Via NEJM: Disease and Famine as Weapons of War in Yemen. Bear in mind that the Saudi coalition's war on Yemen marked the rise of Mohamed bin Salman, who is now Crown Prince and unindicted instigator of the murder of Jamal Khashoggi. Excerpt:
How can the medical community take stock of the humanitarian disaster in Yemen? The 3-year-old war intermittently garners attention from Western media — for example, in August, when an air strike on a school bus killed more than 50 civilians, mostly children — but is woefully underreported relative to the magnitude of the ongoing crisis. Such neglect highlights the numbing of our collective sensitivity to atrocity.
Although the human toll of any war is dreadful, the infliction of suffering in Yemen has particularly toxic characteristics that we believe demand attention from health care providers worldwide: the destruction of health care facilities and the spread of disease and hunger as apparent means of waging war. A Mobile Phone Tower Destroyed in Sa’ada, July 2018.
Yemen was beset with widespread poverty and an ailing health care system when this conflict began. Most health indicators ranked in the bottom quartile of the world, with 1 in 25 children not surviving to the age of 5. In March 2015, after the Houthis, a faction based in the north of the country, took over Sana’a (the capital city), a coalition led by Saudi Arabia and the United Arab Emirates and supported by the United States, the United Kingdom, and France, launched air strikes in the country to overturn the Houthis.
In more than 3 years of air strikes, Yemeni hospitals and clinics have continued to be destroyed, both indiscriminately and sometimes apparently deliberately. With access to health care almost entirely eliminated owing to bombings (see photo) and blockades, infections have spread as — at best indirect and at worst direct — weapons of war.
A massive cholera outbreak is the most obvious example of the devastating impact of the war on health. It is suspected that more than 1.1 million people have had cholera, and at least 2000 people have died from it, nearly 20% of them children under 5 years old. Geospatial patterns of cases of diarrheal disease reveal alignment of the spread of cholera with patterns of aerial bombardment by the Saudi-led coalition. Civilians living in Houthi-held areas had higher cholera attack rates and higher case fatality rates between September 2016 and March 2018 than those in government-held areas.
The Saudi-led coalition — heavily supported by the United States through munitions sales, military training, and aerial refueling — has bombed both medical facilities and water-treatment centers in these areas. Within the first few months of the war, a major water-treatment plant outside Sana’a was out of operation because its electrical grid had been bombed. Subsequent restriction of fuel imports by a Saudi-led blockade caused the facility to lose all power and become inoperable, according to UNICEF.
Then the deadly grip of diarrheal disease took hold. Shockingly, water-treatment plants and sewage systems continue to be bombed. UNICEF reports that between March and July 2018, water-treatment facilities in the Sa’ada governorate were repeatedly attacked, which left much of the nearby civilian population without safe drinking water and caused thousands of dollars of damages to water-treatment projects.
Direct bombardment of medical facilities has triggered the spread of disease and put health care personnel and relief workers in danger since the start of the war. Médecins sans Frontières (MSF) reported that 39 hospitals were bombed during the first 7 months of the conflict despite the fact that they were clearly marked as medical centers and their GPS coordinates had been shared with Saudi authorities. Both MSF and Physicians for Human Rights have reported that assaults on hospitals, mobile clinics, ambulances, and cholera treatment centers continue to occur.
