Yemen: War and poverty are what make cholera a killer

A woman collecting water from a village water tank, with hygiene information posters

What does cholera mean for people already weakened by hunger, displaced from their homes by years of war, living without access to safe water and basic sanitation, and unable to afford to pay for medical treatment?

Hanan Shaker, who works as a community health volunteer with CARE in Yemen, writes:

I’m from Hajjah, in the northwest of Yemen, an area facing the double threat of conflict and cholera. Up to half a million people have already been displaced from their homes, leaving them extremely vulnerable to disease as they lack even basic sanitation.

I recently visited a crowded corridor-turned-cholera isolation unit in a local hospital. At the hospital doctors moved quickly from one bed to the next, hoping that no more cases came in that afternoon. It has been an overwhelming few weeks for hospital staff and the pressure doesn’t seem to cease. Amidst the outdated monitors and rows of rehydration drips were people of all ages – all waiting desperately for some form of relief.

Twenty-year-old Amal, a pregnant mother of two children, spent five days in the cholera isolation unit. She came to the hospital as soon as she started experiencing cholera symptoms. She told me:

When I started feeling sick I knew it was cholera and I was very worried about the baby inside me. I was afraid I would lose him.

When I met nine-month-old Razye, I could see he was clearly suffering. He’d had severe diarrhoea that had left him desperately dehydrated and unable to move. Two weeks ago, Razye was admitted to the cholera isolation centre in Hajjah in a critical condition. His weak body had been attacked by an acute cholera infection. His parents had delayed bringing him to hospital, hoping that the infection would clear through home remedies.

Like thousands of others, poverty is what stopped Razye’s family from initially taking him to hospital when he began to show symptoms of cholera.

His parents were forced to make the difficult choice between spending their meagre daily income on food for the family, or seeing a doctor. His mother explains how lucky they are that in the end they were able to find the money to bring him to hospital. She told me:

I know that there are a lot of sick people in this city who are unable to even afford travel expenses to come to the hospital.

Kloud’s mother was eight months pregnant when she contracted cholera and died just four weeks ago. Kloud’s mother had contracted cholera two years ago and managed to survive, but this time tragically her body didn’t respond to treatment, and she and her baby both died.

Kloud remembers her mother suffering from severe diarrhoea and violent vomiting. She told me:

I tried to treat her at home. But she didn’t get better. She was weak and dehydrated and she couldn’t eat or drink anything. When we took her to the hospital it was too late.

Cholera is spreading in Kloud’s village. Many of her friends and family have been infected by contaminated water. Kloud told me:

They don’t have clean bathrooms in their houses, which forces them to go to the toilet outside in the open.

What happened to Kloud’s mother could happen to thousands more unless more funding for cholera treatment and prevention is made available. Kloud says that when her mother was dying: 

She asked me to take care of my siblings and keep them clean so that none of them would be infected by this terrible disease.

Cholera in Yemen: The facts

  • There are over a million malnourished pregnant and breastfeeding women in Yemen who are extremely susceptible to contracting cholera, which threatens both them and their babies – between 2016 and 2018 the number of pregnant and breastfeeding women treated for acute malnutrition almost doubled. 
  • There are reports from Hajjah of women dying of cholera in pregnancy, and pregnant women who contract cholera worrying for the health of their unborn babies.
  • One of the biggest challenges families are facing is the cost of transportation to hospitals. This means even when there is treatment available they can’t access it, or they have to sacrifice food to pay for transport.
  • Sanitation services are non-existent in many areas. In Sana’a, raw sewage and rubbish can be observed flowing through the streets due to drainage issues.
  • In 2019 so far, there have been around 300,000 suspected cholera cases, with over 580 deaths; around a quarter of cases are children under the age of five. Many CARE staff have friends or relatives who have contracted cholera.

CARE’s response

To respond to the current cholera outbreak, CARE is providing water and taps for communities and chlorination tablets for household water treatment, as well as distributing basic hygiene kits to vulnerable households. CARE’s team of community health volunteers also conduct hygiene awareness sessions focused on cholera prevention, and distribute information materials which help to educate people about the simple steps they can take to prevent the disease.

In 2018 CARE’s humanitarian response reached a total of over 1.7 million people across Yemen.

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News and stories are provided by CARE staff working to support our emergency responses and long-term development programmes.