if the current conditions persist,” he said.

DISEASE AFTER DISEASE

Arishi began her medical career in the mid-1990s after Yemen unified following years of conflict between communist and pro-western forces. She joined the al-Sadaqa hospital, which was built in the 1980s with funds from the Soviet Union.

In her two decades at the hospital’s pediatric ward, Arishi has seen Yemen slowly come apart again. Even in…