Highlights
- From 27 April to 24 July 2017, 396,086 suspected cholera cases and 1,869 deaths (CFR: 0.5%) have been reported in 91.3% (21/23) of Yemen governorates, and 88.6% (295/333) of the districts.

Geographical distribution of cases
- The five most affected governorates were Amanat Al Asimah, Al Hudaydah, Hajjah, Amran and Ibb with 53.2% (210,718/396,086) of the cases reported since 27 April 2017.
- Al Mahwit, Al Dhaele’e, and Amran governorates had the highest attack rates (30.1‰, 29.5‰ and 26.5‰ respectively).
- Raymah ,Hajjah and Ibb governorates reported the highest case fatality ratios (1.3%, 0.9% and 0.8% respectively) (see table).

Situation Overview
- From 27 April to 16 July 2017, a total of 351,045 suspected cholera cases and 1,790 associated deaths were reported from 21 governorates.
- More than half of the suspected cholera cases have been reported from Sana’a City (45,701), Hudaydah (42,813), Hajjah (37,647), Amran (36,116) and Ibb (27,098) (Table 1).
- Al-Dhale’e governorate accounted for the highest attack rate (26.1 per 10 000), followed by Al-Mahweet (25.3 per 10 000) and Amran (23.6 per 10 000).
- The national case fatality ratio is 0.5%. The case fatality ratio is below the internationally accepted threshold of 1% in all governorates except in Reymah where it is 1.3%.

Highlights
- From 27 April to 20 July 2017, 372,915 suspected cholera cases and 1,837 deaths (CFR: 0.5%) have been reported in 91.3% (21/23) of Yemen governorates, and 88.6% (295/333) of the districts.

Geographical distribution of cases
- The five most affected governorates were Amanat Al Asimah, Al Hudaydah, Hajjah, Amran and Ibb with 53.7% (200,155/372,915) of the cases reported since 27 April 2017.
- Al Dhaele’e, Al Mahwit and Amran governorates had the highest attack rates (27.8‰, 26.7‰ and 25.1‰ respectively).
- Raymah ,Hajjah and Ibb governorates reported the highest case fatality ratios (1.3%, 0.9% and 0.8% respectively) (see table).
- The five most affected districts were Al Hali district (Al Hudaydah governorate, 14,354 suspected cases and 23 deaths), Ma’ain (Amanat Al Asimah governorate, 9,274 suspected cases and 10 deaths), Bani Al Harith (Amanat Al Asimah governorate, 9,132 suspected cases and 10 deaths), As Sabain (Amanat Al Asimah governorate, 7,285 suspected cases and 11 deaths), and Al Hawak (Al Hudaydah governorate, 7,010 suspected cases and 11 deaths).

Highlights
- From 27 April to 21 July 2017, 377,894 suspected cholera cases and 1,847 deaths (CFR: 0.5%) have been reported in 91.3% (21/23) of Yemen governorates, and 88.6% (295/333) of the districts.

Geographical distribution of cases
- The five most affected governorates were Amanat Al Asimah, Al Hudaydah, Hajjah, Amran and Ibb with 53.6% (202,536/377,894) of the cases reported since 27 April 2017.
- Al Dhaele’e, Al Mahwit and Amran governorates had the highest attack rates (28.3‰, 27.2‰ and 25.4‰ respectively).
- Raymah ,Hajjah and Ibb governorates reported the highest case fatality ratios (1.3%, 0.9% and 0.8% respectively) (see table).
- The five most affected districts were Al Hali district (Al Hudaydah governorate, 14,489 suspected cases and 23 deaths), Ma’ain (Amanat Al Asimah governorate, 9,342 suspected cases and 10 deaths), Bani Al Harith (Amanat Al Asimah governorate, 9,153 suspected cases and 10 deaths), As Sabain (Amanat Al Asimah governorate, 7,329 suspected cases and 11 deaths), and Al Hawak (Al Hudaydah governorate, 7,056 suspected cases and 11 deaths).

Cholera continues to spread in Yemen, causing more than 390 000 suspected cases of the disease and more than 1800 deaths since 27 April.

WHO and its partners are responding to the cholera outbreak in Yemen, working closely with UNICEF, local health authorities and others to treat the sick and stop the spread of the disease.

Each of these cholera cases is a person with a family, a story, hopes and dreams. In the centres, where patients are treated, local health workers work long hours, often without pay, to fight off death and help their patients make a full recovery.

