12 May 2015 - 19 out of Yemen’s 22 governorates are now affected by violence and conflict. More than 300 000 people are estimated to have been newly displaced, while thousands of others are trapped by the fighting and unable to flee to safer areas.

There are an estimated 3600 internally displaced persons (IDPs) living in safe areas of Aden governorate, adding a serious burden on already impoverished areas such as Al-Buraika district, which has been receiving an influx of internally displaced persons every day since the conflict escalated. The district’s 7 schools are currently overcrowded with hundreds of IDPs who fled the violence by boat or on foot.

WHO is one of the few organizations that provides health services, medicines and water and sanitation supplies for IDPs in Al-Buraika. The Organization has distributed essential medicines, cleaning materials, water tanks and pipes to each school.

In cooperation with the Field Medication Foundation, a local nongovernmental organization, WHO has established mobile clinics in Al-Buraika to provide health, nutrition, water and sanitation, and referral services for the IDPs.

“The turnout to the mobile clinics is high and we’re doing our best to cope with increasing number of IDPs who need urgent health interventions,” said Dr Latifa Abbas, nutrition officer at WHO’s sub-office of Aden. “We’re making every effort to provide health services amid a serious lack of electricity, fuel and water.”

In terms of health staff, the clinics consist of 2 physicians, 2 nurses and a registration assistant. Cases of severe acute malnutrition and diarrheal diseases among children have been screened and treated. There are also 20 pregnant women in the schools who need special care, with 2 women requiring delivery with caesarian section.

“There are no means of transport, no ambulances and no fuel to refer urgent cases to the main hospital, especially complicated severe acute malnutrition cases who need to receive intensive care in a therapeutic feeding centre. We’re also facing many challenges in transporting medical supplies to the area,” said Dr Abbas, who adds that the members of the host community help transport urgent cases to the hospital with their own private cars.

Humanitarian partners estimate that almost 15.9 million people – or 61% of the population -- require some kind of humanitarian assistance in Yemen, of which more than 7.5 million people are estimated to be in need of health care services.

15 May 2015, Amman, Jordan — The World Health Organization (WHO) is scaling up its provision of medicines and medical supplies into Yemen during the current humanitarian pause. More than 20 tonnes of medicines and medical supplies have been flown from WHO’s humanitarian hub in Dubai to Djibouti, where they will be loaded on a UN vessel departing for Hodeida today. The shipment contains international emergency health kits, trauma kits, surgical supply kits, emergency diarrhoeal disease kits, and water, sanitation and hygiene items for more than 120 000 beneficiaries. WHO is also providing a shipment of anti-malaria medicines from the Global Fund to Fight AIDS, Tuberculosis and Malaria sufficient for 44 950 treatment courses of malaria.

An additional 74 tonnes of medicines and medical supplies from WHO’s warehouse in Sana’a will be distributed to 14 locations (Sana'a, Taiz, Aden, Al Baida, Shabwa, Sa'ada, Lahj, Abyan, Al-Dale, Hodaidah, Hadramout, Hajjah, Marib and Aljawf).

WHO is scaling up its activities on the ground during the pause, including providing primary health care services through mobile health clinics in Aden, Sana'a and Hodeida and expanding vaccination activities to previously inaccessible areas. WHO is also providing more than 251 800 litres of fuel to 13 hospitals, 2 kidney dialysis centres, 2 vaccine centres, oxygen factory, national laboratory and ambulances to ensure continued functionality of health services, as well as providing safe water to hospitals and locations hosting internally displaced persons.

“In addition to giving WHO and other humanitarian partners the chance to scale up their response on the ground, we hope that this pause will provide much-needed respite from the insecurity and allow populations, especially pregnant women and children, to safety reach health facilities and receive the urgent care they need,” said Dr Ahmed Shadoul, WHO Representative for Yemen.

Dr Shadoul and WHO’s emergency coordinator for Yemen Dr Iman Ahmed are currently in Yemen as part of an interagency mission, and are meeting with local health authorities, WHO national staff and health cluster partners to discuss gaps and urgent needs.

“Our discussions with national and local health authorities and WHO staff on the ground are allowing us to immediately identify and respond to urgent health needs,” said Dr Shadoul. “We are working closely with local and international nongovernmental organizations that have continued to support the communities in Yemen during this difficult time and are taking full advantage of the pause to provide health care services for all vulnerable people, especially those in areas trapped by the violence.”

