Waiting for cancer care in a parking lot
Yemen’s health system is near collapse: people with chronic diseases have nowhere to turn.
Mohammad Atef waits impatiently, sheltering in a parking lot outside the Al-Jumhoria Hospital in Yemen’s capital city, Sana’a. He is with his wife, who has cancer, and their two children. Mohammad’s wife desperately needs chemotherapy, and her only hope is a few steps away from her in the hospital. But their tiring journey from their home in Sa’ada, 200 km away, just ended in the hospital parking lot: Al-Jumhoria has no beds available.
Mohammad’s children, who are too young to understand much of what is happening, sit on the concrete eating bread for lunch, their mother asleep on a blanket beside them. “This hospital is the only hope for cancer patients, and we are waiting for a bed to become available,” said Mohammad. “Until then, we have no other choice but to stay here.”
Yemen has experienced brutal conflict since fighting escalated in March 2015. As of 16 October, health facilities had reported 32,307 injuries and deaths — an average of 153 injuries or deaths every day. Responding to the large number of inpatient requests, Al-Jumhoria Hospital’s administration has converted offices into patient wards. But the unprecedented caseload is overwhelming.
“Despite all of our efforts to scale up the institute to its maximum capacity, there is a never-ending flow of patients reaching us from all over the country,” said Dr. Nasr Al-Qadasi, General Manager of Al-Jumhoria Hospital, the city’s second-biggest medical facility. “We are stretched to exhaustion due to the on-going crisis. Unfortunately, we have to prioritize the treatment of patients according to the critical level of their illness.”
Some families waiting for hospital beds can rent hotel rooms or houses in the capital, but Mohammad and his family have no place to stay. The sharp increase in casualties and disease outbreaks has left the hospital unable to support the treatment of chronic diseases, such as cancer, diabetes, HIV and renal dialysis.
Lack of fuel, equipment and staff
The health circumstances faced by Mohammad’s wife are not unusual in Yemen, where over 14 million people need health-care services from an already fragile health-care system. Every day, many patients from all around Yemen seek treatment at the Al-Jumhoria Hospital. Many health facilities elsewhere are no longer functioning, as the conflict has stripped them of fuel, supplies and personnel. The World Health Organization estimates that more than 600 health facilities out of about 4,000 have stopped functioning. Al-Jumhoria Hospital has lost 40 foreign doctors since March due to insecurity.
The conflict has critically affected imports, meaning few medicines are entering the country. Yemen does not produce its own pharmaceuticals. “We cannot source medicine to treat cancer or burn wounds, including anti-retroviral medication to treat HIV/AIDS,” said Dr. Al-Qadasi.
Scarce electricity means health facilities rely on back-up generators to keep functioning, but hospitals are also short of cash. “We have been running our generators 24 hours a day since the onset of the conflict, we need much more fuel than before, yet the price of fuel has doubled compared to pre-conflict levels,” added the doctor.
Even when medical equipment is available, the hospital administration cannot mobilize the necessary technical expertise to install or maintain it. Al-Jumhoria Hospital has a scanner to determine the type and degree of cancers, but the technical expert was unable to travel to Yemen to install it. The old scanner no longer works, leaving the hospital with no diagnostic capacity.
Dialysis treatment cut back
The almost collapsed health system is leaving thousands of patients with inadequate care. Ali Ibrahim, 47, from Al-Hudaydah, suffers from renal failure and requires three dialysis sessions per week. But he has received this only once a week, as the Al-Hudaydah dialysis centre is often overcrowded. It operates on five shifts a day, has 29 dialysis machines and provides services to 250 patients per day. But this is not enough to meet demand. As the only specialized renal centre in the whole governorate, it currently receives patients from neighbouring governorates, such as Al-Mahwet and Raymah.
“Sometimes the centre stops operating due to fuel shortages, while drinking water and medical supplies are urgently needed,” said another patient, Mohammed Ahamad, while waiting for his treatment.
More support needed
International organizations are providing medicine and supplies to many hospitals, paying incentives to health workers and supporting the Ministry of Health. The Health cluster, along with its international and national partners, reached more than 6.2 million people throughout the country between March and October 2015, providing basic health care, mass casualty management, immunizations, reproductive health services, medical supplies and fuel.
“Without the support of international organizations, we would not be able to continue functioning,” said Dr. Al-Qadasi. But the health system urgently requires more support. Humanitarian partners estimate that 14.1 million people lack sufficient access to health care in Yemen, including 3 million malnourished children and pregnant or lactating women.
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