By Gursimar Sawhney
Yemen has now seen the worst cholera outbreak in history. Every year, there are 3-5 million cases worldwide but in the past year and half, one million cases have occurred in Yemen alone.
According to the CDC, cholera is an acute, waterborne illness caused by infection of the intestine due to bacterium Vibrio cholerae. Symptoms include watery diarrhea, vomiting, and leg cramps due to dehydration and shock. Though it’s easily treatable with immediate replacement of the lost fluid and salts, it can lead to death in hours without access to healthcare.
The outbreak originated in Sana in October 2016 and spread to 15 provinces in just two months. Since then, humanitarian efforts have been initiated. The World Health Organization prepared to send 1 million cholera vaccines to Yemen until the national government decided against it. Additionally, the United Nations organizations delivered 900 health workers, supplies, and makeshift clinics, but it was not enough. Antonia Zemp, a Swiss nurse for the Doctors Without Borders emergency team shares, “the epidemic has spread so rapidly that the capacity of the 50 beds of the newly opened treatment centre is by far exhausted after the first week…. At the end of my deployment, more than 400 patients were treated per day. The epidemic is out of control.” Though there are measures in place for cholera outbreaks, the countless number of challenges to its people has allowed this one to snowball into an epidemic that has caused over 2,000 deaths from May 2017 to January 2018.
The outbreak in Yemen is not just due to lack of clean water, which the country has been battling for years, but the effects of the civil war. Conflict between the Saudi-led coalition and Houthi rebels has tarnishedwhatever was left of the national government and left some parts of the country in the control of the Islamic State militant group. Divided regions governed by various groups hasled to a lack of infrastructure and therefore a breakdown of the workforce. For example, Yemen’s healthcare workers and sanitation workers do not receive salary. Strikes among sanitation workers resulted in the accumulation of garbage and its eventual contact with the water supply. Moreover, Saudi Arabia enacted a blockade of water, air, and land ports—an important change since Yemenis import more than 80% of their food, fuel, and water, not to mention medications. The bombings by Saudi-led coalition destroyed the public water system, and scarce fuel means inability to boil water, nonfunctioning water pumps, and no running hospitals—necessities in preventing the spread of cholera.
It is unfortunate that with the correct leadership and early intervention, the intensity of this outbreak could have been diminished. Many could have been saved if they reached a treatment center during the initial stages of contracting the disease but lack of money for transportation, countrywide destruction, and the fear of death from air attacks have prevented them from reaching help on time. This situation brings to light that though we can look back on responses of earlier outbreaks for help, each case is unique. The same protocols that were successful in previous outbreaks might not work with the additional set of challenges in Yemen, when constant air strikes and trade blockades are depleting the population of its resources faster than they can be replenished.
Responses to past outbreaks have included early intervention and implementation of both domestic and institutional infection control measures. Water chlorination in particular decreases transmission according to The Journal of Infectious Diseases. These options are unrealistic as of now. However, after the outbreak in Bangladesh, it was found that using a water and sugar solution is extremely beneficial for patients. Sharing information about how to treat patients at home to free up space for dire cases at treatment centers could greatly affect quality of care. Also, continuing to spread health care information on how to prevent the disease could also be beneficial to those who have not yet been exposed.
According to Pro-MED Mail, the number of new cases has been declining for 20 weeks. However, continued lack of access to clean water, fuel for water pumps, and healthcare may lead to a second outbreak in March. Since access to clean water and sanitation is primarily an infrastructural issue, the most important thing Yemen needs is time—time to rebuild and reunite. Right now, all we can do is initiate more humanitarian efforts to focus on prevention and help those lucky enough to access care. In the future, however, public health officials everywhere should keep in mind the challenges facing countries in conflict, and be prepared to, at the first sign of disease, make early interventions.
References
https://academic.oup.com/jid/article/217/4/641/4643205
http://www.cbc.ca/news/technology/cholera-s-seven-pandemics-1.758504
http://www.promedmail.org/?p=2400:1000
https://www.cdc.gov/cholera/general/index.html
http://blogs.msf.org/en/staff/blogs/life-in-the-e-team/cholera-in-yemen-ali-is-fighting-for-his-life
https://www.unicef.org/yemen/activities_11440.html
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