As of 11 May, more than 1700 people have been killed and nearly 7075 injured by the conflict in Yemen. More than 300 000 have been newly displaced since March, and almost 8.6 million people are in need of health services around the country.

Media contacts

Tarik Jašarević Mobile: +41 793 676 214 E-mail: jasarevict@who.int

Sadeq Hasan Mobile: +962 7 9840 5345 E-mail: hasansa@who.int

19 May 2015 - Vaccinating children against life-threatening diseases during conflict can be a daunting task. Over the past few weeks, vaccinators and volunteers in Yemen have persevered to ensure the continuation of immunization activities in some of the most crisis-affected areas of Yemen. Their work has been challenged by insecurity, roadblocks, fuel shortages and power outages.

Mohammed Khaled, one of the supervisors of the immunization programme in Al-Zohra district of Hodeida, said that vaccinators have to walk for long distances to remote areas in extremely hot weather conditions due to lack of transportation caused by fuel shortages. “By the time they reach their destination, vaccinators are covered in sand from head to toe. One female vaccinator was treated for sunstroke,” he said.

‪‎Despite these challenging conditions, vaccinators have been able to successfully reach internally displaced persons (IDPs) and host communities and immunize children against polio, measles and rubella, as well as provide them with vitamin A supplementation. These vaccinations were implemented in Sana’a City, Al Hodaida, Hajja, Shabwa, Abyan, Lahj and Aden. Unfortunately, due to the insecurity, total figures of children vaccinated have not been yet obtained from the field. ‬‬‬‬

“Due to the insecurity, parents are reluctant to take their children out to health facilities to be immunized. This makes it even more critical that we expand our outreach activities, and make sure that we reach as many children as possible,” said Dr Ahmed Shadoul, WHO Representative for Yemen. “WHO is committed to continuing its utmost support to save lives of Yemeni children, especially in affected areas. Yemen has been polio free since 2006 and we want to make sure that every child continues to be protected against this disfiguring disease,” he added.

WHO, together with Yemen’s Ministry of Health and health partners,‬‬‬‬‬ has scaled-up its support to immunization programmes by providing fuel needed for generators to maintain the vaccine cold chain, and making regular visits with officials from the Expanded Programme on Immunization to national vaccine stores to ensure that vaccines are safe and the cold chain is functioning.

21 May 2015 – In a speech at a side meeting "A tribute to health workers" at the World Health Assembly, Dr Ala Alwan, WHO Regional Director for the Eastern Mediterranean, called for the respect and safety of health care workers and facilities and paid tribute to the invaluable, and often dangerous work, health and aid workers undertake. He began by paying tribute to the hundreds of health care workers in West Africa, who on the frontline in the battle against Ebola, had contracted the disease. Many had died while helping to save the lives of others.

In the Eastern Mediterranean Region, health care workers in many countries face challenging circumstances that pose a serious threat to their lives. On a daily basis, they face physical injury, mental trauma and even death. An impact felt also by families, friends and colleagues.

Dr Alwan said that each time there had been an attack on health care workers or premises WHO had urged all parties to respect their obligations under international humanitarian law and the Geneva Conventions, which strictly prohibit attacks on health care premises, vehicles, personnel and patients. While some measures to protect health workers and volunteers had been taken, attacks in the Region and around the world had continued. “The neutrality of health care workers and health facilities is not being respected in many conflicts across the Region. Escalating conflict and the massive scale of humanitarian needs across the Region continue to place health care workers at great risk. What we see today in terms of the magnitude of conflicts and their devastating impact on health is unprecedented and the same is true for the risk to health workers,” he added.

Just 4 weeks ago, two Yemeni Red Crescent paramedics – brothers – were killed when their ambulance was hit as they helped injured patients in Aden. At around the same time, 2 Syrian Red Crescent volunteers were killed while retrieving dead bodies in Idlib. In March, attacks on polio vaccination teams in Pakistan left 4 dead and one injured. In February, 3 aid workers from the Sudanese Red Crescent were killed and one injured after supporting a humanitarian relief mission. In January, 5 health workers were kidnapped by gunmen in Herat province, Afghanistan, during a field visit.

In 2013, attacks on aid workers reached an unprecedented global high, with 75% of attacks taking place in the Region, in Afghanistan, Pakistan, Somalia, Sudan and Syrian Arab Republic. This trend is increasing.

