Aden: Safa Nasser and Sahar Mahyoubi
Sana’a: Aseel Sariya and Muhammad al-Hasani
Taiz: Ali Salem
While countries across the world are racing to provide their citizens with the coronavirus vaccine, the Yemeni authorities remain confused and divided. The internationally recognized Yemeni government on the one hand is trying to gradually obtain the vaccine for free, while the Houthi movement (Ansar Allah) on the other hand categorically rejects the vaccine.
Meanwhile, the country’s medical sector is not immune to violence. As our investigation team visited the Al-Thawra Hospital in Taiz on February 14, the hospital guards exchanged fire with gunmen attacking the gate. On more than one occasion in the past, hospitals and Red Cross teams have been robbed, doctors kidnapped and medication stolen.
Daraj and Raseef22 collaborated in assessing the vaccine rollout in Palestine and Yemen in light of the many challenges these two countries face. The second part of this investigative series deals with the complicated situation in war-torn Yemen.
The country’s health sector is fighting a permanent battle on multiple fronts. In addition to the many security threats, the most urgent crisis is an overall lack in material and technical capacity. It is in this context that Dr. Ghazal Al-Maqtari, Head of the Training and Rehabilitation Department at the Aden Al-Jumhuriya Teaching Hospital, told us about her brother’s experience with the coronavirus a few months ago.
“His health began to deteriorate until he lost consciousness as a result of the low oxygen level in his blood, so I had to transfer him to the Al-Amal Isolation Center in the Buraiqeh District in the west of the Aden governate,” she said. “However, at that time, it was not yet equipped to receive patients. It did not have ventilators nor specialized doctors.”
Her brother’s symptoms had surfaced suddenly and violently, yet Maqtari did not immediately take him to hospital, believing the symptoms were due to seasonal diseases.
“Due to the large number of epidemics in Yemen, people are used to using antibiotics,” she said. “Only when my brother did not respond to the treatment, I had to take him to hospital. After it was confirmed that he was infected with Coronavirus, the doctors dealt with him inappropriately and very fearfully, to the point where they initially refused to admit him. However, I was able to enter him as an emergency case and I took care of him until he recovered.”
At the height of the Covid crisis, many public and private hospitals in the city of Aden – weakened as a result of 6 years of war – refused to receive any suspected corona cases, under the pretext of a shortage of protective equipment for their staff.
According to one doctor at the Al-Jumhuriya Teaching Hospital, about 400 medical staff refused to work out of fear of infection, leaving the hospital with only 14 doctors and and some nurses.
According to the World Bank’s Emergency Crisis Response Project in Yemen, less than half of the country’s health facilities are operating at full capacity. An additional problem is that many people refuse to recognize they have the coronavirus for fear of “stigma.”
Will the Vaccine Arrive? And When?
Dr. Ali Al-Walidi, Undersecretary for Primary Health Care at the Ministry of Public Health and Population (MPHP) of the Yemen government in Aden, told our team in an exclusive interview that it has not yet been specified when the vaccine will arrive.
“We requested the vaccine to arrive in the first quarter or first half of this year,” he said. “However, we are already working with the World Health Organization (WHO) and UNICEF in terms of training, logistics and distribution.”
“Yemen is a member of the Global Alliance for Vaccines and Immunization (GAVI),” he continued. “A few months ago we started to form committees in accordance with the COVAX program. We also hold regular meetings with representatives from the WHO, UNICEF and GAVI.”
Coordinated by the WHO, GAVI and the Coalition for Epidemic Preparedness Innovations (CEPI), COVAX is a platform that supports the research, development and manufacturing of a range of COVID-19 vaccines, and negotiates their pricing. All participating countries, regardless of income levels have equal access to the vaccines once they are developed.
GAVI has promised to supply 20 percent of Yemen’s population with the vaccine. The first batch will target health professionals, the elderly and people suffering from chronic diseases. The vaccine will cover all regions of Yemen, including those under control of the Houthi movement, who according to Al-Walidi, will be communicated with through the WHO and UNICEF.
Yemen’s health ministry had also applied to the Saudi King Salman Humanitarian Aid and Relief Centre for it to finance vaccines for the remaining 50% of the population.
Yemen is set to receive 2,316,000 doses for one million inhabitants (two doses per person), according to Dr. Khaled Zain, charged by the MPHP in Aden and the WHO with supervising the import of the Covid vaccine as part of the COVAX program. The latter is reportedly ready to deliver by the end of February.
