MSF opened its hospital for trauma and emergency surgery inside Al Sadaqah hospital complex in Aden. Since its opening, more than 30,000 emergency consultations have been provided here. At that time, we treated patients with open fractures, burn injuries, or wounded by gunshot and explosives. There was only one operating theatre, a small intensive care unit, no laboratory and no orthopaedic surgeon. We were not specialized, but patients forced us to learn.

Ansar Allah troops, allied with former President Ali Abdallah Saleh, took control of Sana’a, the capital of Yemen. That year, we performed 91,000 outpatient consultations and 4,300 surgical interventions in five health facilities across the country.

We saw Aden changing and turning into an urban battlefield, with fighting raging inside the city. During this period, our hospital was one of the very few surgical facilities still functioning in Aden, and teams mainly treated war-wounded people. So, between March and July 2015, we treated more than 2,800 war-wounded at the hospital. Staff and medical supplies were sent by boat from Djibouti to Aden, and later by plane. In July, I remember that an MSF boat was targeted by snipers at the entrance of Aden port, fortunately with no casualties.

Ansar Allah forces with the help of Saleh loyalists took over Aden’s airport. The battle for Aden began between them, against southern movement militias, the Yemeni army and forces loyal to current President Abdrabbo Mansour Hadi, elected in 2012.

The Saudi and Emirati-led coalition launched an aerial bombing campaign to push back Ansar Allah forces. On that day, MSF teams in Aden hospital received and treated more than 100 wounded. I remember there was no proper triage to deal with this huge number of injured people, but we started somehow classifying cases depending on the severity of their condition. We worked night and day.

Access to healthcare was extremely difficult inside the city because of airstrikes, shelling, road blocks and snipers. We decided to run an advanced emergency post in Crater, a neighbourhood in the south of the city, in order to stabilize war-wounded patients and to improve their chance of survival.

To respond to increased medical needs, our teams launched outpatient surgical mobile clinics in two neighbourhoods in the south of the city. Admitted patients, emergency consultations and surgical interventions almost tripled in Aden hospital between 2014 and 2015.

At that time, fighting between Southern Resistance and Ansar Allah troops led to a large number of victims, including civilians being trapped and shelled in populated areas of Aden. On July 1, there was a bombing on a residential area in Al Mansoura neighbourhood. More than 80 people, among them a lot of women and children, were treated at our hospital.

The international airport reopened after loyalist forces supporting President Hadi recaptured the city. Ansar Allah forces were pushed back toward the northern neighbourhoods.

Since 2012, the hospital has faced unstable activity levels depending on the political context, moving frontlines and the effectiveness of other medical facilities’ referral systems closer to the frontlines… Surgeons here have developed wide experience with different types of trauma, such as abdominal, thoracic, orthopaedic, and vascular injuries, but also burns and Caesarean sections.

We experienced a massive influx of wounded after an explosion hit a nearby neighbourhood. Forty-six dead bodies and more than 60 patients were brought to the emergency room within three hours. Even if it was not the first time it happened, it was very difficult to manage such a significant number of wounded patients.

We improved infection prevention and control measures inside the hospital and implemented an antibiotic resistance stewardship program in order to improve the quality of care. In 2018, 70 percent of infected patients tested for antibiotic resistance were multidrug-resistant. We receive patients from the frontlines very late, sometimes between 12 and 24 hours after they are injured. Stabilization is not always done properly, so it means that we have to control infections: isolating the patient, analysing the bacteria and selecting the appropriate antibiotic.

Teams supported a cholera treatment centre inside the hospital to treat an increasing number of patients affected by cholera, after a massive outbreak swept across Yemen.

We started implementing internal fixation for patients with fractures, in order to treat post-surgery complicated cases over the long-term. Year after year, we adapted our admissions criteria and admitted various types of patients, for instance those with abdominal or maxillofacial injuries, or eye trauma. If needed, we would call an external surgeon. Our intensive care unit has been working at full capacity, and we admit, for instance, patients who need to be intubated.

Teams rehabilitated an entire floor of Al Sadaqa hospital and trained its staff. We equipped an operating theatre to respond to a diphtheria outbreak, which was eventually handed over.

After months of fighting along the frontlines between Taiz and Hodeidah, a military offensive was eventually launched by the Saudi and Emirati-led coalition-backed forces, loyal to President Hadi, to seize Hodeidah from Ansar Allah troops.

Following the Hodeidah offensive, the capacity of MSF’s Aden hospital increased to 104 beds to respond to an influx of war-wounded. War weapons are causing complex injuries, sometimes with significant internal injuries and severe fractures. Most of the surgery we do is ‘life-saving’: chest and abdominal gunshot wounds, amputations.

In response to the intense fighting along the Hodeidah frontline, our teams opened a field surgical hospital in Mocha. Complicated cases are referred from MSF’s Mocha hospital to MSF’s trauma hospital in Aden for further care. These patients need multiple surgical procedures and specialized care over a longer period of time.

In 2018, MSF teams provided more than 6,000 emergency consultations and performed 5,400 surgeries at Aden hospital. Ninety percent of surgeries were violence-related.