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Health catastrophe: the toll of cholera in Yemen
Editorial
Yemen is in the grips of the worst cholera epidemic in history. At the time of our going to press in mid-July, more than 330 000 cases and 1700 deaths (a quarter of them children) have been recorded since the start of the outbreak in late April, 2017. The UN is calling it a man-made humanitarian disaster, placing the blame squarely on the parties involved in the country’s ongoing civil war and their political allies. Cholera—a diarrhoeal disease caused by the bacterium Vibrio cholerae—is transmitted by consumption of faeces-contaminated water or food. The disease is virtually non-existent in developed countries (no cases originating in the UK have been reported for over a century), but it thrives in conditions of poor water sanitation and hygiene; its health effects are compounded by poor health and malnutrition. In Yemen, the disease has spread with unprecedented speed. The outbreak started in late April, 10 days after the sewer system failed in Sana’a, Yemen’s capital and the centre of the outbreak. By early July, an estimated 7000 new cases were being diagnosed each day. Cholera is easily treated—80% of cases can be successfully treated with rehydration therapy, and more severe cases with antibiotics—but without prompt treatment, it can be fatal within hours. The civil war started in 2015, when Saudi Arabia and its regional allies launched a bombing campaign to restore the Yemeni government that was ousted from Sana’a in 2014 by Shia Houthi rebels. After more than 2 years of war, the country’s water and sanitation systems are nearing collapse, fewer than half of hospitals and clinics in the country are operating, and blockades on Saudi-controlled air and sea ports hamper import of medicines and humanitarian aid. As a result, deaths from cholera are mounting, adding to more than 10 000 civilian deaths already attributed to the war itself. In mid-June, the International Coordinating Group (ICG) on vaccine provision announced that it would dispatch to Yemen one million doses of cholera vaccine—only a third of the doses requested by WHO but roughly half of the global stockpile. However, with half the doses already en route, plans for a vaccination effort were deemed futile and scrapped, citing security issues, challenges in distribution and administration, and the sheer scale of the epidemic (the vaccine can only be given to uninfected individuals). Efforts will instead www.thelancet.com/gastrohep Vol 2 September 2017
shift to providing clean water to the nearly 16 million Yemenis who currently lack access. The Red Cross, for example, has dispatched engineers who are working to restore water supply systems locally. Provisions are also flowing into Yemen in response to the cholera epidemic. On July 3, WHO sent a 403-tonne shipment of aid, including hospital equipment, medical supplies, and ambulances—one of many organisations providing emergency supplies. The Red Cross has shipped 300 tonnes of intravenous fluids, huge quantities of chlorine, antibiotics, and oral rehydration kits. But so far the epidemic is outpacing humanitarian efforts; fewer than half of the roughly 5000 beds needed in cholera treatment centres and a third of the 2000 oral rehydration points are currently available. Funds are also meagre. Before the cholera outbreak even began, the UN estimated that US$2·1 billion would be needed to prevent a full-blown humanitarian catastrophe in Yemen. Their High-Level Pledging Event for the Humanitarian Crisis in Yemen, held on April 25 in Geneva, raised only US$1·1 billion, pledged from various donors, including the European Commission, the Central Emergency Response Fund, and non-governmental and humanitarian organisations. A separate $250 million funding appeal to combat cholera yielded only $47 million. Cholera has also forced aid groups to divert funds away from combating malnutrition for the roughly 12 million people facing famine. In the short term, additional, immediate, unimpeded humanitarian aid is needed to save the lives of those suffering from cholera in Yemen. The humanitarian organisation Oxfam has called for the international community to redouble efforts to broker a ceasefire in Yemen so that this aid can be delivered more effectively and safely. In the longer term, however, ensuring the health of the Yemeni people will require lasting peace. In a June 15 statement, the UN Security Council called for “all parties to engage constructively and in good faith to find a peaceful solution to the conflict in [Yemen].” So far, the warring parties show no sign of backing down. But without peace, another devastating health crisis will undoubtedly follow on the heels of cholera, and the Yemeni people have little hope of finding relief from the suffering wrought by this man-made humanitarian crisis. ■ The Lancet Gastroenterology & Hepatology
Khaled Abdullah/Reuters
Health catastrophe: the toll of cholera in Yemen
For more on the WHO international coordinating group (ICG) on vaccine provision see http://www.who.int/csr/ disease/icg/qa/en/ For the statement from the UN Security Council meeting see https://www.un.org/press/ en/2017/sc12873.doc.htm
