Yemen: Misery Under Fire

The refugee crisis sweeping Europe has drawn world attention back to its origins in the Syrian conflict, which is already in its fifth year. However, to the south of Syria, on the other side of the Arabian Peninsula, another humanitarian catastrophe created by brutal war is unfolding but  even more neglected.

In Yemen, the fighting that erupted at the end of March between a range of armed belligerants displaced more than one million people and injured or killed tens of thousands. People have not been able to get medical care as most health facilities have been destroyed, shut down or  run out of medicine. Ongoing airstrikes and roadblocks made the situation even worse. MSF teams are working in eight governorates in Yemen and have treated more than 10,000 war wounded as of August 2015. We have seen the disproportionate price civilians are paying in this conflict.

Nowhere to hide from the fear of airstrikes

Christine Buersser, MSF's field coordinator in Yemen, felt the threat of airstrikes on the day she arrived in Qataba, the southwestern part of the country. Each time a bomb hit near the hospital where she lived and worked, she could feel the ground shake. “During the strikes, the women and children huddled together in the hospital corridor, some of them crying. Other patients left the hospital when the bombing started, either to check on family members, or because they were afraid the hospital would become the next target. ” The team has been receiving seriously injured patients day and night. They were also working hard to reinforce the hospital building with sandbags and bring in more medical supplies.

"I had never heard such explosions in my life,” said a nurse working in the MSF hospital. “Now I start shivering and trembling even when I hear a gunshot or any sound of explosions.”

26-year-old Jasmin Mohammed Ali, a primary school teacher, said the school was affected by the airstrikes as it is close to the central security office. The explosions terrified her and the children. Since the conflict erupted, Jasmin and her sister have been thinking of leaving the town but they have 26 family members living in one house, “We don't know where to go.” 

The hardships of life without essentials

It is tough to make a living as petrol, medicine, water and food is in short supply during the conflict. MSF teams have witnessed pregnant women and children dying after arriving too late at the health centre because of petrol shortages or roadblocks.

Dr. Ali Dahi, who works for MSF, said, “There are severe shortages of fuel and electricity, which also means a shortage of water, as it cannot be pumped.... we need to get more supplies in.” The main water facility for the town where Jasmin lived stopped working due to fuel issue. She had to walk to another well and this trip usually takes three to four hours on foot. Unfortunately, this borehole wasn't working either because of the fuel problem.  

Food shortages are also a grim reality for people in Yemen. In the main city, Aden, the price of flour has increased by 70% in some areas and meat is all but non-existent.  Data collected by MSF in two other areas show that 15% of children are undernourished.

Civilians in Yemen are now trapped in double suffering, as continuous fighting brings heavy casualties and the shortage of supplies makes life nearly impossible. MSF has been urging warring parties to stop the indiscriminate bombing and the targeting of civilians, and to ensure humanitarian assistance can reach people in need across the country.

Doctors under stress

Dr. Natalie Roberts from the United Kingdom worked in an emergency room of a health centre that MSF has been supporting in north Yemen. Since the conflict started she and her colleague have been seeing 40-50 wounded patients a week. ”Usually every time I come here there is blood all over the floor and there are injured patients lying on all the beds.” The team is often trying to manage a “mass casualty event” of four, five, six or even seven wounded patients all arriving at once. After a busy day, she was still wide awake lying on the bed with the mosquitoes buzzing around and the sound of anti-aircraft fire.

Dr. Karina Marie Aguilar, an anaesthetist from the Philippines, had been deployed to Yemen four times by the MSF-Hong Kong office, but this fifth assignment in Yemen was the worst year she had seen. MSF runs a 50-bed capacity Emergency Surgical Unit in Aden but since the conflict in March, the facilities have been overstretched and the number of patients at any given time ballooned to more than a hundred. 

“The influx of patients forced us to double the capacity of the hospital with some patients recuperating on mattresses in our meeting room and one physiotherapy room was hastily converted into the inpatient ward,” she said.

“Yemenis need OUR help,” Dr. Aguilar stressed, “They live day by day without food, fuel, electricity and water. The medical needs of the civilians and the fact that ours is the only hospital fully functioning in Aden during the war kept my team going. ”

Afghanistan: MSF’s trauma hospital bombed in Kunduz

The hospital was the only facility of its kind in northeastern Afghanistan. On the early morning of 3 October, it was hit by a series of aerial bombing raids, killing at least 12 MSF staff and 10 patients. MSF is calling for an independent investigation by the International Humanitarian Fact-Funding Commission (IHFFC) into the brutal attack, to establish the truth and reassert the protected status of hospitals in conflicts. 

Jordan: new hospital for war victims

To treat even more patients, MSF opened a newly upgraded reconstructive surgery hospital in Amman in early September. It serves war wounded patients, mainly from Syria, Iraq, Yemen and Gaza who otherwise have no access to specialized surgical care, including orthopaedic, maxillofacial and plastic reconstructive surgery.

Syria: Half a million more people under siege

13 makeshift hospitals supported by MSF experienced a series of extreme mass-casualty influxes resulting from 20 consecutive days of intense bombing attacks in August in the besieged communities of East Ghouta, near Damascus. The sieges around Damascus have also tightened and expanded to three new areas where at least 600,000 people live. It has become increasingly difficult for MSF to get medical supplies through the siege lines.