Read the photostory

Download multimedia material: http://bit.ly/2vYhlOm

ADEN/SANA’A, 26 July 2017 – “As the heads of three United Nations agencies – UNICEF, the World Food Programme (WFP) and the World Health Organisation (WHO) – we have travelled together to Yemen to see for ourselves the scale of this humanitarian crisis and to step up our combined efforts to help the people of Yemen.

“This is the world’s worst cholera outbreak in the midst of the world’s largest humanitarian crisis. In the last three months alone, 400,000 cases of suspected cholera and nearly 1900 associated deaths have been recorded. Vital health, water and sanitation facilities have been crippled by more than two years of hostilities, and created the ideal conditions for diseases to spread.

“The country is on the brink of famine, with over 60 per cent of the population not knowing where their next meal will come from. Nearly 2 milllion Yemeni children are acutely malnourished. Malnutrition makes them more susceptible to cholera; diseases create more malnutrition. A vicious combination.

“At one hospital, we visited children who can barely gather the strength to breathe. We spoke with families overcome with sorrow for their ill loved ones and struggling to feed their families.

“And, as we drove through the city, we saw how vital infrastructure, such as health and water facilities, have been damaged or destroyed.

“Amid this chaos, some 16,000 community volunteers go house to house, providing families with information on how to protect themselves from diarrhea and cholera. Doctors, nurses and other essential health staff are working around the clock to save lives.

“More than 30,000 health workers haven’t been paid their salaries in more than 10 months, but many still report for duty. We have asked the Yemeni authorities to pay these health workers urgently because, without them, we fear that people who would otherwise have survived may die. As for our agencies, we will do our best to support these extremely dedicated health workers with incentives and stipends.

“We also saw the vital work being done by local authorities and NGOs, supported by international humanitarian agencies, including our own. We have set up more than 1000 diarrhoea treatment centres and oral rehydration corners. The delivery of food supplements, intravenous fluids and other medical supplies, including ambulances, is ongoing, as is the rebuilding of critical infrastructure – the rehabilitation of hospitals, district health centres and the water and sanitation network. We are working with the World Bank in an innovative partnership that responds to needs on the ground and helps maintain the local health institutions.

“But there is hope. More than 99 per cent of people who are sick with suspected cholera and who can access health services are now surviving. And the total number of children who will be afflicted with severe acute malnutrition this year is estimated at 385,000.

“However, the situation remains dire. Thousands are falling sick every day. Sustained efforts are required to stop the spread of disease. Nearly 80 percent of Yemen’s children need immediate humanitarian assistance.

“When we met with Yemeni leaders -- in Aden and in Sana’a -- we called on them to give humanitarian workers access to areas affected by fighting. And we urged them – more than anything – to find a peaceful political solution to the conflict.

“The Yemeni crisis requires an unprecedented response. Our three agencies have teamed up with the Yemeni authorities and other partners to coordinate our activities in new ways of working to save lives and to prepare for future emergencies.

“We now call on the international community to redouble its support for the people of Yemen. If we fail to do so, the catastrophe we have seen unfolding before our eyes will not only continue to claim lives but will scar future generations and the country for years to come.”

###

About UNICEF
UNICEF promotes the rights and wellbeing of every child, in everything we do. Together with our partners, we work in 190 countries and territories to translate that commitment into practical action, focusing special effort on reaching the most vulnerable and excluded children, to the benefit of all children, everywhere.

For more information about UNICEF and its work for children, visit www.unicef.org

For more information, please contact:
Bismarck Swangin, UNICEF Yemen, +967 712 223161, bswangin@unicef.org
Toby Fricker, UNICEF MENA Regional Office, +962-79-9-54-48040, tfricker@unicef.org
Juliette Touma, UNICEF MENA Regional Office, +962, 79-867-4628, jtouma@unicef.org

About WFP
WFP is the world’s largest humanitarian agency fighting hunger worldwide, delivering food assistance in emergencies and working with communities to improve nutrition and build resilience. Each year, WFP assists some 80 million people in around 80 countries.
Follow us on Twitter: @wfp_media and @wfp_mena
Abeer Etefa, WFP/Sana’a, Mob. +201066634352
Reem Nada, WFP/Sana’a, Mob. +201066634522

About WHO
WHO helps countries prepare for, prevent, respond to and recover from emergencies quickly, whether these are caused by disease outbreaks, disasters or conflict. WHO’s Health Emergencies Programme is comprehensive, addressing all hazards, flexibly, rapidly and responsively, with a principle of ‘no regrets’. It works synergistically with other WHO programmes and partners to address the full cycle of health emergency preparedness, response and recovery.