Staff will be trained, as soon as the national vaccination plan is completed, according to Zain. He also said that if the Houthi movement refuses to introduce the vaccine in areas under its control, the surplus vaccines will be used by his government the for groups following the first category of health workers, elderly and gravely ill.
As for Taiz, according to the media official in the governorate’s health office, Tayseer Al-Sama’i, there is no information yet about the type of vaccine, its source, and the timing of distribution.
The challenges in Yemen are not limited to the type and quantity of vaccine that the state will receive. Yemen’s problems go far beyond that and include many financial and political issues, as well as conspiracy theories.
Arguably the biggest problem, however, remains storage, given the country’s many power cuts. Some areas controlled by the Houthis, for example, have been witnessing a complete blackout for over four years. Since August 2020, there has also been a major crisis in oil derivatives, especially in diesel, which is needed to operate power stations and central refrigerators.
It is likely that Yemen will receive the Oxford – AstraZenica vaccine, due to the ease of storage. This vaccine needs temperatures ranging from 2 to 9 degrees and can therefore be kept in regular refrigerators. Other vaccines, such as Pfizer-Biontec and Moderna require storage between 20 and 70 degrees below zero, for which Yemen lacks the infrastructure.
As for the price, a single dose amounts to maximum $8, which constitutes a difference of up to $11 with the Pfizer vaccine. It is what Yemen in cooperation with international organizations can bear.
Given Yemen’s poor infrastructure, a number of doctors and laboratory specialists at the Jumhuriya Hospital admitted to be concerned about storage. This includes the means of shipment by which the vaccine will arrive, the cooling conditions during transportation, as well as the warehouses owned of the Ministry of Health. Although the cold chain will be covered by UNICEF, people’s doubts about safe storage have not subsided.
“Even if the vaccine is not completely corrupted, it will lose its effectiveness when exposed to the slightest change in temperature,” said Dr. Fahd Abdulaziz, an assistant lab specialist at the Jumhuriya Hospital.
More than one doctor at the hospital recalled that, a few years ago, polio vaccines proved corrupted and had to be withdrawn after the vaccination process had started.
In the Houthi-controlled areas, the authorities have so far refused to reveal the exact number of coronavirus cases. Initially, they acknowledged only four cases. Since June, no additional cases have been announced despite the positive results shown by lab tests in medical centers and hospitals.
Dr. Taha Al-Mutawakel, Minister of Public Health and Population in the Houthi Salvation Government in a press conference on May 30, 2020, attributed the reason for the group’s silence over the number of injuries to damaged tests producing false positives. According to him, announcing numbers related to corona would moreover negatively affect the immune system and psychological state of both people and society.
As the epidemic peaked during March and August 2020, deaths in Yemen reached record rates. All evidence indicates the spike was caused by the coronavirus. Yet, the authorities in Sana’a, Aden and Taiz did not announce a general lockdown. Our team visited 4 governorates, Aden, Lahj, Taiz and Sana’a, and noticed a general lack of compliance in terms of quarantine and social distancing.
As for Aden, according to Dr. Ishraq Al-Sebaei, spokesperson for the Higher National Emergency Committee (HNEC) of the internationally recognized government, the committee since the beginning of the pandemic has recorded more than 2,127 confirmed cases and 615 deaths. This included 298 infected and 37 deaths since February 7.
Taiz recorded 1,048 suspected corona cases, of which 303 confirmed by PCR tests, and 82 deaths from march 30 till October 25, 2020. In addition, 92 health workers were infected, of whom 12 died. Our team was not able to obtain data on the health status in the areas of Taiz outside Houthi control.
One thing is certain: the official figures on infection, death and recovery do not reflect the reality of the virus. Medical sources suggest it has affected a huge part of the population. Even the WHO, which takes random samples to measure the rate of infection in Yemen, doubts the official figures.
Houthis Reject the Vaccine
Najeeb Al-Qubati, spokesperson for the Ministry of Public Health and Population in Sana’a, refused to discuss whether the vaccines may become available in Houthi-controlled areas or confirm the health organizations which would be in charge of providing and distributing them. UNICEF is still trying to come to an agreement with the authorities to allow for distribution of the vaccine.
Our team contacted many sources at the ministry, as well as several health organizations in Sana’a, yet we did not receive an answer as to why the Houthis reject the vaccine.
