Across the world, the Covid-19 pandemic has tested the ability of governments to react to rapidly changing circumstances and devise social and economic countermeasures that would have been politically unthinkable in ‘normal’ circumstances. Effective and coordinated governance is essential if governments are to adapt successfully to the need for far greater state intervention and regulatory involvement in the short- and perhaps the medium-term as well. From both a public health and a wider economic perspective, Covid-19 is a test of the resilience of states and societies on a level never seen before in peacetime.
For Yemen, which reported its first coronavirus case on April 10, pandemic response measures are complicated by the impact of more than five years of war and displacement, a lack of a functioning or unified central authority, and a health system heavily reliant on international aid and donor support. While the number of cases officially remains low, with only 67 reported cases and eleven deaths as of May 13, the figure represented a tenfold increase from the seven cases on May 2, and is almost certainly far higher. Moreover, the fact that cases have now been recorded in at least eight of Yemen’s 21 governorates, from Taiz on the Red Sea coast to al-Mahra along the border with Oman, suggests that widespread and undetected transmission may be occurring throughout the country.
Coronavirus Spreads Amidst War and Famine
Responses to Covid-19 in Yemen face numerous challenges from the fact that the country has been divided since 2014 between an internationally-recognized government, with a temporary capital in the southern city of Aden, and the Houthi movement in control of the capital, Sana’a, and much of northern Yemen. To complicate matters further, on April 26 the Southern Transitional Council (STC) declared it would establish self-rule in areas under its control in southern Yemen, as strains between the STC and the internationally-recognized government escalated into armed clashes. Moreover, a ceasefire declared unilaterally by the Saudi-led coalition on April 9 and extended on April 24 for a month, was neither recognized by the Houthis nor successful in stopping the fighting on Yemen’s multiple battlefronts.
The impact of years of conflict meant that Yemen was already the world’s worst humanitarian crisis before the pandemic struck. Figures for 2019 published by the United Nations High Commissioner for Refugees (UNHCR) indicated that 80 percent of the population required assistance, including 20 million who were food insecure and 14 million who were classified as in need of urgent humanitarian intervention. These numbers have likely increased further in 2020, together with the more than four million people internally displaced within Yemen and the 276,000 refugees and asylum-seekers in the country. Yemen has also been hit hard by a cholera epidemic that has affected more than two million people since 2016, while other diseases, such as malaria, diphtheria, and dengue fever have added to the strain on health facilities.
The Yemeni government has established a high-level committee in Aden to coordinate the response to Covid-19 and has worked on a national governmental preparedness plan. However, the three-way split between the Aden government, the Houthis, and the STC has hampered efforts to align policies in practice, especially as fighting has continued despite the unilateral Saudi-led ceasefire. There is concern that health officials in Houthi-held Sana’a have been slow to share information with the World Health Organization (WHO), and on May 10 the WHO temporarily restricted the activities of its staff in Houthi-held territory in northern Yemen. Already the rival leaderships in Aden and Sana’a have exchanged a war of words accusing each other of covering up the scale of the number of cases.
An additional challenge to pandemic response measures is the fragile state of the health infrastructure in Yemen. Health facilities and healthcare workers continue to come under attack from all parties to Yemen’s conflicts with 156 recorded attacks in 2019 alone. Only about half of all health facilities in Yemen are classified as functional or partially functional and there are shortages in laboratories and epidemiologists to detect cases of Covid-19 as well as personal protective equipment to shield healthcare workers. Limited testing capacity and practical difficulties in enforcing social distancing and lockdown measures mean it is likely that rapid transmission is already occurring in many areas in Yemen.
Politics and Funding Cuts May Worsen Outbreak
Above all, Covid-19 is likely to have a catastrophic impact on the people of Yemen. Years of privation, malnourishment, lack of sanitation and access to clean drinking water has resulted in compromised immune systems that put millions of people into the higher risk category. Cases could quickly overwhelm the existing healthcare infrastructure with only 154 intensive care unit (ICU) ventilators and 520 ICU beds currently available across the country. Moreover, torrential rains and widespread flooding in April and May has led also to a spike in cholera cases, adding to the competing demands on overstretched and chronically underfunded medical facilities.
The UN’s Humanitarian Coordinator for Yemen, Lise Grande, has warned that the impact of Covid-19 will be “terrifying” and that there is a “race against time” to try and stop the spread of the virus before it spirals out of control. And yet, just as international humanitarian assistance is urgently needed, the work of UN agencies is being hampered, rather than facilitated, by funding gaps and widening geopolitical fissures. In late-March, as much of the world went into lockdown, the United States Agency for International Development (USAID) halted most of its funding for healthcare programs in Yemen, citing interference by the Houthis in the management and distribution of resources. The consequence of a$150 million shortfall in the WHO’s work in Yemen became evident on May 7 when the WHO reported it would have to phase out ‘top-up’ payments to the salaries of thousands of Yemeni doctors, nurses, and other healthcare workers.
Pandemic responses in Yemen therefore remain deeply vulnerable to the politicization of resources both locally and internationally. Any hopes that Covid-19 might create or expand a humanitarian ‘space’ have so far failed to materialize as the fighting and power plays have continued and, in some cases, intensified as the parties to the conflict seek to position themselves ahead of a potential endgame to the war. The prospect of a full-blown outbreak of Covid-19 in Yemen could take what is already the world’s most dire humanitarian situation to another level altogether, which is why early and rapid response measures are so badly required before it becomes too late.
Dr. Kristian Coates Ulrichsen, Fellow for the Middle East, Rice University’s Baker Institute for Public Policy.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views of Gulf International Forum.