Yemen

• People in need: 21.6 million¹
• People targeted: 19 million
• People in need of health assistance: 21.9 million
• Requirements (US$): 141.5 million

Context

The aftermath of over seven years of conflict has resulted in the freefall of Yemen’s economy, mass displacement, increased humanitarian needs and the disruption of public and social services for millions of people. Yemen is the 4th largest internal displacement crisis in the world and over 24 million people, or 73% of the population, will need humanitarian assistance in 2023. More than 4.3 million people have been displaced since 2015. The expiry of a six-month ceasefire on the 2nd October 2022, has pushed Yemen back into conflict, which will further impede the delivery of desperately needed humanitarian aid and access for those working to support the population.

Currently, 19 million people are food insecure as catastrophic hunger looms for almost 170 000 people, with children the most at risk. An estimated 2.2 million children are acutely malnourished, of which 500 million suffer from severe acute malnutrition (SAM), and many from SAM with medical complications (SAM/MC), greatly diminishing their chances of survival.

Vulnerable groups, including mainly internally displaced persons (IDPs), refugees, women and children rely entirely on essential services that are free-of-charge to survive. Families in Yemen barely have enough to purchase food, as their buying power has been drastically reduced due to the ongoing conflict. According to Health Cluster data, an estimated 1 million consultations are related to communicable diseases, as millions are prone to preventable diseases and natural hazards.

The already fragile health care system in Yemen is unable to meet the needs of the population, with less than 50% of all health facilities fully functional across the country and inadequate access to primary, secondary and tertiary health care. Currently operational facilities lack qualified staff, equipment, medicines and funding for operational costs. Most health personnel have not received a salary for two years or more. There is an urgent need to increase levels of funding for the Humanitarian Response Plan (HRP), to address the immediate critical care needs and help support Yemen on the route to stability.

Additionally, Yemen is affected by two separate strains of circulating poliovirus outbreaks: vaccine-derived poliovirus Type 1 (cVDPV1) and Type 2 (cVDPV2). With 150 cases reported in 2022, Yemen accounts for one-third of all cVDPV cases globally. Poliovirus from Djibouti has also been confirmed internationally and the risk of further spread in the region remains high.

While the Polio Eradication Strategy 2022-2026 prescribes timely detection of viruses, and timely, quality outbreak response, improvements in key parameters need to be strengthened in Yemen. In particular, urgent additional measures must be implemented in the northern parts of the country, where the majority of cases are occurring.

Within the Global Polio Eradication Initiative, northern Yemen is now considered to be part of a set of ‘consequential geographies’, which include Pakistan, Afghanistan, south-east Africa, eastern DR Congo, northern Nigeria and south-central Somalia. These are areas with some of the highest proportion of ‘zero-dose’ children, who are either under- or unvaccinated.

Emergency response

WHO will work to deliver a strategic and coordinated response to meet the acute needs of those affected by the crisis, and provide health and nutrition services, based on and responding to the HRP and Humanitarian Needs Overview (HNO) 2022, to reduce suffering and lessen the prevalence of infectious diseases.

WHO will enhance the health system’s capacities in the areas of preparedness, readiness, response and recovery and provide operational support to health facilities. WHO will also increase access to the health service’s delivery mechanism, the Minimum Services Package (MSP) and strengthen accessibility to emergency and specialized health services. Additionally, WHO will continue to apply evidence-based planning and results-based monitoring when implementing its emergency response. Furthermore, it will strengthen information management and emergency preparedness to ensure that health emergencies are rapidly detected and responded to, and that epidemics and pandemics are prevented.

To support the Global Polio Eradication Initiative, efforts are ongoing to fully implement international outbreak response standard operating protocols (SOPs), consisting primarily of implementing a series of large-scale and high-quality emergency outbreak response campaigns, in addition to strengthening disease surveillance.

There is a global effort to eradicate polio, which was declared a Public Health Emergency of International Concern under the International Health Regulations. At its most recent meeting in October 2022, the IHR Emergency Committee emphasized that Yemen remained a country officially classified as ‘infected with cVDPV1 and cVDPV2’ and put forward temporary recommendations to further limit international spread of the virus.