Likewise, UNICEF, which is the world’s largest body purchasing vaccines, refused to give any interviews or provide information, although it announced on its website that, as part of COVAX, it would lead the procurement and supply of the vaccine in support of 92 low-income countries, including Yemen, in addition to providing shipping and storage services for the vaccines.
Taiz Between Two Sieges
Taiz is not much different from the other Yemeni governorates. It was the third governorate to be hit by the epidemic after Hadramout and Aden. The first infected person, who was in his forties, was reported on May 1, 2020, and died two days later in isolation at the Republican Teaching Hospital.
The epidemic has since swept Yemen’s largest governate in terms of population. Some 12.16% of the country’s population of 30 million live in Taiz, of which 59% is regarded poor.
The bitter irony is that Taiz is caught between two sieges. On the one hand, there have been the epidemics, most notably cholera and corona, and on the other hand there has been the military siege imposed by the Houthis since the spring of 2015, which has worsened patients’ suffering.
“We used to reach the Al-Thawra Hospital in 10 minutes,” said 50-year-old Muhammad who lives in the Al-Houban neighborhood, which is under control of the Houthis. “But now you need between 4 and 5 hours of arduous travel during which a patient may die before reaching the hospital.”
“We fear citizens’ rejection of the vaccine, especially as it is a new and controversial disease,” said Dr. Yassin Abdulmalik, director of the Department of Disease Control and Epidemiological Surveillance in the Taiz governorate.
According to Dr. Ilan Abdel-Haq, Undersecretary of Health Affairs in the Taiz Governorate there has been a great failure in officials dealing with the epidemic. “We sent many urgent telegrams and inquiries to the concerned authorities,” he said. “But they did not bear fruit.”
Determining the size of the Taiz portion of the vaccine and how to distribute it, is up to the WHO and UNICEF. Yemen’s task will be limited to providing medical staff. “In the event Taiz obtains limited quantities, the priority will be areas with the highest prevalence and displaced people,” Abdul-Haq said.
Virus and Vaccine as Conspiracy
“We do not want vaccines, there is no corona in Yemen, we are fine,” said 31-year-old Ahmed Al-Washali, who lives in Sanaa and refuses to get a vaccine if ever it becomes available. “It has not affected us. While other countries were imprisoned in their homes, and could not work, we lived normally and nothing happened.”
Our team met with 53 people in areas under control of the Houthi movement, most of whom hold a university degree, are employed in the public or private sector and have an average age of 27 to 35.
We found that 42 out of 53 people refuse to receive the vaccine if it were available. Because they did not need it, most said, while 17 claimed the vaccine may be a “conspiracy” posing a threat to their health. Of the 9 people willing to receive the vaccine, 7 stipulated it should be free of charge. Two people said to have never heard about a vaccine against the virus.
University student Siham Al-Rimi (27) said the virus exists, but not in the way the media depicts. She believed she and members of her family had the virus, yet were able to overcome it. She would not mind getting the vaccine if it is provided by the state or aid organizations free of charge.
According to her, Yemen suffers from “force majeure,” as the economic situation in the country prevents the majority of the population from getting the vaccine if it is not provided for free.
Some people found the lack of a complete outbreak of the epidemic a reason to reject the vaccine and denounce the integrity of the WHO. A doctor in Taiz, who requested anonymity, said he supported the Great Barrington Declaration, a statement signed by thousands of scholars in the field of medicine and public health calling for an alternative approach to the Covid pandemic based on “focused protection” of those most at risk.
Despite the low rate of illiteracy compared to other governorates, in Taiz too resistance to vaccination remained high. And here too it was not just limited to religious people, but included holders of university degrees and secular people. For 49-year-old teacher Jamil, for example, corona was “just an illusion.”
Things were not too different in Aden, as fear for the vaccine prevailed. In a poll conducted by our team among 121 residents in the city of Aden, over 84% refused to have the vaccine. The main reason was a lack of confidence in the authorities responsible for importing the vaccine and a fear for the conditions in which the vaccine would be cooled and stored. Even some health workers feared the vaccine in terms of safety and potential side effects.
While fundamentalist religious opinion does contribute to this atmosphere of fear and hesitation, there is no unified religious opinion regarding the vaccine. One sheikh, one of the main centrist imams in Yemen, said in an interview with our team that he would get the vaccine and make people aware of the importance of vaccination.
Another imam refused the vaccine, as he considered corona “a virus like any virus that affects the respiratory system.” A third described the virus as a “plague of the age”, which resulted from “sins, violations and transgressions.” He discredited the vaccine because it was “made in the West.”