In countries where conflict is ongoing, the negative impact on access to health care has been enormous. Attacks on health care workers and health facilities create shortages of qualified health staff, as health care workers leave with their families. In Iraq, more than 40% of the health workforce has left as a result of the conflict. In Somalia, attacks on health care workers and facilities have forced the suspension of medical activities, delaying critical health and nutrition programmes. When Médicines Sans Frontières ended its 22-year operation in Somalia in August 2013 due to threats to its staff, more than 50 000 people lost access to outpatient medical treatment every month, and a total of 1.5 million people lost access to health care. In Pakistan, recurring fatal security incidents involving polio vaccination teams in Pakistan have resulted in immunization campaigns being cancelled: in 2015 alone, 5 rounds of immunization campaigns were cancelled because of serious security threats.

“We must find new approaches so that we can take more effective and robust action to protect people and health workers during conflicts. At the same time we need to train health care professionals, especially those who are at most risk in protecting their own lives. This is a collective responsibility. Civil society, media, and international institutions should play a role in ensuring that violations are brought to light,” urged Dr Alwan.

As the international community continues to advocate for the protection of health care workers, Dr Alwan encouraged governments to play a greater role by ensuring safe and secure access to health services for all and strengthening accountability for attacks on health. He stressed the need to work together beyond the health sector to ensure that providing health care and life-saving measures did not come at the expense of the lives of health care givers and their patients. He concluded that this was only possible if countries took up this task as a priority.

Media contact

Rana Sidani
Senior Communication Officer
WHO Regional Office for the Eastern Mediterranean
Direct: +20 2 22765552
Mobile: +20 1099756506
E-mail: sidanir@who.int

WHO statement by WHO Director-General, Dr Margaret Chan

27 May 2015

The conflict in Yemen is entering its 10th week and the numbers of dead and injured continue to grow. As always in conflict, it is innocent civilians that pay the highest price. Almost 2000 people have been killed and 8000 injured so far, including hundreds of women and children.

The shelters housing internally displaced persons are full of stories of loss and survival. For example, 6-year-old Malak lost her mother and saw others around her die as her family fled the fighting and 65-year-old Fathiya lost 13 members of her family and is now the sole guardian of 3 grandchildren who survived.

Almost 8.6 million people are in urgent need of medical help. WHO was able to dispatch almost 48 tonnes of medicines into the country during the 5-day ceasefire earlier this month, serving some 400 000 people. This is vastly insufficient - and people continue to suffer not only from war-related injuries, but from inability to get basic treatment for the most common health conditions, or get obstetric care during childbirth.

As the conflict continues, more lives are lost every day, not just due to the violence, but as a health system that has been seriously damaged barely copes with the extraordinary needs posed by the unrelenting violent conflict and can no longer provide them with the health services they need to stay alive. The health and lives of millions of people are at risk.

Hospitals around the country are closing down their emergency operations rooms and intensive care units due to shortages in staff and fuel for generators. Medicines for diabetes, hypertension and cancer are no longer available. The National Tuberculosis Programme has shut down in some areas, and infectious diseases such as malaria and dengue fever are spreading. Outbreaks of polio and measles are also serious risks.

Throughout the conflict, there have been widespread violations of international humanitarian law and Geneva Conventions for the protection of health facilities, staff and patients. Health infrastructure continues to be hit, with attacks reported on hospitals and ambulances, a medical warehouse, an oxygen factory, and a blood transfusion centre. Some health care workers were killed trying to save lives and more injured.

This unnecessary loss of innocent lives cannot go on. The health system must be allowed to function unimpeded by the insecurity. All parties must respect their obligations under international humanitarian law to protect civilians, health facilities and health staff during conflict and to permit the supply of vital humanitarian aid, such as medicines, vaccines and medical equipment to areas where it is needed most, and ensure the right to urgently-needed lifesaving health care.

Current major event

Ongoing conflict in Yemen: Surveillance needs to be stepped up

The ongoing conflict in Yemen has severely damaged the public health infrastructure in the country. As a result and owing to severe destruction of the public utility services and routine public health services, there is an apprehended risk of major outbreaks in the country as the summer months progress.

3 June 2015, Amman, Jordan – Mass population movement and a failing health system have exposed internally displaced people in Yemen to increased, life-threatening health risks.

More than one million internally displaced people have fled the violence to neighbouring governorates. Many of them are housed in public spaces where living conditions are overcrowded and often unsanitary. Within schools, for example, some of which host upwards of hundreds of displaced Yemenis, people share a single washroom per gender.

