Fighting, power outages, and collapse of government systems in Yemen have left cities vulnerable to Dengue and other infectious diseases, with trash, sewage, and stagnant water providing a breeding ground for mosquitoes.
An outbreak of dengue fever in Yemen’s third-most populated city has prompted urgent calls from the World Health Organization (WHO) for a “humanitarian corridor” to facilitate the flow of medicine and other necessities to over three million civilians trapped in the war-torn area.
Taiz, located on the country’s southern tip, has been on the frontline of fighting between Houthi rebels and a Saudi Arabia-backed coalition of Arab states supporting fighters loyal to deposed President Abd-Rabbu Mansour Hadi since March 2015.
All six public hospitals in Taiz have either been destroyed or are inaccessible, leaving 3.2 million people – many of them sick or injured – without access to basic healthcare. This “untenable” humanitarian situation has been exacerbated further in recent weeks as Houthi-linked fighters have blocked supply routes into Taiz city, Reuters reports.
Since fighting broke out six months ago, an estimated 832 people in the city have died and 6,135 have been wounded, according to WHO figures. More than 2,100 deaths have been documented throughout Yemen.
To make matters worse, in the past two weeks alone the number of dengue cases in Taiz has nearly tripled from 145 cases in early August to 421 by August 25, marking an “extreme spike” in an already concerning outbreak.
As the conflict escalates with both sides showing little regard for civilian safety, the WHO fears that the outbreak — along with other public health and humanitarian problems — will grow more severe in the coming months, worsening the misery of people caught between Houthi gunfire and Coalition airstrikes.
“With the ongoing insecurity and mass displacement of thousands of people, it is likely that the situation will deteriorate in the coming days, placing over 3.2 million people at additional risk,” the agency warned.
What is dengue fever?
Dengue fever is a mosquito-borne viral infection and one of the leading cause of illness and death in the tropics, according to the Centers for Disease Control and Prevention (CDC.) A 2010 study identified dengue as a leading “emerging infectious disease in the Middle East,” meaning it is appearing in new places and/or the number of cases has rapidly increased.
There is no vaccine or treatment for the disease, which causes flu-like symptoms, including high fever, severe headache, nausea and vomiting. If symptoms are not quickly identified and managed, the patient may experience dangerously low platelet counts, internal bleeding or low blood pressure. Undetected, the disease can be fatal.
Each year, dengue infects 50 million people worldwide and causes approximately 12,000 deaths — mostly in Southeast Asia and the Western Pacific, but the range of the virus is expanding due to climate change. Forty years ago, the disease struck only nine countries; it is now endemic in more than 100.
Why Yemen is so vulnerable
Mosquitoes carrying the virus thrive in stagnant water, and dengue epidemics often spread quickly in densely populated areas where open sewer systems or uncollected garbage provide convenient homes for the larvae.
More than 15,000 Yemeni refugees have arrived in UNHCR’s refugee camp site in Djibouti, where crowded living conditions are contributing to the spread of dengue fever.
The last major outbreak in Yemen, which occurred in the western Hodeida province in 2011, resulted in 1,500 cases. With huge numbers of displaced Yemenis living in cramped and unsanitary makeshift settlements, current conditions are ripe for rapid transmission.
The WHO’s most recent situation report for Yemen reveals that the country has logged over 5,600 cases of dengue fever since March, including 3,000 cases in the coastal city of Aden alone.
Incomplete levels of medical reporting as a result of heavy fighting suggest that the real number of cases could be much higher. Reports from humanitarian groups like Mercy Corps put the figure at more than 8,000 cases as of early August, and even that startling count is considered to be an underestimate.
Children are more likely than adults to develop the severe form of the disease, known as Dengue Hemorrhagic Fever. With children accounting for over 600,000 of the nearly 1.5 million displaced in Yemen, health officials are on high alert.
Dengue prevention efforts inhibited by conflict
Since there is no vaccine against the diseases, and no specific antiviral drug with which to treat it, prevention is the only long-term solution.
The WHO is partnering with other organizations and local health authorities to distribute insecticide-treated mosquito nets, educate families on how the disease spreads, conduct indoor spraying to disrupt breeding grounds and secure necessary laboratory supplies for medical facilities.
However, these tasks are not easily accomplished in the midst of relentless air strikes and heavy fighting.
“There is an urgent need for a humanitarian corridor to assess the situation and institute control measures,” said Dr. Ala Alwan, WHO’s Regional Director for the Eastern Mediterranean. “We need protection and safety for all people working to control the worrying outbreak of dengue fever in Taiz.”
The WHO reminded all parties to the conflict of their obligations under international humanitarian law to protect civilians, health facilities, and health professional during the conflict, and that health facilities must be treated as neutral premises and never be exploited for military purposes.
The climate change connection
The crisis in Yemen highlights something that experts have been warning about for years: the connection between climate change, conflict, and global health. Not only is global warming contributing to the spread of infectious diseases like Dengue, but it’s also increasing regional instability and making populations more vulnerable to disease.
Security experts have long predicted that climate change will be a major source of conflict as drought and rising temperatures hurt agriculture, putting a further strain on resources in already unstable regimes.
By exacerbating resource shortages, climate change is increasing conflict risk across the Middle East.
While the fighting in Yemen has many complex causes, the country’s dwindling natural resources, including an impending water crisis, are thought to be a key driver of conflict. Abdulrahman Al Eryani, Yemen’s minister of Water and Environment, said much of the country’s rising militancy is a conflict over resources, citing one study that found that between 70-80 percent of all rural conflicts in Yemen are related to water.
“They manifest themselves in very different ways: tribal conflicts, sectarian conflicts, political conflicts,” said Minister Eryani. “Really they are all about sharing and participating in the resources of the country, either oil, or water and land.”
The effects of climate change in the region have also been implicated as contributors to the conflict in Syria. In a study published earlier this year, researchers explained how global warming intensified the region’s worst-ever drought, pushing the country into civil war by destroying agriculture and forcing an exodus to cities already straining from poverty, an influx of refugees from war-torn Iraq next door and poor government.
As climate change worsens, experts say this will lead to mass migration of people, which in turn can create tense situations between ethnic groups. Several hundreds of millions of climate refugees are expected by 2050 due to droughts, natural disasters, sea level rise, lack of food and water, and so on.
Everyone will be affected by these changes, the WHO says, but not equally. Vulnerability to climate change will be determined by a community or individual’s ability to adapt. As a result, the impacts of climate change will disproportionately affect people living in poverty in poorer, developing countries — notwithstanding their minimal per-capita contributions to greenhouse-gas emissions. It’s here where the damage will be greatest and where people have the lowest capacity to cope.