Life and death in a Yemeni hospital
By SUDARSAN RAGHAVAN | The Washington Post | Published: December 30, 2016
HAJJAH, Yemen — The infant was barely breathing when his uncle brought him to the hospital in a cardboard box. He was wrapped in a blue towel, and wads of cotton were stuffed around his frail body to keep him warm.
Muhammad Haithem was just hours old, born two months premature.
His mother had gone into labor when an airstrike by a Saudi-led coalition hit near their home in the town of Abs. The hospital there was destroyed by an airstrike in August. So the baby's uncle put him in a pickup truck and drove three hours to the nearest government hospital, recalled Ahlia Ashumali, a nurse who received the baby.
A week later, Muhammad was still teetering between life and death. He weighed four pounds and was being fed through tubes.
Surviving even birth is a struggle in Yemen. After nearly two years of war, thousands of children and adults have died from easily treatable diseases, illnesses and injuries as the health-care system collapses.
The situation is deteriorating quickly. Vital drugs, vaccines and medical equipment often cannot enter the country because of an air, sea and land blockade imposed by the coalition. Because of a banking crisis, traders cannot afford to import wheat and other staple foods, triggering alarms that hunger and illness could soon worsen. Government medical workers have not been paid in four months.
The human fallout is visible at Al-Jamhuri Hospital, a large government facility built in 1950 that is tucked behind high walls in this northwestern city. Like every hospital in the country, it has been under heavy stress. Last year, an airstrike hit about 100 yards from its green front gate, killing 18 people and wounding 120.
That stress went into overdrive in August when coalition warplanes destroyed the Abs hospital, killing 19 people. It was the latest in a series of assaults on medical facilities that human rights activists say are war crimes. Doctors Without Borders, the medical charity that ran the facility, pulled out its international staff from six hospitals in northwestern Yemen.
Overnight, Al-Jamhuri became the only government hospital for the province and nearby areas, where 2 million people live.
The coalition of Persian Gulf nations, supplied with weapons, intelligence and other support from the United States, frequently bombs this front-line region bordering Saudi Arabia. The coalition seeks to defeat rebels known as Houthis and restore an internationally recognized government to power.
At least 274 health facilities have been damaged or destroyed in the war, and 12 health-care workers have been killed, according to the United Nations. More than 14 million people, half of them children, lack access to basic health care.
"We are feeling the pressure from so many directions," said Mohamed As Sowmaliye, the director at the Al-Jamhuri Hospital, who narrowly escaped an airstrike outside the city a day earlier as he traveled to the capital, Sanaa, to seek more support for the hospital.
Across the courtyard from his office, a giant CT scanner sits in a small room. It is the only such machine in the province, and it has not worked since August. Many patients with head and other serious injuries must be transported to Sanaa. It is a six-hour journey, and the hospital's aging ambulances are not equipped with proper ventilation systems.
Since August, three patients have died minutes before reaching Sanaa, Sowmaliye said.
The hospital has 160 beds but receives as many as 500 patients a day. Some are treated in beds in the hallways.
But they are the fortunate ones: They have somehow found the means to come to the hospital.
"The others - we don't see them," said Colette Gadenne, the Yemen head of mission for Doctors Without Borders. "They die very far from our eyes."
The hospital has just one defibrillator. Ventilation machines and other vital equipment are broken down, including some of the incubators in the maternity war.
There is only one machine to sterilize surgical instruments in the entire hospital, and it does not work properly. The blood transfusion device needs repair. There are severe electricity blackouts, so the hospital operates most of the time on generators. Its biggest operating cost is fuel.
Spare parts from abroad are often delayed at ports for months at a time because of the blockade and bureaucratic inefficiency by the Houthis. But the hospital can no longer afford the items anyway.
Eighty percent of the regional government's revenue came from customs duties at the Saudi border, which is now closed. The banking and liquidity crisis has brought more obstacles.
"The problem we are facing now is we don't have cash," said Abdul Malik Jahaf, the deputy governor. "We are incapable of providing even the simplest service here with the means we have."
Today, the hospital depends largely on meager fees from patients and assistance from international aid agencies. It owes $55,000 to the water department.
Al-Jamhuri is actually considered one of the better functioning hospitals in the country. Doctors Without Borders runs its emergency room, and the World Health Organization provides fuel and other support. "Without international assistance," Sowmaliye said, "the hospital would have closed down."