In Aden governorate, doctors are reporting increasing cases of dengue fever and malaria, as well as growing cases of acute watery diarroea due to poor sanitation and limited access to safe water. “As the number of internally displaced persons increase, diseases and infections are spreading rapidly,” said Dr Moheeb Obad, head of the Field Medical Foundation (FMF), a local nongovernmental organization working with WHO and UNICEF to provide primary health care and referral services to internally displaced persons in Aden, Lahj, Al-Dhalea, Shabwa and Abyan governorates.

With disruptions in vaccination activities as a result of the insecurity, cases of measles have also increased, especially among internally displaced persons living in overcrowded shelters, where risk of transmission between under-vaccinated children is high. Polio is also a serious risk, although until now, Yemen remains polio-free.

“The health situation in shelters hosting internally displaced people is worrying,” said Dr Ahmed Shadoul, WHO Representative for Yemen. “This is exacerbated by a disrupted disease surveillance system due to the insecurity, as well as inadequate access to basic health care services due to shortages in qualified health staff and limited functionality of health facilities.” In Aden, Abyan, Hodeida, Amran and Sana’a governorates, conditions in shelters have exacerbated the health situation of internally displaced people, especially those suffering from chronic disease such as diabetes, asthma, kidney diseases and hypertension who have limited access to treatment due to reduced health care services and critical shortages in essential medicines.

Thousands of internally displaced people in Hajja governorate are overloading the local health system. Dr Khaled Al-Nadheri, Deputy Director of the Health Office in Hajja governorate, told WHO that Al-Jamhouri Hospital, the only public hospital in the governorate, is barely functional. “Many of the internally displaced people are women and children, including a large number of pregnant and lactating women and malnourished children in need of urgent support,” said Dr Al-Nadheri. Health partners on the ground in Taiz governorate are reporting that health facilities are overburdened by large numbers of internally displaced people and Khalefa hospital reporting zero stocks of medicines in its supply store.

“WHO is working with partners to support the health needs of internally displaced people throughout the country with mobile health teams, safe water supplies, sanitation services, and medicines and medical supplies. But much more needs to be done, and this can only happen if health facilities remain fully functional, if health staff and disease surveillance officers are able to report to work safely, and if medicines and medical supplies are able to reach areas where they are needed most,” said Dr Shadoul.

Dengue situation in Yemen

For over 10 years (2000 to 2011) Yemen faced repeated outbreaks of severe dengue. An upsurge of dengue fever has recently been reported in Yemen where over 1 million people have been internally displaced and health systems have been disrupted.

More than 3 026 suspected cases of dengue fever have been recorded since 27 March to 04 June 2015 and three deaths, a case fatality rate of 0.01%. However, unconfirmed reports that WHO is verifying with national authorities suggest that cases of dengue fever and deaths in the affected governorates especially in Aden, could be much higher.

New cases were first reported in Hodeidah governorate on 27 March 2015. Since then, additional suspected cases have been recorded in five other governorates of Lahj (Al-Hoata,Tuban), Hadramout,Aden, Taiz, Shabwa.

Dengue Fever is endemic in Yemen, occurrence of the disease follows seasonal patterns with high incidence in the month of April to August; the last major outbreak was in 2011 in Hodeida governorate with 1500 confirmed cases. The number of reported cases received from multiple cases by WHO and validated by MOH are currently increasing.

WHO Response

As a result of a concerted multi sectorial approach by health partners and WHO to support the Ministry of Health and health authority governorates, epidemiological field investigations and entomological survey focusing on the dengue mosquito vector and breeding sites in Al-Hodiedah, Hadramout and Aden governorates have been carried out; WHO standard case definitions have been adopted in Yemen to identify symptoms consistent with dengue fever

Currently, WHO is supporting health authorities in Yemen and other health sector partners to coordinate the response efforts; 24/7 hours operation room has been activated in the ministry of Health in Saana to monitor the upsurge in cases; weekly meetings are being conducted to gather more data, discuss challenges and take actions to address them.

In addition, WHO has enhanced epidemiological surveillance in all affected governorates and delivered Rapid Diagnostic test for testing Malaria in affected areas.

WHO has also supported the printing and distribution of case management for Haemorrhagic Fevers and provided more than 100 thousand units of IV fluids and other supplies for supportive treatment; these have been delivered to health centres and hospitals in affected governorates with the exception of Aden and Taiz due to access challenges.

Health Situation

The crisis in Yemen has caused immense suffering to the population, leaving them vulnerable to diseases like dengue fever, other communicable and non-communicable diseases. Access continues to challenge the delivery of humanitarian health assistance, through which dengue fever may spread further and cause higher mortalities and impede laboratory confirmation.

