Yemen blockade leads to Diptheria outbreak, 28 deaths reported

The ongoing war and blockade are creating a new threat to public health in Yemen, as a suspected diphtheria outbreak takes hold, the aid agency Medecins Sans Frontieres (MSF) have warned.

The charity have revealed that by December 4, 318 suspected cases of diphtheria and 28 deaths had been reported in 15 of Yemen’s 20 governorates.

According to emergency coordinator in Ibb, Marc Poncin, if left without treatment, diphtheria is fatal in up to 40% of the cases.

"But after 2.5 years of violence and a blockade on supplies including medicines and vaccines, the health infrastructure is in tatters. The blockade on fuel has meant that patients cannot afford to travel to the very few health centers still operating across the country.

"Globally, diphtheria has been eradicated from most countries after systematic childhood vaccination campaigns, and it’s become something of a neglected and forgotten disease. Even in Yemen, the last diphtheria case was recorded in 1992, and the last outbreak in 1982. Its re-emergence is a clear indicator of the state of Yemen health’s infrastructure."

Humanitarian actors are also struggling to start diphtheria treatment and prevention activities due to the ongoing logistical difficulties bringing specialized staff and needed supplies into Yemen and to areas where they’re most needed.

“This is undeniably another human-made disease inflicted on a country that has barely recovered from a massive cholera outbreak - which is not even over yet,” said Poncin.

“Globally, the decline of diphtheria in recent years was accompanied by a concrete loss of knowledge regarding its treatment. This is making it much more difficult for health workers to quickly and correctly identify, isolate and treat cases,” adds Poncin. “To treat diphtheria, patients need to be isolated and receive antibiotics and anti-toxins. But the global supply of the anti-toxin, which is the single most important aspect of treatment, is very limited, and no anti-toxins were available in Yemen prior to a few weeks ago.”

To tackle the outbreak, MSF, together with WHO, is acquiring most of the antitoxin that is still available worldwide, and ordering more antibiotics. MSF has also put together a rapid response team to survey and identify suspected cases in communities, and provide prophylaxis to those in contact with a diphtheria patient.

On 11 December, MSF opened a Diphtheria Treatment Unit in Nasser Hospital in Ibb city, and is in the process of supporting two others in Yarim and Jiblah hospitals - the later with Intensive Care Unit capacities. An ambulance referral system will also be set up to transport suspected cases to hospital. MSF will additionally, support transport of samples to a laboratory to better confirm cases, and carry out health promotion activities to alert communities to diphtheria. Meanwhile MSF is also setting up an intensive care unit in Sadaqa hospital, Aden, where 14 cases were recorded, resulting in 4 deaths.

“We have been visiting houses where six or more displaced people are living in very cramped conditions. In such settings there are no ways to properly isolate cases, and it creates the perfect conditions for diphtheria to spread. Isolating and treating patients, offering preventative care for affected communities and raising public awareness are therefore crucial to halt the spread of diphtheria,” says Poncin. “Yemen’s healthcare system cannot afford another outbreak.”

Blog from the front line ... 

In this first person piece from the war torn region and published here for the first time, Monia Khaled, WATSAN Supervisor for MSF in Yemen, reveals how ’just living has become more difficult’.

"I was on annual leave when the clashes and airstrikes started last week. The diplomatic area in Sana’a, where the worst fighting was, is near my home. The day clashes began I saw lots of armed men setting up checkpoints in the streets. The roads were completely empty so I quickly went out with my sisters to get groceries and went straight back home. Then the fighting started.

I stayed at home with my family the whole week. We couldn’t go out so it was lucky that we had bought everything we needed. We watched the news the entire time and checked in on all our family and friends. We were hearing about all the dead bodies in the street and we didn’t feel safe.

My mum and sisters slept on the floor in the safest room in the house, away from the windows. My relatives were affected a lot - their three-story house has been badly damaged. There were snipers in the surrounding buildings so they couldn’t escape until the house next to them was destroyed by an airstrike.

I also heard about a woman who couldn’t leave her house to deliver her baby at hospital. Another family was trapped in a burning building because there was too much fighting outside. We heard many horrible stories.

The war over the last two and half years has changed a lot of things here, and it’s had a big impact on public health. Some medications that my parents depend on haven’t been available for the past two months. Now we have to search for replacements or ask people we know coming from abroad to bring them in for us.

My dad’s heart medicine used to be readily available but now it’s almost impossible to find, and the cost has gone up a lot. The price of everything here changes from one day to another, depending on availability. Before the fighting last week, cooking gas cost 4,500 YER; now it’s 6,000.

Food prices have gone up so much that most people don’t buy fruits anymore, only the basic things that will feed their families, and this affects their health. I help support my family and the fluctuating prices really affect us. Now we try to keep money on the side for emergencies, and we only buy the necessities.

Many of the clinics and hospitals in Sana’a closed during the fighting this month, but the war in general has made it more difficult for people to find medical care.

During the blockade people who needed to go abroad for medical care had to find other ways to get out, or they got stuck here. As a medical organisation, MSF is doing a lot in Yemen, ranging from water and sanitation, supplies and health promotion, to humanitarian and medical assistance. It’s good to know that while many organisations left the country because of the recent violence, MSF stayed. We are on the ground, standing shoulder to shoulder with the people.

The living situation is very bad for many families now. We really started to feel the war when people stopped receiving their salaries. Many public sector workers, like Ministry of Health staff, haven’t been paid for over a year. Every day is a struggle for many - just living has become more difficult.

The last time street fighting happened was in 2011. I think the street fighting is worse than airstrikes. At least with the airstrikes we know they usually hit certain targets, so we can still go out, come to work, etc. But with street fighting, it’s more difficult and there is no guarantee of safety.

It means a lot of civilians will die. Before the clashes, I was optimistic that the problems here were almost over and that finally the war would end. But now things seem to have gotten worse."

?Monia Khaled, WATSAN Supervisor for MSF in Yemen

KEYWORDS: Yemen, Diptheria


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