‘Hand-washing is a luxury’: Coronavirus fears compound dire situation for pregnant women in Yemen’s displacement camps

MSF says pregnant women in displacement camps are among the world’s most vulnerable to complications and disease, as Fuad Rajeh and Charlene Rodrigues report

Even before Covid-19 came to Yemen, only three in 10 women used hospitals for birth (UNFPA)

Laila Al-Hofaishi is nearly eight months pregnant, weighing just 40kg with a pallid face and tired eyes. She has struggled to leave her mattress for three days straight, exhausted from walking long distances through the hot desert.

She doesn’t have a choice. As a resident of a cramped shelter in Jufainah, the largest displacement camp outside the Yemeni city of Marib, even the simplest of errands to access basic amenities is a chore that takes its toll on a body weakened by poor nutrition. “All I eat is bread and water,” she tells The Independent from the camp by phone.

Al-Hofaishi, 35, says that when the first Covid-19 cases were confirmed in neighbouring Hadhramout province last month, the 500 families living, eating, sleeping, praying and playing in close proximity in her Block 12 were gripped with fear over the threat of coronavirus.

Since then, two cases have been identified in the Marib region itself, among 180 confirmed across the south of Yemen, of which 29 have resulted in deaths. The Interior Ministry’s Civil Registration Office has, however, issued 950 death certificates citing “unknown reasons”.

Locals, in both the north and the south of the country, say they are helpless and confused as obituaries multiply and photos of preparations for mass graves populate their online media. There are alarming inconsistencies in the death toll numbers as testing capacity is low, but government officials have also been tight-lipped and heavy flooding in Aden, where one of only five Covid-19 laboratories is based, has hampered efforts.

Al-Hofaishi fears that the cramped nature of the camp means it would be easy for infections to spread there, but with her baby’s birth only a few weeks away, her biggest concern now is whether she can afford a hospital birth.

Her worries don’t end with the delivery. When the baby does arrive, it will have to contend with the hunger, and the hot weather. Electricity only comes to the campsite for four hours a day. Cholera, diphtheria, dengue, and malaria are rife: the scarcity of sanitation and clean water make most camps an ideal incubator for disease. Last week, heavy flooding battered several provinces across the country from Sana’a in the north to Aden in the south, with camps among the worst affected.

Located 170km east of Yemen’s capital, Sana’a, Marib province has enjoyed relative economic stability. Since the start of the war, it is estimated nearly 4.03 million people have been displaced and Marib alone hosts at least 800,000 of those who have fled the fighting. Yet since January this year, Marib too has become the site of some of the fiercest clashes.

Yemen’s brutal war started in 2015 after the Iran-backed Houthis ousted the then president, Abedrabbo Mansour Hadi, and took control over vast swatches of the country. Saudi Arabia and its allies intervened and started a bombing campaign to reinstate Mr Hadi and stop Tehran establishing a stronghold.

The conflict has been described by the UN as the world’s worst humanitarian crisis and rendered roughly half of the country’s health facilities non-functional.

At the beginning of March, the International Organisation for Migration (IOM) opened its first health centre at the Jufainah camp, extending ante-natal care to nearly 800 women. But Nabila Al Ayal, a co-ordinator for reproductive health programmes in Marib, says it is not enough: displaced women and children far outnumber the capacity at local medical centres.

Last week, the UN Population Fund warned more than 48,000 women in Yemen could die from childbirth and pregnancy complications due to funding shortages which threaten the survival of reproductive health centres.

Even before Covid-19 came to Yemen, only three in 10 women used hospitals for birth. This is down to a number of factors: health centres lack specialised doctors and neonatal units, and expectant mothers are often unaware of the importance of routine check-ups. But more than anything else, families who have gone without regular incomes for nearly three years because of the war cannot afford either to pay for medical services or the transportation to get to hospital.

Al-Hofaishi has not seen a doctor in seven months. Her husband’s unreliable work as a labourer earns them 5,000 rials (£16) per day, less than the 8,000 rials cost of baby formula. Like 80 per cent of Yemen’s 30 million people, she is reliant on the UN’s humanitarian assistance – and the announcement that the UN plans to shut 31 of its 41 major humanitarian programmes due to a lack of funding came as a severe shock. “Child milk is so expensive for a family in our situation. Vaccination and diapers too,” she said, feeling let down by the international community.

Women who miss routine medical checkups put themselves and their babies in grave danger, says Nawal Al Saqqaf, a gynaecologist at Kara Public Hospital in Marib. In mountainous regions, there are stories of mothers using trees or caves as shelters in which to give birth.

Even without the added threat of coronavirus, Médecins Sans Frontières says pregnant women in displacement camps are some of the most vulnerable in the world. Common complications include prenatal bleeding and anaemia due to severe malnourishment. “We sometimes receive dead pregnant women, dead babies or women with pre-labour complications such as severe bleeding,” Al Saqqaf says. Even after successful treatment, women are physically and psychologically traumatised.

The maternal mortality rate has more than doubled throughout the war, from five to 12 deaths per day in 2018. Yet, these figures are scant in the absence of proper health records in both Houthi and Yemeni government-controlled areas.

With the arrival of Covid-19, the World Health Organisation (WHO) and local aid groups have rolled out awareness programmes to educate Yemeni families about hand-washing and physical distancing. But one mother in the camp, nursing her 5-year-old and speaking on condition of anonymity, said that washing hands was a luxury. “Water is not available. There are no sterilisers. All we have is masks.”

In Azzan Health centre, a remote UN-funded clinic in northwestern Hajjah province, gynaecologist Dr Amani Al-Tayeb said that since the start of the outbreak, panicked mothers had been rushing to her clinic with the common cold, fearing they have the virus.

The fighting rages unabated, despite the Saudi-led coalition’s calls to extend a unilateral ceasefire for a month, due to end on Saturday. An earlier two-week ceasefire was rejected by the Houthis, who continued to pound key military fronts.

The British foreign secretary, Dominic Raab, has called on all parties to the conflict to cease hostilities. Yet last month the RAF and Britain’s largest weapons company BAE Systems were accused by Declassified UK of continuing to support Saudi Arabia with defence equipment and training under a shared government agreement, despite the UN’s calls for a truce.

A spokesperson for the Houthi-run health ministry, Yousuf Al-Hadhri, said the authorities have increased awareness programmes and testing for all Yemenis including displaced persons in areas under their control. In Yemen’s government-held territories, the health ministry spoke of plans to open quarantine centres and testing labs, but declined to comment on any specifics for pregnant mothers.

Like any mother, Al-Hofaishi says she wants a “normal life” for her children, a solid roof over their heads and access to education and healthcare.

“Our homes have been destroyed, our men killed, our land confiscated, our sources of income ended. They are fighting for power, and we are dying from hunger, cold and hot weather and rain.”