Yemen: Delivering Health Care Systems Support in a Conflict Zone

Dr. Yaser Alsaleh is team leader of the European Union (EU) funded “Support for Effective Stewardship in the Yemeni Health Sector” project being implemented by EPOS Health Management.  The project aims to support capacity development of the Ministry of Public Health and Population (MoPHP) at individual, organisation and system levels to lead in the performance of core functions.

Dr. Alsaleh, a trained medical doctor and senior international public health expert, has worked in Yemen since 2009.  He shares with us insights into working in Yemen amid increasingly critical conditions, as well as key support that has enabled him and his team to implement more than 1,000 capacity building activities at a time when civil war since March 2015 has “pushed Yemen to the brink of famine, obliterated the health system, led to broad human rights violations and impeded imports of crucial food, resources and medicines (Bloomberg).” Interview conducted early May 2017.

What has impacted you most working in Yemen?

“It’s the human factor that stands out most when working in Yemen right now. There is extreme human distress and vulnerability on a massive scale, with United Nations’ statistics highlighting more than 10M people are in acute need and unable to meet even their most basic needs of food, lodging, hygiene, etc. Since civil war broke out in March 2015, escalating violence and air strikes of the conflict have displaced 3M people. Salaries have simply stopped, or are incredibly irregular, and people have no resources left any more.

It is very hard to work along-side such a magnitude of people, across all ages and backgrounds, severely suffering each day for the most basic human needs. Currently, the situation is culminating in a cholera epidemic which has killed at more than 100  people in Yemen in recent weeks, according to Deutsche Welle, Germany’s international broadcaster. Authorities have declared a state of emergency in the capital Sana'a and have called for international help.

In non-conflict countries, colleagues or neighbors may come together to support someone or a family that has fallen on hard times. Now in Yemen, it is impossible to organise such support because the conflict and blockades have led to a full scale humanitarian disaster with millions of people in need of urgent aid. Everyone is struggling for essential goods and services, there is no excess for anyone to give. Minimum provision levels are not even being met. Even prior to the conflict, Yemen was one of the Arab world's poorest countries. Deaths and injuries from the ongoing civil war over the past two years underpin the escalating humanitarian tragedy, with  more than 10,000 civilians killed 40,000 more wounded.”

Amid such devastation, what keeps you focused?

“The human factor stands out here as well – despite what is happening and how difficult living conditions have become, people want to help out however they can. They go on working where ever possible, or join efforts in clearing rubble from the aftermath of air strikes or providing emergency first aid to those injured.

The desire to remain useful and purposeful, amid such harsh conditions and so much of daily life now taken up with the basics of organising food, keeping safe and clean, is a truly remarkable testament to human nature. And this keeps the team and myself focused on moving forward, with the local community along-side us, to overcome obstacles and continue providing much needed health and emergency response trainings.”

How have you and the team managed to continue project activities?

“I’m very grateful that we have been able to continue our project work, delivering emergency health care training and support services in line with MoPHP measures. The Yemeni people need help and all project initiatives, small or large, make an important difference. We have a team of 5 national experts, consisting of 4 experienced physicians and 1 financial manager, and 6 additional support staff that have been on the ground in Yemen and all working together, for the most part, since 2009. They are a highly dedicated and close knit group, focused on continuing to make a difference in their home country.

When country borders and airports are open, I am able to be in Yemen at our project office in Sana’a. When this is not possible, I work remotely from Syria, where my family is, keeping in constant contact throughout the day via internet-enabled communications tools. Although at times we are geographically apart, our work on project activities continues real-time with daily discussions and decision-making within the team, with our counterparts and even with the Minister of Health.

Through this constantly unified working style, we have been able to deliver close to 400 short-term capacity building workshops across six governorates, providing training to nearly 7,200 people in the areas of maternal and neo-natal care, emergency obstetric care and health administration services. Nearly 700 long term capacity building courses were carried out as well in specialised health areas and manuals and guidelines were created to underpin best practice.”

