Increased fighting in northern Yemen in recent weeks is causing new waves of displacement. Gisela Vallès, medical team leader at the Médecins Sans Frontières/Doctors Without Borders (MSF) hospital in the district capital of Abs, explains the challenges her team faces in providing assistance to uprooted people and host communities.

How does the conflict affect people in Abs district?

The MSF hospital in Abs city is currently receiving war-wounded [patients] every day. Between August and September, we treated 362 injured people, more than 40 percent of the total number of wounded we have treated in 2018 at this facility. Many are civilians who have been caught in the crossfire of airstrikes and missiles.

The intensification of the fighting about 50 kilometers [31 miles] north of Abs, around Beni Hassan, near the border with Saudi Arabia, has caused a massive new wave of displacement. Since August, about 20,000 people have relocated to other parts of the region, joining several thousand others who fled earlier fighting. It is difficult to trace them because there are no formal camps for internally displaced people (IDPs). They are scattered across a very large area. Sometimes there are groups of IDPs living under basic plastic sheets that they buy or that are donated to them. Other times they are mixed with local communities. In any case, they all live in very precarious conditions.

Do people have access to health services?

The majority do not have access to health services because, after several years of conflict, there are few health centers open in Abs district. Many health centers are no longer functional or are open for only a few hours a day with just a nurse or a small staff. Those working in the health centers have not received salaries for more than two years and work without adequate medical supplies. The health system can’t respond to the needs of displaced people.

At the same time, we are severely restricted in the assistance we can offer in the places that are absorbing newly displaced communities. In September, our mobile team was only able to go out to the periphery of Abs seven times during the month, despite being prepared to leave every day.

In addition to this, in recent weeks the Yemeni currency, the rial, has lost a lot of value as inflation has risen, causing fuel and transportation costs to increase. This had made it unaffordable for many people to reach the hospital in Abs.

It is important that the few medical organizations that are supporting the Ministry of Health on the ground gain more access to address the needs of vulnerable displaced communities.

What are the consequences of limited access to health care for people in the region?

One consequence that strikes me is seeing many patients arrive at the hospital too late. Some pregnant women and sick children arrive at the hospital so late that we can’t save their lives. Virtually none of the women here receive antenatal care because this service is non-existent or ineffective outside of Abs town. They arrive with conditions that could be prevented, such as eclampsia and pre-eclampsia, both of which can be fatal to the mother. By providing proper antenatal care and ensuring a safe birth, we could reduce the risk of complications for both mothers and newborns.

How do our teams try to improve access to care?

In areas where the security situation and the authorities allow, we have a network of community health workers who manage a referral system for the most severe cases. Currently we focus on areas with new IDP settlements where the most basic services are missing. In September, 153 patients from other parts of the region were referred to the Abs hospital, 50 percent more than in August. The forecast is that in the near future there will be many more patients referred, as hostilities intensify.

Can the situation get worse?

The worsening fighting is undermining the capacity of NGOs [nongovernmental organizations] on the ground to provide relief, water and sanitation services, food, and more. High inflation, linked to the rapid devaluation of the rial, import restrictions, etcetera, can have an impact on the nutritional status of the population. We continue to receive many cases of easily preventable diseases, such as diphtheria. This shows that the impact of the war on the deteriorating health system is increasingly affecting vaccination coverage.

MSF is an independent, neutral, impartial medical organization working in Yemen to assist people affected by the conflict on all sides of the frontlines. MSF works in 13 hospitals and health centers across the country and provides support to more than 20 hospitals and health facilities across 12 governorates: Abyan, Ad Dhale, Aden, Amran, Hajjah, Hodeidah, Ibb, Lahj, Saada, Sana’a, Shabwa, and Taiz.