It nearly did. After the airstrike near the hospital last year, most medical specialists left. Today, there is no radiologist and no urologist. There is no mental health specialist to treat the psychological traumas of the war. An orthopedic doctor quit this month.
In the emergency room, Ibhrahim Abdelabi, 30, was nearly comatose. He was suffering from hepatitis B, and the price of his medicine had soared 50 percent because of the war. So Abdelabi did not come to the hospital until he started vomiting blood, his cousin said, standing nearby.
Now, he needed an operation to keep him alive, but there was neither a specialist nor the equipment.
"It is a hopeless case," said Taha Faqeh, a doctor who examined him.
That evening, Abdelabi was placed in an ambulance to be taken to Sanaa with a prayer he could have the surgery there.
Scores of pregnant women have miscarried this year, unable to reach the hospital in time. Some bled to death along the way.
Nearly 600,000 pregnant women in Yemen today are living in areas without adequate or nonexistent health-care facilities, according to U.N. data.
Airstrikes force many to wait until the last minute to make the long and expensive journey to the hospital.
"Sometimes women arrive at the gate and deliver the baby before they enter the ward," said Wajidah Al-Gudemi, the director of the maternity department.
The hospital has just one full-time obstetrician. Samar al-Mudwahi is 27 and has been practicing for two years. An airstrike destroyed her family's home in the city of Ibb last year.
Assisted by midwives, Mudwahi said she performs an average of 30 Caesarean sections and 15 abortions a month, most for reasons related to the war.
On this morning, Mudwahi had just delivered a baby girl named Dina. She weighed 4.4 pounds and was placed in an incubator near Muhammad.
Her mother, Rugiah Ahmed, had spent five hours in a 1987 Land Cruiser on a bumpy road to reach the hospital. Last year, she miscarried after an airstrike struck close to her home, and this time, her blood pressure was high when she arrived, threatening her unborn child. It is a condition doctors attribute to the stress of living under relentless airstrikes and shelling.
"Sometimes the baby dies, sometimes the mother dies," Mudwahi said matter-of-factly, adding that in recent weeks three pregnant women had bled to death.
In the kidney dialysis unit, only five of the 12 machines are working. With 360 patients needing dialysis each month, the machines run round-the-clock.
"All the cases are chronic," said Sultan Masood, the nursing supervisor. "If these machines stop, it will be like a mass death."
Every Saturday and Thursday, Yahya Saleh struggles to find $20 to cover the four-hour trip for his treatment. His life revolves around it. He used to work at construction sites, but no one is building anything these days. His relatives and neighbors donate money when they can. Mostly, though, he begs on the streets.
"Sometimes I don't eat in order to have money to come here," Saleh said, his arm hooked up to a machine.
When Masood sees that a patient missed the appointment, he calls to find out why. There are usually two reasons: The road has been cut by airstrikes, or they can't afford to come anymore.
"They end up dying in their homes," he said.
Between August and October, 16 of his patients died.
Recently, Tarik Nasser felt dizzy. Then the fever and headaches came, followed by vomiting. Before the war, doctors might have been surprised by his ailment - but they had seen four other cases in the past month.
Nasser, 21, had dengue fever, a mosquito-borne disease.
The hospital is also seeing more cases of measles, malaria and skin diseases, mostly affecting the more than 3 million people displaced by the war.
Many live in tents or in the open, with limited access to clean water. Western and local aid agencies regularly visited remote areas to spray pesticides and provide other assistance to prevent such diseases in the past.
"But with the war, all this stopped," said Mansour Al-Hajaji, a hospital official.
Now, cholera is a growing concern. Once nearly eradicated, U.N. workers have so far recorded 122 confirmed cases, with 10 confirmed deaths and 72 suspected deaths. In mid-November, the hospital opened up a cholera treatment center, with funds from the WHO. It has received 200 suspected cases of cholera.
The staff is also seeing more injuries from motorcycle accidents. With soaring fuel prices, a growing number of people use motorcycles for transport. There are also more displaced people arriving with bites from street dogs. But the hospital cannot treat them. Doctors Without Borders used to provide rabies vaccines, but that stopped because of the blockade.
On any given day, it seemed, life could easily give way to death in the hospital.
So it made sense that the nurses in the incubator room considered Muhammad somewhat of a miracle for remaining alive.
Days before he was brought in, another premature infant arrived in the arms of her father. She was wrapped in a pink blanket, recalled Ashumali, the nurse. When she unwrapped the infant, she saw specks of blood on her nose and mouth. She touched her. And she understood.
"She was cold and blue," Ashumali said.