Disrupted immunisation activities have left millions of children below the age of five unvaccinated, increasing the risk of outbreaks of measles, which is prevalent in Yemen, and polio, which has been eliminated but is now at risk of reappearing with devastating consequences.

Limited access to health care services and a breakdown in safe water supply and sanitation services has facilitated the spread of endemic diseases such as malaria and dengue fever, as well as acute diarrheal diseases. The insecurity is preventing control activities for malaria season, expected in July.

Dengue

There is no specific treatment for dengue fever. For severe dengue, medical care by physicians and nurses experienced with the effects and progression of the disease can save lives – decreasing mortality rates from more than 20% to less than 1%. Maintenance of the patient's body fluid volume is critical to severe dengue care.

There is no vaccine to protect against dengue. However, major progress has been made in developing a vaccine against dengue/severe dengue. Three tetravalent live-attenuated vaccines are under development in phase II and phase III clinical trials, and 3 other vaccine candidates (based on subunit, DNA and purified inactivated virus platforms) are at earlier stages of clinical development. WHO provides technical advice and guidance to countries and private partners to support vaccine research and evaluation.

At present, the only method to control or prevent the transmission of dengue virus is to combat vector mosquitoes through: preventing mosquitoes from accessing egg-laying habitats by environmental management and modification;

19 June, 2015 | Sana’a, Yemen: A major health crisis is unfolding in conflict-ravaged Yemen, where hospitals have been destroyed, health workers killed and critical shortages of food, medical supplies and fuel are causing large-scale suffering , according to the World Health Organization (WHO).

“Urgent action is needed to safeguard health facilities and ensure people caught up in the insecurity have access to health care,” says Dr Ahmed Shadoul, WHO’s Representative to Yemen.

“Yemen’s health system is on the verge of breakdown, and it is only thanks to the heroic efforts of the country’s health workers, the resilience of its brave people and the tireless efforts of national and international humanitarian organizations that any semblance of health care is being provided.”

From 19 March to 15 June 2015, more than 2800 people have been killed in the conflict, and approximately 12 500 injured, according to Yemen’s Ministry of Health.

Key health challenges include:

• more than 15 million people, including over one million internally displaced person (IDPs), in dire need of health services;

• critical shortages of medicines for diabetes, hypertension and cancer, and essential supplies including trauma kits and blood bags;

more than 3000 suspected cases of dengue fever;

• 1.8 million–2.5 million children at risk of diarrhoeal diseases and up to 1.3 million children at risk of acute respiratory infections;

• increase in hospital admissions for malnutrition by 150% since March;

• tens of thousands of pregnant women face great difficulty in accessing antenatal and emergency obstetric care;

• health worker safety under threat, including 5 deaths and 5 injuries, and at least 53 health facilities damaged – including 17 hospitals, as well as the Operations Room of the Ministry of Health in Sana’a, which manages all emergency operations for the entire country;

• more than 20 million people in Yemen lack access to safe drinking-water and sanitation.

WHO and Health Cluster partners have been responding to the Yemen health crisis by providing supplies, services and support to national and regional authorities.

Since March, WHO has:

• dispatched approximately 130 tonnes of medicines and medical supplies, to provide emergency and routine care to 4.7 million people for 3 months;

• distributed more than 650 000 litres of fuel to health facilities to support their continued functioning;

• deployed disease surveillance and humanitarian experts to support WHO’s response;

• provided safe water and sanitation kits and supplies to health facilities and IDP camps;

• delivered cleaning tools and equipment, safety materials and awareness publications to health centres and more than 250 households;

• trained local nursing staff of 3 main hospitals in Sana’a (Al-Kwait, Al-Jumhoori and Al-Sabeen hospitals) who have replaced evacuated foreign staff.

Humanitarian needs have grown immensely since the conflict started. On Friday, the revised Yemen Humanitarian Response Plan was released to respond to these increased demands, including in the health sector. The plan calls for US$ 152 million to enable WHO and Health Cluster partners to continue meeting the health needs of 15 million people.

Current major event

Suspected dengue fever cases rise in Yemen

Yemen is currently experiencing a significant surge of suspected dengue fever in six of its governorates -Hodeidah, Taiz, Aden, Lahj, Shabwa and Hadramount. According to some unconfirmed sources, a total of 3,026 suspected dengue fever cases including 3 related deaths were reported from these governorates. Owing to escalating conflict and war, this information could not be verified.

