In four weeks since Yemeni health officials first announced a cholera outbreak on 6 October, of 11 cases, the number has jumped to 67 in addition to more than 2,070 suspected cases this week. There are eight confirmed deaths because of cholera and 38 suspected to have died from the infection. According to the World Health Organisation, more than 7.6 million people are currently living in areas affected by the outbreak, while more than three million internally displaced persons are especially vulnerable. Unless the primary causes of the outbreak are addressed, cholera cases are likely to increase, with predictions of up to 76,000 additional cases across 15 governorates, including 15,200 severe cases requiring admission for treatment. Yemen, the Arab world's poorest country, already had a weak and unsustainable infrastructure and a vulnerable health sector. Both have been severely damaged as a result of the 18-month long Saudi-led war on the country since March 2015. The cholera outbreak has exacerbated Yemen's health crisis where half the country's health facilities have been rendered non-operational. “There's a total collapse in the entire health sector,” said Rana Sidani from WHO's regional office. And now two-thirds of Yemen's population don't have access to safe drinking water. “The infrastructure is very damaged; it has affected water supplies.” Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It has a short incubation period and can quickly lead to severe dehydration and death if treatment is not promptly given. The infection has spread in nine governorates, including Taiz, Aden, Lahj, Al-Hudaydah, Hjjah, the capital Sanaa, Al-Baida, Dhammar and Ibb. No cases have appeared in the northeast governorates. The armed conflict in Yemen — which isn't limited to the Saudi-led coalition but also extends to besieged southern areas resisting Houthi control, with little or no access to food and medical supplies — has caused internal migration of millions of Yemenis, many of whom are continuously moving from one governorate to the other, thus spreading the disease across southwest Yemen. There is also external migration of thousands from neighbouring Ethiopia and Djbouti. “This has exacerbated the problem,” said Sidani. According to the World Food Programme (WFP), one in every five in Yemen is severely food insecure. More than 14 million Yemenis are already food insecure, including more than seven million in desperate need of food assistance, in addition to facing a measles outbreak, famine and malnourishment. In some areas, like Hodeidah governorate, Global Acute Malnutrition rates among children under five as high as 31 per cent have been recorded — more than double the emergency threshold of 15 per cent. Almost half of all children countrywide are irreversibly stunted, according to the WFP. As a result, the organisation was forced to resort to emergency funds from its main headquarters in Geneva and regional office in Cairo. With the help of health partners in Yemen, the money is funding emergency units in existing hospitals and health facilities mandated to address cholera only. Health volunteers are going from house to house in infected areas distributing hygiene kits and advising Yemenis on how to prevent infections. But without an end to the war, no amount of money can contain the rapid spread of the infection as long as the vast majority of Yemenis continue to have no access to potable water or health facilities amid a battered infrastructure.
