ADEN – Tarek al-Salami, 7, sat weakly in a diaper, his frail body worn down by malnutrition and diarrhea. Under normal circumstances, treatment could have restored him within days. But in Yemen, where war has disrupted nearly every part of daily life, little is normal.
As Iran-backed rebels advanced this month and civil war returned to the area, Tarek’s father carried him on foot from the southwestern city of Mokha. Two days later, the boy reached a hospital in the government-held city of Aden, about 270 kilometers (170 miles) away, only to learn that no beds were available. The facility was overwhelmed with people wounded in the fighting. Eventually, the family found a therapeutic feeding center.
The delay left Tarek in “acute crisis,” according to the center’s director, Dr. Arwa Atef. More than a week after arriving, he took his first steps again on Wednesday.
“I swear to God, when I look at him, my heart breaks,” his father, Mohammed al-Salami, said. “He looks almost lifeless.”
Tarek’s ordeal reflects the collapse of an already fragile healthcare system in the Arab world’s poorest country, now caught up in a new front of the Iran war. The Associated Press spoke with patients, medical workers and aid organizations in Yemen and abroad as medicine supplies dwindled and some healthcare workers fled. Several facilities have also been seized or damaged by the fighting.
Some health centers are turning away pregnant women and other patients so they can prioritize those injured in the conflict. Vulnerable children are filling incubators and sharing beds. Millions have been affected as Iran-backed Houthis push against government forces supported by Saudi Arabia, while more than 130,000 people have fled their homes.
The feeding center treating Tarek and other children is struggling to manage a surge in admissions, Atef said, in a country where hunger was already widespread.
“We can’t keep up with the situation,” she said.
Overwhelmed hospitals focus on the wounded
Most hospitals and primary health centers in areas affected by the latest escalation shut down during the first 48 hours before reopening, the United Nations said. Access has since become more difficult in some locations. Houthi forces have taken control of the Red Sea coast, including major ports used to deliver aid.
The World Health Organization says fewer than 10% of affected health centers are fully equipped to provide the trauma care required by the wounded. With supplies and staff stretched thin, hospitals are being forced into painful decisions over who can receive treatment.
Fewer facilities are now able to handle pregnancy-related emergencies, which were already killing three Yemeni women each day before the escalation, said Francesco Galtieri of the United Nations Population Fund. That was among the highest maternal death rates in the Arab world.
“Around 2,000 pregnant women are on the move,” Galtieri said, with more than 200 expected to give birth within the following week or so.
In some hospitals near the front lines, maternity wards have been converted into emergency rooms, said Hashem Osseiran, a spokesperson for the International Committee of the Red Cross. Many of those facilities lack sufficient anesthesia, oxygen and sterile surgical gloves.
At Martyr Mohamed Hayel hospital, which treats mothers and children in the government-held city of Marib, Dr. Ahmed Modhesh said emergency maternity cases have increased as other hospitals in the city concentrate on treating the wounded.
The hospital lacks intensive care specialists and does not have enough generators to keep every department operating during a power outage.
A midwife said the number of births handled by the hospital has nearly doubled, reaching about 80. In one case, a woman with an ectopic pregnancy arrived suffering heavy bleeding. Despite limited resources, staff performed emergency surgery that saved her life, the midwife said. She spoke anonymously because she was not authorized to talk to the media.
Yemen’s healthcare was in trouble before the fighting
Yemen’s hospitals were already struggling before the latest escalation, relying on limited government funding and donations from citizens. Some facilities could not even pay their staff in full.
“We are in a very dangerous situation,” said Fahd al-Nazari, manager of the health office in Taiz province, which has taken in most of the newly displaced people. “Within a day or two, or a week at most, we might have to close down (some facilities). In fact, some hospitals are already closed.”
Three of the province’s 17 hospitals are no longer under government control. Hospitals across Taiz had received around 635 casualties, including 112 bodies, as of Thursday after the Houthis captured Mokha, al-Nazari said. They included civilians and combatants.
“We’re exhausted receiving wounded people under these circumstances,” al-Nazari said.
Medical supplies and fuel are running short after key supply routes between Mokha and Taiz were largely cut off, forcing convoys onto mountainous roads unsuitable for large trucks. Even before the escalation, public hospitals in the province had just one MRI machine available.
At the Yemeni-Swedish Maternity and Children’s Hospital in Taiz, incubators were full and two or three children were sharing beds in the emergency room, general manager Sami al-Sharabi said.
“I’m scared that the conflict would reach the hospital,” he said. “Any explosive that could hit us would destroy the hospital, as some parts of the building are already weak.”
Even hospitals in Aden, where Yemen’s government is based, struggle to cope. Doctors Without Borders said more than 60 wounded people had been admitted to Al-Gamhouria hospital in a week. Many needed urgent surgery or blood transfusions.
Fighters are also seeking emergency treatment
At a private hospital treating rebels in the Houthi-held city of Sanaa, two medical officials last week said it was overwhelmed with hundreds of wounded. The officials spoke on condition of anonymity because of security concerns.
It was not clear how many Houthi fighters have been killed or wounded overall. Few aid agencies operate in rebel-controlled areas, as the group has detained and harassed dozens of humanitarian workers. Experts say the Houthis have struggled to pay salaries to civil servants, including public sector doctors and diverted most tax revenues to their military wing.
The ICRC, one of the few global agencies still able to operate in Sanaa, last week said it delivered 22 tons of badly needed medical supplies to support “overwhelmed” hospitals.
There is also little information about casualties among government forces, though one government-allied group has said over 1,500 of its fighters were wounded.
Some medical workers have fled the conflict, making it harder to find care.
In Mokha, Doctors Without Borders said its small team was still working “despite the severe shortage of health professionals.” The charity’s deputy coordinator of operations in Yemen, Emmanuel Massart, said three other hospitals there had closed for days before resuming services.
The need for hospital funding and resources in Yemen remains urgent, Massart said, speaking to the AP from Brussels, even as he acknowledged that resupplying remains a major challenge because of closed roads.
“We should not forget about Yemen,” he said. It “remains one of the worst humanitarian crises in the world.”
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Khaled reported from Cairo and Anna from Jerusalem. Associated Press writers Abdulnasser Alseddik in Aden and Toqa Ezzidin in Cairo contributed to this report.
