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Yemen: The Perfect Target for COVID-19

A new report says the Middle East’s poorest country is uniquely vulnerable, as it records its first case of the coronavirus.

By Colum Lynch

April 10, 2020, 11:11 AM

From the perspective of an opportunistic pathogen, Yemen has it all: a dense population, epic poverty, a broken health care system, and a five-year conflict that has rendered the country incapable of sustaining itself without massive outside assistance.

Yemen confirmed its first case of the novel coronavirus on Friday in Hadramout, the country’s largest province. U.N. and relief officials believe that the virus has likely spread more widely and that a spike of COVID-19 infections in neighboring Saudi Arabia seems to only reinforce those suspicions.

“Despite precautions issued by Yemeni national authorities and WHO [the World Health Organization] to minimise the risk of the virus transmission, there is a high risk that COVID-19 spreads rapidly throughout Yemen,” according to a risk report published this week by ACAPS, a nonprofit project of the Norwegian Refugee Council and Save the Children that publishes forecasts on the world’s most vulnerable communities. Foreign Policy is highlighting the report as part of its Document of the Week series.

The health warning follows a recent spike in fighting between a pro-government Saudi-led coalition and the country’s Houthi rebels—though Saudi Arabia announced this week that it would unilaterally observe a U.N. call for a cease-fire.

Still, the report provides a troubling snapshot of the all but insurmountable challenges poor, conflict-plagued countries face as the coronavirus spreads from the world’s global capitals to some of the most hard-bitten places on Earth.

“Within a month of the first case being registered in Yemen, many deaths are likely to have been recorded and increasingly stringent movement restrictions begin to be instigated,” the report predicts. “Nevertheless, the number of infections and deaths will continue to rise sharply. Death rates are higher than the global average due to the underlying poor health conditions, lowered immunity among a malnourished population, and limited medical resilience in the general population.”

“While we knew this was coming, still, the spread of COVID-19 to Yemen is a nightmare scenario,” Tamuna Sabedze, the Yemen country director for the International Rescue Committee, said in a statement Friday. “Millions of Yemenis live in cramped and unsanitary areas, vulnerable to contracting the virus. It is vital that the warring parties honor the ceasefire they’ve committed to and extend it.”

Yemen, a country of 28 million, was already the poorest country in the Middle East before Saudi Arabia launched an air war against rebel ethnic Houthi forces, which ousted the country’s internationally recognized government.

More than 3.6 million people have been displaced by the conflict, including tens of thousands driven from their homes since January. A third of Yemeni households consume inadequate diets. The conflict has had a devastating impact on the country’s hospitals and medical centers, which have been targeted in more than 140 attacks. Today, only 51 percent of Yemen’s medical facilities are functioning. “Five years of war in Yemen has greatly limited the capacity of communities and government to prepare and respond to the global COVID-19 pandemic,” according to the report.

The report, which was last updated on April 7, notes that Yemen will likely be overwhelmed and unprepared as the coronavirus spreads. As of this month, it had a total of three testing centers in the cities of Sanaa, Aden, and Mukalla, with the capacity to carry out a “few hundred tests.”

The country has already been hit by soaring levels of malnutrition and cholera, which increased by 132 percent last year over 2018 and has led to more than 56,000 suspected cases in the first seven weeks of 2020.

Yemen relies on imports for some 80 to 90 percent of its food, fuel, and other basic necessities, making any attempt to close its borders deadly. The country has virtually no stocks of personal protective equipment, which has been critical to slow the spread of the virus in other parts of the world. The country has a severe shortage of health workers—only 10 per 10,000—and it has been forced to compete for scarce ventilators, thermometers, and other vital equipment with its rich Gulf neighbors.

The humanitarian crisis has been exacerbated in recent months as Houthi rebels have imposed further restrictions on the delivery of assistance to the country’s neediest, infuriating Western donors and prompting the United States to freeze some funding for Yemen aid. The report says U.S. cuts could worsen the international cholera response: “Planned cholera response activities will reportedly stop from March-June 2020 in Ibb, Taiz, Al Hodeidah due to the US decision to freeze funding from April 2020, unless the Houthis allow greater humanitarian access.”

“For quite some time we have warned the Houthis that we expect our assistance to reach those for whom it’s intended,” U.S. Agency for International Development Administrator Mark Green told Foreign Policy. “No diversions, no quote-unquote taxes, no bureaucratic barriers, and no political games. We asked for accountability and transparency as we do everywhere in the world. And unfortunately, the Houthis have not followed through in commitments that they have made.”

“We are beginning to suspend certain activities in northern Yemen that have become untenable in the face of long-standing Houthi interference in humanitarian operations,” USAID’s acting spokesperson Pooja Jhunjhunwala told Foreign Policy. “U.S. aid programs remain fully operational in southern Yemen, and in northern Yemen we continue to support critical, life-saving activities focused on preventing the spread of cholera, as well as the treatment of malnutrition.”

Fear of the coming coronavirus has driven up transportation costs, raising the costs of basic goods like food and medicines.

The pandemic has already fueled rumors and conspiracy theories—one Houthi leader has claimed that the coronavirus was manufactured in America—and set the stage for a backlash against humanitarian aid workers, who will be blamed “rightly or wrongly” for introducing the virus, and anyone suspected of being infected. According to the report, one 4-year-old girl “was denied from treatment in several hospitals in Aden” because she was suspected of being infected. The girl died, and testing found that she did not have the disease.