What impact are the trainings having?

“Before the conflict, emergency preparedness and response medicine was a normal public health topic. Hospital teams occasionally put emergency response training to use first-hand. Since the war, hospital staff now needs to be able to perform rapid and effective mass casualty triage on a regular basis due to casualties from bomb blasts or other conflict-related activities. Seconds make a difference when assessing and connecting severely injured or burned victims to critical care. Post-training indicators show professionals that have received our emergency training have been able to act more effectively and ensure better treatment outcomes.

Since the war, motivation levels to participate in emergency training have also clearly increased. The ongoing fighting and violence results in constant casualties and health professionals are on the front lines of treatment. They want to be able to confidently perform and treat what has unfortunately become their regular work environment.”

What has helped you and the team to achieve so much?

“First, these initiatives have only been possible due to the dedicated and experienced project team. Additionally, we have been able to build and maintain strong communications and trust with our counterparts at the MoPHP and in the governorates. This has been very important as the conflict has impacted what measures we undertake, always in accordance with the ministry and donor delegations. This as well is an important source of extended teamwork.

The EPOS Health Management headquarter team in Germany also greatly enables our work. Daily contact, for technical, financial or administrative guidance, makes it possible for the project team to keep moving forward. Without this well coordinated team work – including project team and staff, ministry counterparts and donor delegations, and technical and professional support from EPOS headquarters – our work could not happen. And that would be devastating, particularly when the Yemeni population is in such great need of aid.”

What does the immediate future hold?

“Our work supports the Yemeni people, independent from political associations or actions. The ongoing conflict and airstrikes have taken a very heavy toll on basic services and social infrastructures. The healthcare sector is experiencing a critical shortage of medical supplies, with only 30% of the medicine that used to enter Yemen now coming in. Human resources for health are also experiencing significant set backs due to the evacuation of most of the foreign health staff. The escalating violence and wide-spread insecurity means very few aid agencies have full teams in Yemen.

Our project team will continue to respond to the urgent need to build capacities that are critical to saving lives. When the conflict ends, whenever that may be, the ongoing training and systems support we provide will enable the country to better respond to needs that emerge as it rebuilds its social and medical infrastructure.”

What impact do you think the recently pledged $1.1 billion of international funding will have for Yemen?

“While I clearly welcome all and any assistance to Yemen, I can’t help feeling that it falls far short of what is actually needed. An entire population is suffering, extremely weakened from the ongoing conflict, and worn down with daily worry of finding food and ensuring basic safety. Out of a total population of 27.4M people, 17.4M are unable to adequately feed themselves on a daily basis. Every ten minutes, a child under five in Yemen dies from preventable diseases (UNICEF). I truly hope no other country will ever have to experience what Yemen and its people are currently going through. The recently pledged funding is very welcome, but more aid is still desperately needed.”

Further information:

European Union Support to Yemen

The European Union (EU), currently made up of 28 Member States who link together their know-how, resources and destinies, has built a zone of stability, democracy and sustainable development whilst maintaining cultural diversity, tolerance and individual freedoms. The EU is committed to sharing its achievements and its values with countries and peoples beyond its borders. To this end, the EU has been active in Yemen since 1998 and provides funding for both humanitarian and development assistance. So far, the EU has committed more than EUR 60 million in support of the Yemeni health sector.

System support, even in periods of crisis, allows services to adapt to changing demands, to be better aware and thus better responsive to emerging needs.

In this frame, the cooperation with EPOS Health Management aims to strengthen local and national structures. The ongoing project ‘Support for Effective Stewardship in the Yemeni Health Sector’ aims to create a coordination mechanism that enables the MoPHP to effectively steer its sectors and departments internally as well as lead the subnational governance levels and development partners. EPOS is providing technical assistance through a team of experts who are posted at key functional units of the Ministry to support its stewardship role, and in the governorates.