For more information on WHO’s work in emergencies, visit www.who.int/emergencies
Follow WHO Yemen on Twitter and Facebook
For more information, please contact:
Lauren O’Connor, WHO Yemen, +967 739 888 991, oconnorl@who.int
Christian Lindmeier, WHO Headquarters, +41 79 500 6552, lindmeierch@who.int

EXECUTIVE SUMMARY

Yemen is in the grip of a fast spreading cholera outbreak of unprecedented scale. This plan presents an integrated response to the significant upsurge of acute watery diarrhoea (AWD)/suspected cholera cases across the country, since 27 April. Consequently, as of 28 June, a total of 254,871 suspected cases, with 1,439 associated deaths (0.6% CFR) were reported from 286 districts (20 Governorates). On 14 May, the MoHP declared a state of emergency stating that the health system is unable to contain this unprecedented health and environmental disaster. An additional, 280,358 cases are projected from the high risk districts in the coming six months till end of 2017.

The plan outlines emergency health, WASH and communications interventions to contain and prevent further spread of the outbreak in the 286 high risk districts, where suspected cholera cases were reported during the period October 2016 to June 2017 (see Annex 1 for details). Health and WASH clusters will continually identify priority districts from high risk districts, by considering the number of cases and attack rate.

A total of $ 254 million is required to implement activities outlined in this integrated plan for 6 months from May to December 2017, to control the outbreak, prevent further spread, and minimize the risk of recurrence. Considering available resources, including almost $50 million allocated through YHPF, WB, China and KSReleif, the net requirement totals to $207 million.

1. OVERVIEW OF THE CHOLERA OUTBREAK

The Yemen’s Ministry of Public Health and Population (MoPHP) confirmed a cholera outbreak in Amanat al Asimah Governorate in October 2016. Subsequently, the outbreak spread to close to 165 districts in 16 Governorates by the end of December 2016. The trend of the cholera outbreak and case-fatality rate then declined during the period January to March, with the number of districts reporting suspected cholera cases dropping to 25. The decline in the epidemic curve could be partly attributed to the health and WASH interventions. A total of 24,504 suspected cases, including 143 associated deaths (with a case-fatality rate of 0.44%) were reported by the end of March 2017.

The resurgence of the outbreak during the last week of April resulted in a cumulative of 254,871 suspected cases, with 1,439 associated deaths (0.6% CFR) by 28 June, rapidly spreading to 286 districts (in 20 governorates). With the rapid spread, the cumulative number of cases during the seven weeks period is six times more than those reported over a period of the first months in the October 2016 outbreak.

The outbreak is spreading against the backdrop of a major humanitarian crisis. The current upsurge of cholera cases is attributed to prevalence of risk factors including disruption of public health and WASH services amidst increasingly collapsing basic services, displacement, and inadequate sanitation conditions. Less than 45 per cent of all health facilities are fully functional and more than 8 million people lack access to safe drinking water and sanitation.

The situation is further aggravated by high prevalence of severe food insecurity and malnutrition. The health condition of this vulnerable population is already compromised by the deteriorating situation, increasing their susceptibility to cholera infection and associated complications contributing to higher case fatality rate. Two years of conflict, compounded by an economic decline have devastated livelihoods, depleted safety nets, weakened social service delivery, and ability to access social services.

Health and WASH clusters immediately mobilized partners to scale up response. Two emergency operations centres have been established in Aden and Sana’a to oversee surveillance activities and coordinate the response. As of 28 June, 2,351 CTC beds have been established to treat severe cases. Additionally, 311 community-level Oral Rehydration Points (ORPs) were opened in Sana’a and other affected governorates to treat moderate and mild cases, with a referral system of severe cases to the CTCs. Over 5 million people benefitted from chlorinated water supplies (at system and household levels), more than 2.5 million people benefitted from water storage disinfection (both at community and household levels). Almost 2 million people were reached with key cholera messages, through household, community and mass media campaigns. Water, sanitation and hygiene related activities took place in 165 districts in 18 governorates. Partners are re-programming resources to respond to the outbreak.

