Yemen’s civil war returns and overwhelms hospitals with 'a very dangerous situation'

ADEN, Yemen (AP) — Tarek al-Salami, aged 7, sat in a diaper, looking frail. Normally, the malnutrition and diarrhea that weakened his tiny frame would have been treated within a few days, but nothing is normal in Yemen anymore.

Tarek's father carried him on foot from the southwestern city of Mokha as Iran-backed rebels swept in this month, bringing a return to civil war. The boy reached a hospital two days later in the government-held city of Aden, 270 kilometers (170 miles) away but it said it had no beds. Like others, it was overwhelmed by the wounded. They finally found a therapeutic feeding center.

The boy arrived in “acute crisis” after the delay in care, according to the center's director, Dr. Arwa Atef, and he only began walking again on Wednesday, over a week later.

“I swear to God, when I look at him, my heart breaks,” said his father, Mohammed al-Salami. “He looks almost lifeless.”

This is how the already fragile health system in the Arab world’s poorest nation is collapsing, caught in a new front of the Iran war . The Associated Press spoke with patients, medical workers and aid groups in Yemen and outside as medicines run short and some workers flee. A few facilities have been overtaken by the fighting.

Some health centers are turning pregnant women and others in need away to focus on trauma patients. Vulnerable children are filling incubators and sharing beds. Millions of people are affected by the fighting backed by two of the Middle East’s biggest powers as Iran-backed Houthis advance against government forces supported by Saudi Arabia. Over 130,000 have fled their homes.

The feeding center where Tarek and other children are recovering is struggling to cope with a rise in patients in a country where many already were hungry, Atef said.

“We can’t keep up with the situation,” she said.

Most hospitals and primary health centers affected by the escalation in fighting closed for the first 48 hours before resuming services, the United Nations said. But some are now harder to reach. The Houthis have seized the Red Sea coast, including key ports for aid.

Less than 10% of the affected health centers are fully equipped with the trauma services that wounded people need, the World Health Organization has said. With resources thin, a painful triage is underway.

Fewer facilities are handling the pregnancy-related emergencies that were killing three Yemeni women every day even before the escalation, said Francesco Galtieri with the United Nations Population Fund. That's one of the highest rates in the Arab world.

"Around 2,000 pregnant women are on the move,” with over 200 expected to deliver in the next week or so, he said.

Maternity wards have been converted into emergency rooms in some hospitals close to the fighting, said Hashem Osseiran, an International Committee of the Red Cross spokesperson, adding that many lack enough anesthesia drugs, oxygen supplies and sterile surgical gloves.

At a hospital treating mothers and children in the government-held city of Marib, Dr. Ahmed Modhesh said they are seeing more emergency maternity cases as other city hospitals focus on the wounded.

But his facility, Martyr Mohamed Hayel hospital, lacks intensive care specialists and doesn’t have enough generators to keep all departments running if the power goes out.

A midwife said the number of childbirths the hospital is handling has basically doubled to about 80. One woman with an ectopic pregnancy arrived bleeding heavily, yet the under-resourced staff were still able to perform an emergency procedure to save her life, the midwife said. She spoke on condition of anonymity because she wasn’t authorized to speak with the media.

Even before the escalation, hospitals in Yemen relied on limited government support and citizen donations. Some were not able to fully pay staff.

Now, “we are in a very dangerous situation,” said Fahd al-Nazari, manager of the health office in Taiz province, which has received most of the newly displaced. “Within a day or two, or a week at most, we might have to close down (some facilities). In fact, some hospitals are already closed.”

Three of the province’s 17 hospitals are no longer under government control. Hospitals across Taiz had received around 635 casualties, including 112 bodies, as of Thursday after the Houthis captured Mokha, al-Nazari said. They included civilians and combatants.

“We’re exhausted receiving wounded people under these circumstances,” al-Nazari said.

Medical supplies and fuel are running short after key supply routes between Mokha and Taiz were largely cut off, forcing convoys onto mountainous roads unsuitable for large trucks. Even before the escalation, public hospitals in the province had just one MRI machine available.

At the Yemeni-Swedish Maternity and Children's Hospital in Taiz, incubators were full and two or three children were sharing beds in the emergency room, general manager Sami al-Sharabi said.

“I’m scared that the conflict would reach the hospital,” he said. “Any explosive that could hit us would destroy the hospital, as some parts of the building are already weak.”

Even hospitals in Aden, where Yemen’s government is based, struggle to cope. Doctors Without Borders said more than 60 wounded people had been admitted to Al-Gamhouria hospital in a week. Many needed urgent surgery or blood transfusions.

At a private hospital treating rebels in the Houthi-held city of Sanaa, two medical officials last week said it was overwhelmed with hundreds of wounded. The officials spoke on condition of anonymity because of security concerns.

It was not clear how many Houthi fighters have been killed or wounded overall. Few aid agencies operate in rebel-controlled areas, as the group has detained and harassed dozens of humanitarian workers. Experts say the Houthis have struggled to pay salaries to civil servants, including public sector doctors and diverted most tax revenues to their military wing.

The ICRC, one of the few global agencies still able to operate in Sanaa, last week said it delivered 22 tons of badly needed medical supplies to support “overwhelmed” hospitals.

There is also little information about casualties among government forces, though one government-allied group has said over 1,500 of its fighters were wounded.

Some medical workers have fled the conflict, making it harder to find care.

In Mokha, Doctors Without Borders said its small team was still working “despite the severe shortage of health professionals.” The charity’s deputy coordinator of operations in Yemen, Emmanuel Massart, said three other hospitals there had closed for days before resuming services.

The need for hospital funding and resources in Yemen remains urgent, Massart said, speaking to the AP from Brussels, even as he acknowledged that resupplying remains a major challenge because of closed roads.

“We should not forget about Yemen," he said. It “remains one of the worst humanitarian crises in the world.”

Khaled reported from Cairo and Anna from Jerusalem. Associated Press writers Abdulnasser Alseddik in Aden and Toqa Ezzidin in Cairo contributed to this report.