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Yemen is in the grips of the worst cholera epidemic in history. At the time of our going to press in mid-July, more than 330 000 cases and 1700 deaths (a quarter of them children) have been recorded since the start of the outbreak in late April, 2017. The UN is calling it a man-made humanitarian disaster, placing the blame squarely on the parties involved in the country’s ongoing civil war and their political allies. Cholera—a diarrhoeal disease caused by the bacterium Vibrio cholerae—is transmitted by consumption of faeces-contaminated water or food. The disease is virtually non-existent in developed countries (no cases originating in the UK have been reported for over a century), but it thrives in conditions of poor water sanitation and hygiene; its health effects are compounded by poor health and malnutrition. In Yemen, the disease has spread with unprecedented speed. The outbreak started in late April, 10 days after the sewer system failed in Sana’a, Yemen’s capital and the centre of the outbreak. By early July, an estimated 7000 new cases were being diagnosed each day. Cholera is easily treated—80% of cases can be successfully treated with rehydration therapy, and more severe cases with antibiotics—but without prompt treatment, it can be fatal within hours. The civil war started in 2015, when Saudi Arabia and its regional allies launched a bombing campaign to restore the Yemeni government that was ousted from Sana’a in 2014 by Shia Houthi rebels. After more than 2 years of war, the country’s water and sanitation systems are nearing collapse, fewer than half of hospitals and clinics in the country are operating, and blockades on Saudi-controlled air and sea ports hamper import of medicines and humanitarian aid. As a result, deaths from cholera are mounting, adding to more than 10 000 civilian deaths already attributed to the war itself. In mid-June, the International Coordinating Group (ICG) on vaccine provision announced that it would dispatch to Yemen one million doses of cholera vaccine—only a third of the doses requested by WHO but roughly half of the global stockpile. However, with half the doses already en route, plans for a vaccination effort were deemed futile and scrapped, citing security issues, challenges in distribution and administration, and the sheer scale of the epidemic (the vaccine can only be given to uninfected individuals). Efforts will instead www.thelancet.com/gastrohep Vol 2 September 2017
shift to providing clean water to the nearly 16 million Yemenis who currently lack access. The Red Cross, for example, has dispatched engineers who are working to restore water supply systems locally. Provisions are also flowing into Yemen in response to the cholera epidemic. On July 3, WHO sent a 403-tonne shipment of aid, including hospital equipment, medical supplies, and ambulances—one of many organisations providing emergency supplies. The Red Cross has shipped 300 tonnes of intravenous fluids, huge quantities of chlorine, antibiotics, and oral rehydration kits. But so far the epidemic is outpacing humanitarian efforts; fewer than half of the roughly 5000 beds needed in cholera treatment centres and a third of the 2000 oral rehydration points are currently available. Funds are also meagre. Before the cholera outbreak even began, the UN estimated that US$2·1 billion would be needed to prevent a full-blown humanitarian catastrophe in Yemen. Their High-Level Pledging Event for the Humanitarian Crisis in Yemen, held on April 25 in Geneva, raised only US$1·1 billion, pledged from various donors, including the European Commission, the Central Emergency Response Fund, and non-governmental and humanitarian organisations. A separate $250 million funding appeal to combat cholera yielded only $47 million. Cholera has also forced aid groups to divert funds away from combating malnutrition for the roughly 12 million people facing famine. In the short term, additional, immediate, unimpeded humanitarian aid is needed to save the lives of those suffering from cholera in Yemen. The humanitarian organisation Oxfam has called for the international community to redouble efforts to broker a ceasefire in Yemen so that this aid can be delivered more effectively and safely. In the longer term, however, ensuring the health of the Yemeni people will require lasting peace. In a June 15 statement, the UN Security Council called for “all parties to engage constructively and in good faith to find a peaceful solution to the conflict in [Yemen].” So far, the warring parties show no sign of backing down. But without peace, another devastating health crisis will undoubtedly follow on the heels of cholera, and the Yemeni people have little hope of finding relief from the suffering wrought by this man-made humanitarian crisis. ■ The Lancet Gastroenterology & Hepatology
Khaled Abdullah/Reuters
Health catastrophe: the toll of cholera in Yemen
For more on the WHO international coordinating group (ICG) on vaccine provision see http://www.who.int/csr/ disease/icg/qa/en/ For the statement from the UN Security Council meeting see https://www.un.org/press/ en/2017/sc12873.doc.htm
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