Yemen: Addressing acute watery diarrhoea

Twenty out of Yemen’s 22 governorates have seen a surge in the number of people with acute watery diarrhoea, as more than 63,000 cases have been reported in the country as of 31 May, according to health authorities. Despite the limited testing capacity in the country, more than 2,700 of the tested cases came back positive for cholera.

MSF teams launched a response in eight governorates, providing medical treatment for patients, training for medical and non-medical staff, donations of medical supplies, and carrying out health promotion activities.

Medical team inside one of the cholera treatment centre’s tent providing medical care for cholera and acute watery patients. Aden city, Yemen. ©MSF
Plan C department for severe cases inside Aden’s cholera treatment centre run by MSF with bed capacity reaching 70. ©MSF

Aseela suffered from vomiting and diarrhoea for four days before her mother Sila was able to make the two-hour journey to bring her to the Médecins Sans Frontières (MSF) mother and child hospital in Taiz Houban, in Taiz governorate, southwestern Yemen, where we run an acute watery diarrhoea treatment centre.

“I had to go into debt to cover the bus transport costs to the hospital,” says Sila. “My husband doesn’t work; we have no source of income. To put food on the table, I go into another village to ask people for flour and rice.”

One and a half year old Amat was falling in and out of consciousness. Her fever wasn’t going down, and she had diarrhoea. Her mother rushed her to a health centre, then another, where she was misdiagnosed and thus given the wrong treatment. When she wasn’t getting better, she was referred to MSF’s treatment centre in Mokha.

My village is three hours away from Mokha. We cannot afford the expensive cost of treatment in the nearby clinic. I lost two children, one because of a high fever. I took him to the clinic, but I could not save him. I fear the same thing will happen again.
Mother of Amat, MSF's one and a half year old patient

Although acute watery diarrhoea has been a recurrent disease in Yemen for years, such a surge in the number of cases poses a risk to the lives of people who already have limited access to healthcare.

A nurse measures the blood pressure and heart rate of a patient in the acute watery diarrhea treatment center inside MSF-supported mother and child hospital in Taiz Houban, Taiz governorate. ©MSF
Measuring the blood pressure of a patient getting treatment in the cholera treatment centre. Aden city, Yemen. ©MSF

Meanwhile, Osama was suffering from severe dehydration and had to leave his kids at home to seek healthcare. He came over from Taiz governorate to the nearby Ibb governorate, where we run a diarrhoea treatment centre inside the MSF-supported Al-Qaida hospital in Kilo.

It took me around an hour and a half on a tough road to make it here. I can’t afford paying for the basic medical treatment needs in a private hospital in my district.
MSF's Patient
The cholera treatment center in Aden city, Yemen. ©MSF

Over at Hajjah governorate, we opened a 60-bed diarrhoea treatment centre in a school five minutes away from the MSF-supported Abs general hospital.

Our centre is the only place providing treatment to acute watery diarrhoea patients in this big district. Acute watery diarrhoea, although treatable, poses a risk to patients with comorbidities and pregnant women who face an increased chance of foetal mortality.
Dr Evangelina Lauxmann
MSF Medical Team Leader in Abs Project

On top of that, the rainy season has started in many areas where we provide support, which will exacerbate the spread of this water-borne disease from contaminated water sources.

Considering the lack of funding allocated for responding to the spread of disease, many international organisations have limited resources to spare, which makes the response inadequate. MSF is one of the few organisations providing treatment to patients with acute watery diarrhoea and cholera – which can kill within hours if left untreated.

In Aden, in collaboration with the health authorities, we run the only cholera treatment centre in the city, equipped with 70 beds, and located inside the MSF-supported Al-Sadaqa hospital. The centre is running at full capacity while the number of patients is steadily increasing.

There is a significant need for additional actions to counter the rising numbers. We emphasise the importance of preventative measures such as the provision of safe water, sanitation and hygiene practices, extensive health promotion efforts, to effectively address this situation.
Federica Franco
MSF Head of Mission in Yemen
Health promoters hang posters about hygiene practices to respond to the spread of acute watery diarrhea. ©MSF
A nurse adjusts the IV line of an acute watery diarrhea patient suffering from severe dehydration, in the diarrhea treatment center of MSF-supported mother and child hospital in Taiz Houban, Taiz governorate. ©MSF

In many areas where we are responding, if the number of patients exceeds our ability to treat them, MSF faces a challenge of finding and training medical, paramedical, and logistical staff to maintain patient treatment activities.

Without wide-scale water and sanitation activities in the most affected governorates, and in the absence of community outreach activities for sensitization on proper hygiene practices and early detection of patients, the surge of acute watery diarrhoea cases is expected to return in waves over the coming months.

Between April and May, MSF treated more than 10,500 patients in different parts of Yemen.

MSF has been working in Yemen continuously since 2007. MSF is present in 13 governorates providing medical support to people living in precarious conditions with limited access to healthcare.
In Taiz governorate, in collaboration with the health authorities, MSF runs two diarrhoea treatment centres; in Taiz Houban inside the MSF-supported mother and child hospital, and in Taiz city inside the MSF-supported Al-Jumhouri hospital. We opened a cholera treatment unit in Mafraq, and a cholera treatment centre in Mokha set up inside MSF’s field hospital.
Elsewhere in Yemen, we are running acute watery diarrhoea treatment centres in Al-Wehda hospital in Dhamar governorate and in a charity centre in Ad-Dahi, Al-Hudaydah governorate. We established oral rehydration points in both governorates inside primary healthcare centres we support.
In Abs, Hajjah governorate, we opened a diarrhoea treatment unit inside Abs general hospital, then moved activities to a treatment centre in a school five minutes away from the hospital.
In Kilo, Ibb governorate, we opened a diarrhoea treatment centre inside the MSF-supported Al-Qaida hospital. In Ataq, Shabwa governorate, we are running a cholera treatment centre in collaboration with the health authorities. In Marib governorate, we established oral rehydration points in two primary healthcare centres we support.

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