By Nima Elbagir, Angela Dewan, Nada Bashir, Barbara Arvanitidis and Yousef Mawry, Bioreports
Graphics by Henrik Pettersson and illustration by Gabrielle Smith, Bioreports
Updated 0825 GMT (1625 HKT) September 15, 2020
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Abs, Yemen — The doctors and nurses at the malnutrition ward in Abs Hospital are used to scrambling — there is rarely enough time in the day to see the number of emaciated children that come in. But things have never been quite this bad.
In the past few months, the power has dropped out daily and high fuel prices mean they can’t always keep their generators going. When that happens, their monitors and ventilators switch off. Children who could have been saved, die.
“Those who aren’t killed by the airstrikes or this war? They will die from shortages in medical supplies,” Dr. Ali Al Ashwal tells Bioreports at the hospital in Hajjah, northwest of the capital, Sanaa.
In March, the Trump administration and the US’ key regional allies, Saudi Arabia and the United Arab Emirates, slashed their funding to the United Nations’ appeal for Yemen. The funding cuts mean reduced health care services for Yemeni civilians, with some forced to close. They have also forced aid agencies to stretch food assistance thin.
This state of affairs is evident at Abs Hospital. In the first half of the year, it received nearly 700 patients suffering from malnutrition. In August, the case load was double the average monthly total, according to hospital staff.
“Our clinic usually takes between 100 and 150 cases in a month, and in one month we have received approximately double the amount. While at the same time, medical supplies have decreased,” Dr. Al Ashwal said.
“The hardest part is when we lose a child when there could have been a chance for them to survive — if the situation was different.”
In 2019, the US contributed almost $1 billion to the UN appeal, but this year, it has donated less than half that so far, giving $411 million, UN data shows.
Those cuts have largely impacted areas in the north controlled by the Iran-backed Ansarullah — known as Houthi rebels — whom the US and several other donor nations accuse of interfering in humanitarian operations.
Despite the US’ sizeable cut in funding, it is still the biggest donor to the UN’s Yemen appeal.
A spokesperson for the United States Agency for International Development (USAID) told Bioreports that the country would resume all operations in the Houthi-controlled north “when we are confident that our partners can deliver aid without undue Houthi interference and account for US assistance.”
The spokesperson pointed to unmet commitments from “other donors” as the reason for the funding shortfall among UN agencies in Yemen, saying “the United States encourages all donors, including those in the Gulf region, to contribute additional funding, to fulfill their 2020 pledges in a timely manner, and for all assistance to be provided according to humanitarian principles.”
Support pledged to the UN by Saudi Arabia for Yemen more than halved this year. In 2019, it delivered more than $1 billion, and this year it has pledged $500 million. The UN says that just $23 million of that money has come through its appeal.
A spokesperson for Saudi Arabia’s King Salman Humanitarian Aid and Relief Center told Bioreports the country had been ready to hand over the rest of the money in July but was now waiting to finalize agreements with the agencies “to ensure that the pledged amount is not diverted to other purposes outside of fulfilling the humanitarian needs.” Like the US, it cited concerns of appropriation of aid by the Houthi rebels.
“We expect that these agreements will be signed soon, and that the total remaining pledged amount will then be released immediately to the UN agencies and other international organizations,” the spokesperson said.
In the UAE’s case, it hasn’t given anything to the UN appeal for Yemen this year so far, UN data shows. Last year it donated $420 million. A spokesperson for the UAE’s Ministry of Foreign Affairs did not confirm nor deny it had given nothing to the appeal this year.
The spokesperson also mentioned concerns about Houthi rebels obstructing and diverting aid. “As such, the UAE regularly evaluates the efficacy of its aid programs in Yemen and adjusts its approach accordingly. The UAE’s commitment to the Yemeni people is unwavering — the UAE will continue to be one of the largest donors to Yemen for as long as support is required,” they said.
All three countries have donated tens of millions of dollars and other aid to Yemen through other channels outside of the appeal.
The UN’s humanitarian chief Mark Lowcock told Bioreports on Monday that while the Houthis’ obstruction is an issue, the funding crisis is having a far greater impact on the lives of Yemenis.
“What’s bringing people to the brink of starvation is the fact that we have no money. And I do think it’s particularly reprehensible for countries which were contributing last year, said they were contributing again this year and then not pay, because the effect of that is to give people the hope that maybe the help is coming and then when you don’t pay, you dash their hopes,” he told Bioreports’s Becky Anderson on Connect the World.
The US, Saudi Arabia and UAE are key actors in the Yemen conflict, and in 2018 and 2019 they were the biggest donors to the UN response in Yemen.
On Tuesday, the 75th UN General Assembly opens with several sessions on Yemen scheduled to take place. Multiple sources from UN humanitarian response teams told Bioreports they hoped countries would pledge more funds at the assembly to fill the deficit left by the three countries’ cuts this year.
The Houthis have placed harsh restrictions on UN agencies trying to access parts of the country it controls in the north. Tensions have been high since the World Food Program, along with the US and its allies, accused the Houthis of stealing food aid from other parts of Yemen.
The Houthi rebels overthrew the internationally recognized government of President Abd Rabbu Mansour Hadi in 2015. A Saudi-led coalition, in which the UAE is a key partner, has waged a campaign against the Houthis for the past five years, destroying much of the Houthi-controlled areas with the US’ backing. Previous Bioreports investigations have shown that the US government profited from the war, by selling Saudi Arabia and the UAE American-made bombs and armaments.