26 June 2015 – The World Health Organization’s response to the crisis in Yemen has been bolstered by an injection of US$ 8,021,884 in funding from the United Nations Central Emergency Response Fund (CERF). The contribution is the largest allocation of funding from CERF to WHO to date, and will be used for the delivery of life-saving medicines for non-communicable diseases.

“Non-communicable diseases – things like diabetes, cancer and high blood pressure – are not the first things people think of when picturing health needs during a humanitarian emergency but, in Yemen, this is a critical need,” explained Ahmed F. Shadoul, WHO Representative to Yemen. “This record-breaking contribution from CERF will enable us to reduce the suffering of hundreds of thousands of people, including over half a million children.”

More than 20 million people in Yemen have been affected by a complex crisis involving ongoing conflict and a strict embargo on the import of many essential commodities, including commercially procured medicines and medical supplies.

As a result, hospitals are running out of medicines for chronic diseases such as cancer, diabetes, hypertension, chronic respiratory illnesses and haemophilia. This shortage is worsening as the embargo continues, affecting increasing numbers of women, men, boys and girls. These patients are mainly civilians who are not party to the conflict, yet their right to health is being jeopardized.

“The $8 million from CERF will allow WHO to immediately address critical health needs and help with delivery of life-saving medicines to affected people in Yemen,” said Antoine Gérard, Chief, a.i., of the CERF secretariat.

However, the effect of the crisis on the broader health system has also been severe:

“The unprecedented scale of this contribution from CERF reflects the unprecedented scale of health needs in Yemen right now,” continued Dr Shadoul. “Yemen’s health system is on the brink of collapse. An increasing number of health facilities are non-functional thanks to both the conflict and the disruption of supplies, and more than 15 million people are in need of health services.

“In addition, the crisis conditions have created the perfect environment for communicable diseases to spread. We have already seen more than 3000 suspected cases of dengue since March, and three confirmed deaths.”

WHO is working with partners to fill critical gaps in the provision of basic health care, strengthen disease surveillance, distribute medical supplies and deliver life-saving services to mothers and their children. To date, WHO has distributed almost 130 tons of medical supplies and more than 500,000 litres of fuel to maintain the functionality of hospitals, vaccine stores, ambulances, national laboratories and health centres.

Yet the health sector response to the crisis is severely underfunded. WHO’s humanitarian response in Yemen is currently facing a funding shortfall of 82%. Under the revised Yemen Humanitarian Response Plan, the total funding request for the health sector is US$ 152 million, of which WHO is requesting US$ 70 million.

Other recent contributors to WHO’s response to the crisis in Yemen include Finland, Japan, Russia, Norway and UNOCHA.

Current major event

Suspected dengue fever cases rise in Yemen

Yemen is currently experiencing a significant surge of suspected dengue fever in six of its governorates-Hodeidah, Taiz, Aden, Lahj, Shabwa and Hadramount. According to some unconfirmed sources, a total of 3,026 suspected dengue fever cases including 3 related deaths were reported from these governorates. Owing to escalating conflict and war, this information could not be verified.

6 July, 2015 ¦ GENEVA: From Tanzania to South Sudan, and Nepal to Yemen, cholera – and the threat of a cholera outbreak – is a major public health concern for governments and the international health community. Use of Oral Cholera Vaccines (OCV) is proving to be an efficient tool to effectively control cholera outbreaks. New outbreaks are ongoing in South Sudan and Tanzania fanned by insecurity and displacement. Intensive control efforts are ongoing, and vaccination programmes have been rolled out to target communities at risk. In conflict-wracked Yemen and earthquake-ravaged Nepal, WHO has been working with national authorities and partners on the ground to prepare for any outbreak of cholera, as well as acute water diarrhoea.

What is cholera?

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, from less than one day to five days, and produces an enterotoxin that causes a copious, watery diarrhoea; vomiting also occurs in most patients. Cholera can quickly lead to severe dehydration and death without prompt treatment.

Effectively controlling cholera

WHO and its partners are responding to outbreaks to effectively control the deadly water-borne disease through improved water and sanitation practices, use of oral cholera vaccines, better surveillance, and greater awareness among communities as to how to control it. The WHO-led Global Task Force on Cholera Control (1) aims to end cholera deaths by strengthening international collaboration and increasing coordination among partners in 3 of the main situations where cholera circulates:

1. in endemic conditions, where the disease is entrenched in communities, such as regions of the Democratic Republic of the Congo;

2. in sudden outbreaks, where an instant vaccination response is deemed most effective, such as in Guinea and Malawi; and

3. as a consequence of a humanitarian crisis, such as the late 2013 outbreak in South Sudan, or current outbreak in Tanzania when thousands of people displaced by fighting in neighbouring Burundi were successfully vaccinated against the disease.