Nigeria: fighting against cholera in Borno State

In September, cholera spread in the displaced persons camps in state capital Maiduguri sheltering over 1.6 million people, mostly displaced by the conflict between Nigerian army and Boko Haram. In response, MSF ran a treatment centre with 100-bed capacity and improved hygiene and sanitation in the camps.

Every year, tens of thousands of people fleeing violence, insecurity and persecution at home attempt a treacherous journey via North Africa and across the Mediterranean to reach Europe. More than 2,500 people have been lost on these journeys in 2015. 

They came from all different places: Syria, Eritrea, Afghanistan, Iraq, Nigeria, Somalia, Sudan, Gambia and as far away as Bangladesh. After overcoming the terrifying waves on the Mediterranean Sea, they reached Europe via Greece, Italy, Spain and Malta.

As of September 2015, MSF is operating land-based projects in five countries along migration routes and on search-and-rescue ships on the Mediterranean Sea. The teams are providing basic healthcare and mental health support, and distributing relief items to people in need.

Take a look at MSF’s sea operations 

MSF worked on three search-and-rescue boats on the Mediterranean Sea – MY Phoenix, Bourbon Argos and Dignity I. As of early September 2015, the three boats have assisted a total of 14,533 people. The operation on MY Phoenix came to an end in late September, but MSF’s work continues on the other two boats.

Vaccination protects children from different infectious diseases. But every year, a million children still die of pneumococcal disease which can be prevented by vaccination. One of the reasons is that many developing countries cannot afford this new high-priced pneumococcal vaccine. So, how expensive is it really?

Vaccine prices have surged in the past decade or so. In the poorest countries, the price to fully vaccinate a child is now a colossal 68 times what it was in 2001. Over the next five years, the richer donor countries will need to pay US$7.5 billion dollars more to sponsor the purchase of vaccines for poor countries via Global Alliance for Vaccines and Immunization (GAVI)*, with over one third of that paying just for the costly pneumococcal vaccine. 

Since GlaxoSmithKline (GSK) and Pfizer are the only two pneumonia vaccine producers, the oligopoly has enabled them to earn billions in sales in developed countries while they are still reaping profits from the poorest countries. As they are selling the vaccine to GAVI-eligible countries at US$10 per child, which is already unaffordable to many buyers, GAVI is offering them an additional subsidy for their research, meaning that GAVI is paying up to US$21 per child for the vaccine. MSF has been asking GSK and Pfizer to slash the price of the vaccine to US$5 per child - but in vain.

In addition, with limited pricing data, pharmaceutical companies can charge wildly different prices in different markets for the same product, making it difficult for governments to compare prices and negotiate for better deals. The data available shows that the pricing today has no clear rationale, with Morocco paying US$63.7 and Tunisia paying US$67.3 per dose, higher than France which pays US$58.4.

We urge the international community to join us in exerting pressure on pharmaceutical companies, asking them to make prices more transparent and affordable for developing countries.

*Global Alliance for Vaccines and Immunization (GAVI) is a global health partnership of public and private sector organizations dedicated to “immunisation for all”.

Stories about children in the Borderline normally come from faraway places and feature kids that have the misfortune to need MSF medical care. But the ones we’re going to talk about here are much closer to home and yet they are still touched by the humanitarian spirit. They are the beginning of a chain of understanding and sympathy that connects all who work in and support MSF. The MSF office in Hong Kong has been trying to find new ways of involving children and their parents to create that awareness of the wider world. Here are just two examples of how that can work.

Waste not, want not

Public information campaigns about how to avoid wasting food are getting more insistent in Hong Kong. So when a little girl in a nursery class suddenly got very enthusiastic about cleaning her plate at lunch, you might suppose that she had got the message from those TV ads. But no. She had made the connection with a different issue and come to the same practical conclusion.

Her ELCHK Grace Nursery School took part in “MSF Day 2015” and helped to recruit students to become MSF Day Student Ambassadors. The school then had a follow up talk about one of the MSF medical topics that is not too technical or difficult to get across: the malnutrition treatment programmes.

Not long afterwards, the form teacher noticed the very determined cleaning of the plate. And then she heard a very clear explanation, a link in that chain of sympathy. “Yes! There are many children who don’t have food to eat!”

No Gift, No Toy

“Self-initiated fundraising” sounds like a rather burdensome way of making a contribution, which could otherwise be done by slipping a cheque in an envelope. But the whole point of the process is to maximize the involvement of the person who wants to give and to multiply their generosity outwards to their family and friends. In this case, through a birthday party for five year old twins, Gerard and Bernard. The guests didn’t bring presents, they brought donations to MSF.

The boys’ mother, Michelle, had prepared the ground with her sons of course. “We watched MSF’s field work videos and website together beforehand. They asked ‘Why do these children have no food? How come their hospital is in a tent and it’s different from that in Hong Kong?’ After hearing our explanation, they were willing to sacrifice their gifts to help others.”

The difference for Michelle was that, unlike her previous, more traditional ways of giving to charities, the birthday party got her totally involved in the cause and the mechanisms. “Through this event all the fifty families at the party learnt about this self-initiated fundraising channel. We not only gathered their support but also got an opportunity to educate the kids.”

If you are interested in organising fundraising events to support MSF, please download the Application Form and return the completed form to MSF Hong Kong office. You can also set up “Online fundraising page” on our website.