A land, sea and air blockade was instated by Saudi vessels at the very start of the war to halt any support that they said could be sent to the Houthis by Iran. That has pushed up the price of staples and fuel, making it difficult for essential services, including ambulances, to keep running.
Document shows a system collapsing
In Yemen, 80% of the population is dependent on aid. UN figures show that agencies have received only 30% of the roughly $3.4 billion they need to keep the country afloat. It’s the worst situation there since the war began — and is a huge slide from last year, when the humanitarian response was 87% funded.
Yemenis like Mushiraya Farah are feeling the impact. On the outskirts of Abs, Farah pushes her young son, Asim, along the street in a wheelchair. He is so malnourished, he can no longer walk.
He was seen by doctors at a nearby hospital which has since been bombed and destroyed. With fuel too expensive and a lack of ambulances, Farah has nowhere to take him for treatment. Money has been scarce since Asim’s father died in a road accident.
“Asim used to go out and study, like other little boys. It was a surprise when he started falling while walking. The doctors carried out tests and told me there’s nothing wrong with him,” she said, showing Bioreports her home, a small wooden frame with rags for a roof. The rags have started to tear and offer no protection from the elements.
After Asim became unable to walk, the doctors told Farah that malnutrition had stunted his development.
She used to receive food aid, but not any longer. She does odd jobs and buys just enough food to keep herself and her son alive. All she has, she says, is prayer.
“I pray for health. I pray for dignity. That’s what I pray for — health and dignity,” she says. “It is in God’s hands.”
As a result of funding cuts, the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA) — which coordinates the international response in the country — told Bioreports that UN agencies have already been forced to either close or reduce more than 75% if its programs this year alone, affecting more than 8 million people. Among the most significant are cuts to the World Food Program and the World Health Organization. In July, the Trump administration formally withdrew the US from the WHO. The withdrawal goes into effect in July 2021.
In a confidential internal UN briefing document obtained by Bioreports, the full, devastating impact of that drawback is revealed in a rainbow of colors marking where aid programs have been closed and which are at imminent threat of shutdown if more funding isn’t received. There is a lot of red, indicating what programs have already been closed or reduced, and very little green, where programs are well-funded.
UN agencies confirmed to Bioreports the details of the document and almost all said they have had their funding seriously impacted.
Among the agencies most affected is the World Food Program, which is only 44% funded. The WFP estimates that more than 66% of people in Yemen are considered “food insecure,” and that more than 14 million of them could die if their food assistance stops.
WFP usually delivers food supplies — like flour, pulses, sugar and salt — to 13 million people a month in the country. Now 8.5 million of those people received rations only every other month, essentially limiting their supply to half. If more funding isn’t received, the other 4.5 million will be in the same boat. Two-thirds of these supplies go to Houthi-controlled areas, most of which are more densely populated than other parts of the country.
“Being forced to essentially halve the amount of food we distribute is very worrying. Yemen is at risk of sliding into famine if there are prolonged disruptions to food supply,” the WFP’s Yemen spokeswoman Annabel Symington told Bioreports.
UNICEF has warned that more than 2 million children under the age of five are suffering from malnutrition, and that with reduced funding for specialist medical units, 260,000 of these children could be forced to go without essential nutritional treatment.
‘We’ve stopped counting the dead’
Getting a grasp on the big picture in Houthi-controlled Yemen is difficult. Bioreports spent weeks reaching out to the Health Ministry in Sanaa, local councils, aid organizations and doctors on the ground in northern Yemen for recent figures to show how many deaths here may have been caused by food shortages, or malnutrition. No one had any data on death numbers.
UN sources told Bioreports they have similarly been struggling to conduct assessment surveys in the north. A UN map showing the current level of food insecurity around the country doesn’t include these Houthi-controlled areas in the north.
And with an apparent excess in deaths, assumed to be from undetected Covid-19 cases, it’s been difficult to even keep count of the dead. No one really knows if the deceased succumbed to coronavirus, malnutrition, or both.
In the southwestern city of Taiz, a local gravedigger tells Bioreports that he and his fellow diggers are struggling to keep up with burials. They stopped counting the dead some time ago.
“When coronavirus arrived in Yemen, it came around the end of the month of Ramadan … since then, we’ve kept on digging and digging. We can’t keep up,” Tamim Yousef says as he digs under the sweltering summer heat.
“You feel the worst pain with the children, when you have to bury a child. You feel sorrow, sadness. My thoughts go out to the parents.”
It’s a sentiment shared at Abs Hospital, where Dr. Al Ashwal laments that they have no way of knowing how many children might be dying at home, unable to reach treatment.
Medical staff all over the country are wondering how much longer they can hold on for.
In northern Yemen’s Aslam, one of the hardest-hit districts, a specialist malnutrition unit has had all its funding suspended. It usually receives the majority of its financial support from the World Health Organization, but the UN says it doesn’t have enough money to keep programs like this going.
Qais Ahmed, a nurse at the clinic, says the patients still come and the staff just can’t turn them away. He says the biggest challenge is the power outages and general lack of resources.
“We have no monitors, and the oxygen equipment when the power stops…” he pauses, finding it hard to go on. “Sometimes, if it stops, children can suffocate. This is the worst part and there is nothing you can do to save them.”
Journalists from Tell Your Tale Productions reported from various locations in Yemen and Yousef Mawry reported from Dearborn, Michigan. Bioreports’s Nima Elbagir, Angela Dewan, Nada Bashir and Barbara Arvanitidis reported from London, Sarah Sirgany and Nada Altaher reported from Abu Dhabi, and Jennifer Hansler reported from Washington, DC.