Cholera compounds problems in Yemen

HAJA, Yemen — The Yemeni farm laborer was picking crops in a hot field when the call came. His children, all seven of them, had fallen gravely ill.

Some were vomiting, others had diarrhea, and all were listless, indicating that they had fallen victim to the latest disaster to afflict this impoverished corner of the Arabian Peninsula: one of the worst outbreaks of cholera infection in recent times.

The laborer, Abdulla Siraa, set about frantically trying to raise money to treat the children — $240, or about six times what he typically earns in a month — and raced the 30 miles home as fast as he could over roads virtually destroyed in Yemen’s civil war.

“I spent the whole journey reciting Quranic verses and praying for the survival of my children,” he said.

But when he arrived, he learned that his 4-year-old daughter, Ghadeer, had already died, after hours of calling out for him, though the rest of his children would survive.

For much of the world, cholera, a bacterial infection spread by water contaminated with feces, has been relegated to the history books. In the 19th century, it claimed tens of millions of lives across the world, mainly through dehydration and electrolyte imbalance.

That ended with modern sanitation and water systems. When it pops up now, it is usually treated easily with rehydration solutions and, if severe, with antibiotics.

But the war currently battering Yemen has damaged infrastructure and deepened poverty, allowing the disease to come roaring back. Cholera is also on the rise in the Horn of Africa because of long-simmering conflicts there. Yemen’s African neighbors, Somalia, South Sudan, Ethiopia and Kenya, have had a total of about 96,000 cholera cases since 2014, international aid groups say.

The crises in Africa, however, pale in comparison to the one in Yemen.

Since a severe outbreak began in late April, according to UNICEF, cholera has spread to 21 of the country’s 22 provinces, infecting at least 269,608 people and killing at least 1,614. That is more than the total number of cholera deaths reported to the World Health Organization worldwide in 2015.

Yemen’s conflict began when Shiite rebels known as the Houthis took over the capital, Sanaa, in 2014, later toppling the government. In response, the Sunni kingdom of Saudi Arabia and other Arab countries launched an air campaign against the rebels with support from the United States in March 2015.

The campaign has so far failed to reinstall the internationally recognized president, Abed Rabbo Mansour Hadi, but the fighting and airstrikes have killed more than 8,000 people and displaced at least 3 million, the United Nations says.

In October, the government stopped paying civil servants, prompting strikes from sanitation workers and leading to garbage pileups and septic backups. That contaminated the wells that many Yemenis rely on for water, providing the ideal environment for cholera to spread. The outbreak picked up speed in April, after dirty rainwater further polluted the wells.

Not everyone who is exposed to cholera will contract the disease. But in places like Yemen, where more than 14 million of Yemen’s 27 million people lack access to clean water and 17 million do not have enough food, people are far more vulnerable — particularly malnourished children.

“The average person lives on tea and bread,” said Jamie McGoldrick, the U.N. humanitarian coordinator for Yemen. “It’s just one meal a day. They are in a weakened state, and that is why they are getting sick.”

Making matters worse, the war has damaged 65 percent of Yemen’s medical facilities, denying more than 14 million people access to health care.

Cholera medications are supposed to be freely provided by Yemen’s two competing administrations, but both have favored their military efforts over public health, forcing many families to buy medications from private pharmacies. Acute cases also require families to buy diapers or carry their infected relatives to the toilet several times an hour.

The United Nations says it needs $2.1 billion for its work in Yemen this year, but it has received only 29 percent of that amount despite repeated pleas for donations from aid groups.

Cultural issues have also aggravated the crisis, said McGoldrick, the U.N. coordinator. Many Yemenis do not seek help immediately after they show symptoms because “they just don’t want to admit that they have cholera, because they think it makes them look dirty or poor,” he said.

Although the epidemic has hit Yemen’s poor the hardest, it has spread among other classes as well. Aziz Ramadan, a Yemeni Coast Guard officer from Hodeida, nearly lost his wife to cholera last month.

The mother of Ahmad Saif Hashid, a member of Yemen’s Parliament, died of cholera last week, he wrote on his Facebook page.

While more medicine and better treatment would help control the epidemic, Ramadan said, it will very likely continue as long as the war does.

“People will continue to get sick, and they will always be treated like cattle here,” he said. “The international community should just make people stop fighting and help our hospitals.”