Effectively controlling a disease means reducing new cases in defined locations to zero through targeted efforts. In the case of cholera, these include the use of oral cholera vaccine, improving water and sanitation practices, engaging the community in implementation of control measures, and sustaining control efforts to prevent its re-emergence.

Using the cholera vaccine to stop outbreaks

A global stockpile, funded by the Bill and Melinda Gates Foundation, the ELMA Vaccines and Immunization Foundation, the EU Humanitarian Aid and Civil Protection department (ECHO), the Margaret A Cargill Foundation and the USAID Office of Foreign Disaster Assistance, initially made 2 million doses of the vaccine available. In 2015, with funding from the GAVI Alliance, the number of doses available for use in both endemic hotspots and emergency situations is expected to rise to around 3 million.

The oral cholera vaccine is an important tool in fighting cholera. Its use must be both supported by local authorities and used hand-in-hand with focused, sustainable water and sanitation actions in targeted communities.

Since the establishment of the stockpile in 2013, close to 2 million doses of OCV were distributed. As this equals the number of vaccines used in 15 years before 2013, it is clear that, by increasing the supply of OCV, the stockpile mechanism was successful in developing the demand for cholera vaccines which is one of its main objectives.

There are several examples where the vaccine has stopped cholera outbreaks in their tracks, such as in South Sudan in 2014 when, before the occurrence of the outbreak, thousands of displaced people who had found shelter in makeshift camps at UN sites were given the vaccine. This action almost certainly averted increased illness and death amongst the vulnerable camp inhabitants who had been at high-risk of the disease.

More information: The Global Task Force on Cholera Control http://www.who.int/cholera/task_force/en/

HIGHLIGHTS

• An estimated 2,584 people have died and 11,065 injured from 19 March to 7 June as a result of the on-going conflict in Yemen (health facility-based reports).

• A total of 3,064 cases of suspected dengue fever have been reported since March 2015. Surges in cases of malaria and incidences of diarrhoeal diseases and pneumonia also continue to be reported.

• Access to health care has been severely impacted with nearly 50% drop in total consultations since the conflict began.

• On 3 June, the Operations Room of the Ministry of Health in Sana’a, which manages all emergency operations for the entire country, was partially damaged. The room plays a critical role in emergency health response throughout Yemen and the damage incurred impeded already strained emergency health relief operations.

• Since the beginning of the crisis, WHO has distributed almost 130 tons of medicines and medical supplies and more than 500,000 litres of fuel to maintain the functionality of hospitals serving an excess of 4.7 million people, including 700,000 internally displaced persons and 140,000 children under the age of five.

11 July 2015, Sana’a, Yemen – A 7-day humanitarian pause is scheduled to begin in Yemen today. This second humanitarian pause, if fully respected by all parties to the conflict, would provide desperately needed respite for millions of civilians, and enable WHO and health partners to respond to some of the most life-threatening needs.

During the pause, WHO will focus its efforts on distributing life-saving health assistance to locations in most dire need in the governorates of Sana’a, Aden, Al Dhale’e, Lahj, Hajjah, Mukalla, Marib Sa’ada, Taizz.

WHO support will include:

• distributing life-saving emergency medicines, health kits and medical supplies to the main functioning health facilities in these governorates;
• conducting field outbreak investigations for dengue fever/malaria, including verifying diagnosis and case management;
• distributing long lasting insecticidal bet nets to internally displaced persons (IDPs) and affected populations;
• distributing water jerry cans to areas hosting IDPs;
• providing water testing kits to the water authority in Aden;
• training rapid response focal points on implementing WHO standard case definition and treatment for dengue fever;
• conducting a malaria entomological survey.

Humanitarian situation deteriorating

A total of 2 374 300 beneficiaries are expected to be reached by WHO and Health Cluster partners during the humanitarian pause.

“The humanitarian and health situation in Yemen continues to deteriorate,” said Dr Ahmed Shadoul, WHO Representative in Yemen. “In some governorates, such as Aden, many people no longer have direct access to food, fuel, medical care and safe drinking-water. This humanitarian pause will allow WHO and health cluster partners to more effectively scale up their response in affected governorates by reaching populations that have been cut off from care and urgently need life-saving health services.”

