Yemen

Situation Report
Emergency Response
cholera
Diarrhea treatment centre in Brum Mayf’ah District, Hadramawt. Photo: UNICEF

Cholera cases across Yemen

In the last quarter of 2023, Yemen experienced a surge in suspected cholera cases across multiple governorates. Initially, partners reported a higher proportion of suspected cases in Shabwah around mid-October 2023. Subsequently, an increased rate was confirmed in the governorates of Shabwah, Hadramawt, Aden, Abyan, Lahj, Al Maharah, Al Dhale’, Taiz, and Al Hodeidah.

Between 16 October and 31 December 2023, a total of 1,018 reported cases were associated with the outbreak, spanning 23 districts in 9 governorates of southern and eastern Yemen. Tragically, there have been six deaths reported. Children under the age of five account for nearly one-third of the cases. However, it is crucial to note that the actual figures are likely much higher due to underreporting in various areas, especially in the northern part of the country. Partners are closely monitoring other governorates, including Marib, Al Bayda, and Al Jawf.

There is some indication of gradual improvement in the situation, as December data suggests a decrease in cases. This decline is likely attributed to the colder weather. Partners are considering this temporary relief as an opportunity to bolster preparedness measures in anticipation of the upcoming rainy season, which can facilitate the spread of cholera more easily.

Cholera is not new in Yemen, as the country has experienced multiple waves of cholera outbreaks since 2016. Yemen also exhibits seasonal trends in cholera cases. Cholera is an infectious disease caused by the waterborne bacterium Vibrio cholerae. It spreads rapidly throughout a population, primarily through the consumption of contaminated water or food. The disease manifests as uncontrollable diarrhea, which, if left untreated, can lead to severe dehydration or even death.

Not a ‘migrant’ issue

Recent clusters of cholera cases have included migrants, exacerbating the already vulnerable position of this population, and subjecting them to further stigmatization. This stigmatization not only infringes upon the rights of migrants but also hampers efforts in prevention, detection, and response. Some communities have mistakenly believed that the cholera situation is solely linked to migrants, a dangerous assumption that can lead to uncontrolled transmission within host communities.

Disturbingly, there have been reports of migrants being denied access to healthcare services, which has reportedly resulted in preventable deaths. Discrimination acts as a barrier to timely diagnosis and appropriate treatment, negatively impacting the health outcomes of migrants and increasing the risk of infection spread.

Cholera knows no boundaries. Like COVID-19, cholera can affect individuals irrespective of their status. Confirmed cases have been observed in both local communities and among migrant populations.

An effective public health response must ensure that all individuals, regardless of their background, have access to medical treatment, safe water, and hygiene resources. Surveillance and case identification efforts should encompass the entire population in high-risk areas. This comprehensive approach is crucial for accurate detection and prevention of further cholera transmission.

Humanitarian cholera response

While a national-level outbreak has not been officially declared, partners have been working to intensify their response. The Health Cluster is collaborating with relevant partners, including the WASH Cluster, inter-cluster coordination mechanisms, OCHA, national and sub-national Health Cluster partners, and local authorities. WHO and Health Cluster partners are providing support to district centers by offering health screenings, services, medicines, and other medical supplies. WASH Cluster partners are focusing on improving water supply and quality by distributing chlorine powder and tablets and conducting hygiene promotion activities at water project sites.

In areas under the control of the Government of Yemen (GoY), the Ministry of Public Health and Population (MoPHP), with assistance from WHO, is conducting daily monitoring of case reports through district-level rapid response teams (RRTs). These RRTs assess districts that experience unexpected or unseasonal increases in suspected cholera cases in the southern and eastern regions of Yemen. Each RRT has been provided with personal protective equipment (PPE), purification tablets, and oral rehydration salts (ORS) by WHO.

Cholera transmission is primarily linked to poor compliance with proper handwashing practices, making risk communication and community engagement (RCCE) crucial components of the response efforts by partners. Approximately 18 WASH partners are currently working together to reach an estimated 400,000 to 450,000 individuals, mainly through hygiene promotion activities. UNICEF has established a network of 330 mobilizers to conduct RCCE activities. Additionally, the Health Education Centre of the MoPHP, supported by UNICEF, is implementing a Trainer of Trainers (ToT) program to train health educators in high-risk districts, aiming to increase cholera awareness and distribute informative materials such as posters and brochures. Community health volunteers also play an active role in promoting hygiene messages and delivering health education activities to the catchment population of supported health facilities. Simultaneously, the Health Education Centre and UNICEF are raising awareness about cholera prevention in schools and through local radio channels.

To address the readiness and scaling-up of the cholera response, WHO and the Health Cluster have developed a scenario-based, costed, multi-sectoral action plan. This plan takes into account estimates of over 9,000 additional cholera cases expected within 10 high-risk governorates, in order to cover the response throughout the rainy season, starting from April. However, partners are encountering challenges due to low contingency stocks, resource shortages (such as rapid diagnostic tests), and insufficient funding.

YHF Reserve Allocation

To address existing gaps, the Yemen Humanitarian Fund (YHF) has launched an eighth reserve allocation to combat disease outbreaks and the negative effects of flooding in several parts of Yemen. This funding is dedicated to supporting health, nutrition, and WASH (water, sanitation, and hygiene) services and aims to facilitate the expansion of assistance in underserved areas, with a specific focus on enhancing disease outbreak prevention, preparedness, detection, and response. Furthermore, it will contribute to ensuring access to safe drinking water, particularly in cholera hotspots and high-risk locations.

A total of $26 million was allocated to 18 partners implementing a total of 21 projects across 3 clusters, including $10.1 million for Health, $8.3 million for WASH and $7.6 million to the Nutrition cluster.

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