Yemen: It’s not always a bullet that kills people
Doctors Without Borders pediatrician Monica Costeira holding a baby at the neonate unit of the Al-Qanawis mother and child hospital in Hodeidah. Yemen, 2021. © Nasir Ghafoor/MSF
On the rooftop of the Doctors Without Borders house in the city of Al-Qanawis, in the Hodeidah governorate of northwestern Yemen, I look at the stars. We all look up at the same sky, I think, but life is so different depending on your vantage point. I am in a beautiful country with a very rich history. Now, it is being destroyed by war.
You might think that injuries in war are about trauma: people are victims of bombs, gunshots or shelling. What many people don’t realize is that war also brings endless invisible misery, as well as physical harm. Al-Qanawis and the surrounding region is an example of it.
The Hodeidah governorate has been one of the most active conflict zones in Yemen in the six years since the war began, but many of our patients are coming from remote villages located in desert-like regions, not from the frontline. They do not normally hear the sound of gunshots, airstrikes or shelling, but even so they feel they are at war every day.
As I speak to our patients, I come to understand that they lack access to healthcare, food, water, safe shelter and education. Many of them die due to diseases that are perfectly treatable and preventable if only they had access to a hospital with the necessary staff and medication. As a result the most severely affected people are the most vulnerable; children, pregnant women, elderly people, and people with chronic diseases. The first thing that a war does to a country is to burden its health system. A country like Yemen, with a health infrastructure that was already weak, has buckled under this extra weight.
Saalima - who went through a C-section for delivery - holding her newborn baby girl Zamzam in the post-operative ward of the Al-Qanawis mother and child hospital supported by Doctors Without Borders in Hodeidah. Yemen, 2021. © Nasir Ghafoor/MSF
Hope for your loved ones
Wherever people live, they try to achieve the best life for their family. People don’t give up. In Yemen too, you find parents selling everything they have for a chance to send some of their children to another country in the hope that they will be able to lead a normal life, to access healthcare, get an education and find a job.
I met so many parents who faced huge challenges just to bring their sick child to the hospital, like Latifa’s mother and father. Latifa had to be a fighter right from the first day of her life.
Her mother and her family live in a small, isolated village, without access to health care. When the war started many of the health centers in their area collapsed, either destroyed, abandoned by medical staff or simply closed owing to a lack of medication and equipment. When she became pregnant Latifa's mother, Fatima, had no access to nearby health facilities. She became sick, but didn’t have the time or the money to get transportation to seek healthcare. The contractions started suddenly one day, but it was still too early. Fatima feared for her baby. She wanted to go to a health facility because she knew it was too early and her baby would be at risk. But there was no time, and she delivered at home. The baby was born very small and with breathing difficulties.
Zaima Hussain is with her newborn baby Aiesha in the post-operative ward of the Al-Qanawis mother and child hospital supported by Doctors Without Borders in Hodeidah. Yemen, 2021. © Nasir Ghafoor/MSF
Doctors Without Borders surgery team conducting a cesarean section alongside the operating theatre team at the Al-Qanawis mother and child hospital in Hodeidah. Yemen, 2021. © Nasir Ghafoor/MSF
She was far from the hospital and her baby did not survive. She was still suffering from the loss when she realized that the delivery had not finished! She was carrying twins, but hadn’t known of it since she had had no antenatal checks.
Fatima gathered the energy and resources to reach the nearest free health facility providing maternal and childhood care, the Al Qanawis Doctors Without Borders hospital, still hours away from her home. Fortunately, she managed to arrive at our hospital in time, and she delivered her second baby, Latifa.
Latifa was admitted to us for two months with a low birth weight. She soon became a source of love and affection for the whole team. When the day finally came for her to be discharged I felt so proud of her and of our work, of the team’s dedication and love. I hope she brings hope to her family, to her community, and to her wartorn country. I hope that Latifa sweetens the life of everyone who meets her, as she has done with us.
Lack of basic healthcare can be fatal
Complications owing to premature deliveries are the leading cause of death in newborns in this part of Yemen. There are multiple and various risk factors for low birth weight and preterm births; many of which are preventable or manageable with good antenatal care. Risk factors include maternal age less than 17 years old or more than 35 years, short intervals between pregnancies, maternal malnutrition, multiple pregnancy, abnormalities of the fetus and maternal health problems like malaria, pre-eclampsia, eclampsia, infections, among others.In Al-Qanawis, many mothers present with these risk factors. However, ensuring basic neonatal care can significantly reduce mortality and improve outcomes.
Sitting on the rooftop that night, I felt satisfied to be part of a team contributing to saving lives, but I also worried for those who can’t reach our hospital. There are mothers screaming in pain and newborns taking their last breaths, simply because they were not able to access simple and basic medical care. Witnessing this reality and realizing how the war impacts so many vulnerable people makes me wish there were more global awareness and consciousness about what is happening here. I wish our resources and our great human capabilities were used to save lives, instead of taking them.