To achieve its strategic objectives, the WHO Country Office for Yemen will put mechanisms in place to ensure coordination with relevant stakeholders to support complementary interventions. This will also include information management mechanisms, especially with health and nutrition clusters, and monitoring and evaluation plan and procedures to ensure accountability toward affected populations. WHO will ensure No Harm Principles, as well as mainstreaming gender and protection considerations, are in place.

Strategic objectives

Key activities

• Strengthening preparedness and surveillance including early detection and response to communicable diseases, outbreaks, epidemics including COVID-19 in 32 health facilities across the country.
• Ensuring access to lifesaving and life-sustaining health services to the most vulnerable populations through a quality Minimum Services Package.
• Focusing on primary and secondary emergency health care, trauma care, referral services and prehospital referral system for trauma and non-trauma emergency cases, in hospitals located in over 120 priority districts across Yemen.
• Strengthening operational support to health facilities and providing operational costs (electricity, water & oxygen), medicines, medical equipment and supplies, structural rehabilitation/ revitalization, capacity building and financial support of Health Care Workers (HCW).
• Supporting provision of rehabilitative, advanced trauma and Intensive Care Unit (ICU) at tertiary care level to improve the resilience of the health system and people, in over 120 priority districts across the country.
• Maintaining lifesaving service availability and interventions in 96 Therapeutic Feeding Centers (TFCs) and referral pediatric wards linked to the TFCs, through payment for performance-based service delivery cost to health workers (e.g., pediatrician, medical doctor, nurse and support staff) and based on duty hours.
• Providing direct support to the health cluster system at hub level to ensure a well-coordinated humanitarian response.

Funding requirements

Overall country funding requirements, including COVID-19, by pillar (US $ '000)

Success stories

Surviving Hunger in Yemen: Therapeutic Feeding Centers give hope and help to thousands

Families in Yemen who endure prolonged exposure to armed conflict and grinding poverty are forced to live on the thinnest margins of survival – especially when displaced from their homes and lacking access to food, clean water and basic nutrition and medical services.

Om Salim confronts the cruel realities of hunger every day as a mother of two young children living in extreme poverty. The family must routinely skip meals, and often have nothing to eat for a day if not longer.

When Om Salim’s youngest child recently began showing signs of malnutrition including severe wasting and swelling, she brought him to a WHO-supported therapeutic feeding center (TFC) with nothing but her anguished prayers that he would pull through.

“When I first brought my baby to this feeding center, he was so thin, and my heart was breaking,” Om Salim said. “But now I can see that he is doing much better, and for that I am so grateful.”

Dr. Athmar Al Saqqaf is the director of the Al-Sadaqa Hospital TFC in Aden governorate. A large number of families arrive to this TFC from surrounding governorates including Abyan and Al Hodeidah. Consequently, it is continuously filled to capacity and beyond with malnourished children and their caregivers.

“We treat children for a number of critical medical complications caused by severe acute malnutrition [SAM] – requiring that we also operate as a pediatric intensive care unit - so we need skilled staff and adequate equipment," Dr. Athmar explained.

WHO and the King Salman Humanitarian Aid and Relief Centre (KSrelief) are the main supporters of the Al-Sadaqa TFC, Dr Athmar said, adding: “We need this support to continue so we can carry on with preventing the deaths of potentially thousands of children.”

WHO in partnership with KSrelief has been providing emergency therapeutic feeding and medical care to about 18 000 infants and children under age five, at eight TFCs in tertiary teaching hospitals located across eight governorates of Yemen. Parents and caregivers arriving to the TFCs are also educated about what they can do to prevent malnutrition, even while lacking many basic necessities. This involves educating them about essential, healthy and affordable food items, to mitigate the recurrence of malnutrition linked to limited nutritional knowledge, living conditions and other contributing factors.

Despite substantial progress being made in the ongoing fight against hunger in Yemen, much remains to be done to loosen its lethal grip on countless families, children and infants.

For more information

Abdel Moneim, Adham Rashad Ismail | WHO Representative for Yemen | ismaila@who.int