Health challenges

Access to health care in many affected governorates in Yemen is extremely challenging due to ongoing conflict and the closure of more than 54 health facilities due to damages. Lack of medical supplies and a disrupted surveillance system has impeded monitoring and response to increasing suspected disease outbreaks, and essential health services, such as immunization, nutrition, Integrated Management of Childhood Illness programme and disease control interventions are limited.

On 1 July, the crisis in Yemen was designated a “Level 3” emergency by the Inter-Agency Standing Committee (IASC), signifying the most critical level of emergency and triggering a system-wide activation to ensure a more effective response to the humanitarian needs of affected populations. Related links

Crisis in Yemen designated "Level 3" emergency

Latest situation reports

13 July 2015, Sana’a, Yemen -- The World Health Organization has delivered urgently needed health supplies to Aden governorate, where the humanitarian and health situation has critically deteriorated as a result of insecurity and restricted access.

The life-saving health supplies, which were delivered in six trucks as part of a United Nations convoy, contained 46.4 tonnes of medicines, medical supplies, and water and sanitation supplies for more than 84 000 beneficiaries in 8 districts of Aden governorate.

The shipment included first aid kits, medicines and supplies for trauma care, and kits for the treatment of diarrhoea. Following a surge in the number of suspected cases of malaria and dengue fever since the start of the crisis, most significantly in Aden, WHO also conducted rapid testing for dengue fever and malaria and provided support to Alwahda Hospital in Aden to resume functionality of its fever/dengue ward and trauma management centre.

National health professionals were trained by WHO experts on epidemiological field investigations and early warning system surveillance. As part of malaria preparedness activities, which had been delayed by the crisis, bed nets were distributed to more than 9000 households in four districts and residual spray materials and equipment were distributed in the 8 districts. Staff were also trained to begin house-to-house spraying.

Access to health care in Aden is extremely limited due to constant fighting, and most of the governorate’s 31 health facilities are non-functional due to critical shortages in medical supplies and fuel needed for generators. “The humanitarian and health situation in Yemen continues to deteriorate, but the health situation is especially critical in Aden, with many people no longer having direct access to food, fuel, medical care and safe drinking-water,” said Dr Ahmed Shadoul, WHO representative in Yemen.

To date, WHO has distributed a total of more than 175 tonnes of medicines and medical supplies and more than 500 000 litres of fuel to maintain the functionality of main hospitals, vaccine stores, ambulances, national laboratories, kidney and oncology centres, and health centres in 13 governorates, reaching a total of almost 5 million people, including 700 000 internally displaced persons and 140 000 children under the age of 5.

• An Immunization campaign against polio, measles and rubella was conducted by the Ministry of Health and WHO for IDPs in 9 governorates (Sana’a Governorate, Sana’a City, Amran, Hajja, Hodeida, Dhamar, Ibb, Shabwa, Hadramout) targeting around 50,000 children below the age of 15.

• 46.4 tons of medicines, medical supplies, and water and hygiene materials were distributed successfully in 8 districts of Aden Governorate. Despite ongoing ground fights in some districts, WHO teams have managed to deliver the supplies to health facilities. (Please note that these delieveries were part of the recent humanitarian convoys)

• Essential medicines, medical supplies and hygiene materials were delivered to Taiz, Hajja and Sa’ada to help main health facilities provide vital health services for IDPs and for those injured by continuous armed conflict.

• There are no reported cases of cholera in Yemen.

• WHO delivered anti diarrheal kits for treatment of 100 severe cases and 400 moderate cases to be used for the AWD/cholera outbreak. (5 kits in Aden and 5 kits in Hodiedah).

• WHO continues to support IDP shelters in Sana’a with mobile health teams, referral services and cleaning materials. WHO will start health education campaign to raise awareness about personal hygiene among IDPs.

• Two fixed medical clinics have been set up by WHO in Crater District of Aden to provide health services.

• Two mobile medical teams operated by Field Medical Foundation (FMF), a local NGO, and supported by WHO, has provided integrated health services including vaccination, IMCI, RH, nutrition and disease control.

• WHO is gearing up for seven mobile clinics to cover most populated districts in Lahj Governorate including Toban where many IDPs are stationed in. Al-Madhariba District will be targeted to cover health services to refugees in Kharaz camp in coordination with UNHCR.