Despite these, the spread of the outbreak continue to outpace ongoing response efforts, and additional resources are required to scale up interventions to control the outbreak and prevent further spread.

Famine has been declared in parts of South Sudan and the food security situation is of grave concern in 7 other countries: Ethiopia, Kenya, Nigeria, Somalia, Sudan, Uganda, and Yemen. In these countries, 42.5 million are in need of humanitarian assistance and 41.8 million are in phase 3-5 Integrated Phase Classification between June and September 2017.

Health is a key component in the response to famine. Severe food insecurity and high levels of acute malnutrition are commonly linked to increased disease outbreaks, related illness and deaths, especially where there is inadequate health services. Health Cluster partners are therefore scaling up their efforts to ensure people most at risk have access to essential health care.

Highlights

From 27 April to 25 July 2017, 402,484 suspected cholera cases and 1,880 deaths (CFR: 0.5%) have been reported in 91.3% (21/23) of Yemen governorates, and 88.9% (296/333) of the districts.

Geographical distribution of cases

The five most affected governorates were Amanat Al Asimah, Al Hudaydah, Hajjah, Amran and Ibb with 53.2% (214,281/402,484) of the cases reported since 27 April 2017.

• Al Mahwit, Al Dhaele’e, and Amran governorates had the highest attack rates (30.8‰, 29.9‰ and 26.8‰ respectively)

• Raymah ,Hajjah and Ibb governorates reported the highest case fatality ratios (1.2% ,0.8% and 0.8% respectively)

Statement by UNICEF Executive Director, Anthony Lake, WFP Executive Director, David Beasley and WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, following their joint visit to Yemen

ADEN/SANA’A, 26 July 2017 – As the heads of three United Nations agencies – UNICEF, the World Food Programme (WFP) and the World Health Organisation (WHO) – we have travelled together to Yemen to see for ourselves the scale of this humanitarian crisis and to step up our combined efforts to help the people of Yemen. This is the world’s worst cholera outbreak in the midst of the world’s largest humanitarian crisis. In the last three months alone, 400,000 cases of suspected cholera and nearly 1900 associated deaths have been recorded. Vital health, water and sanitation facilities have been crippled by more than two years of hostilities, and created the ideal conditions for diseases to spread.

The country is on the brink of famine, with over 60 per cent of the population not knowing where their next meal will come from. Nearly 2 million Yemeni children are acutely malnourished. Malnutrition makes them more susceptible to cholera; diseases create more malnutrition. A vicious combination. At one hospital, we visited children who can barely gather the strength to breathe. We spoke with families overcome with sorrow for their ill loved ones and struggling to feed their families.

And, as we drove through the city, we saw how vital infrastructure, such as health and water facilities, have been damaged or destroyed.
Amid this chaos, some 16,000 community volunteers go house to house, providing families with information on how to protect themselves from diarrhea and cholera. Doctors, nurses and other essential health staff are working around the clock to save lives.

More than 30,000 health workers haven’t been paid their salaries in more than 10 months, but many still report for duty. We have asked the Yemeni authorities to pay these health workers urgently because, without them, we fear that people who would otherwise have survived may die. As for our agencies, we will do our best to support these extremely dedicated health workers with incentives and stipends.

We also saw the vital work being done by local authorities and NGOs, supported by international humanitarian agencies, including our own. We have set up more than 1000 diarrhoea treatment centres and oral rehydration corners. The delivery of food supplements, intravenous fluids and other medical supplies, including ambulances, is ongoing, as is the rebuilding of critical infrastructure – the rehabilitation of hospitals, district health centres and the water and sanitation network. We are working with the World Bank in an innovative partnership that responds to needs on the ground and helps maintain the local health institutions.

But there is hope. More than 99 per cent of people who are sick with suspected cholera and who can access health services are now surviving. And the total number of children who will be afflicted with severe acute malnutrition this year is estimated at 385,000.

However, the situation remains dire. Thousands are falling sick every day. Sustained efforts are required to stop the spread of disease. Nearly 80 percent of Yemen’s children need immediate humanitarian assistance.

When we met with Yemeni leaders -- in Aden and in Sana’a -- we called on them to give humanitarian workers access to areas affected by fighting. And we urged them – more than anything – to find a peaceful political solution to the conflict.

The Yemeni crisis requires an unprecedented response. Our three agencies have teamed up with the Yemeni authorities and other partners to coordinate our activities in new ways of working to save lives and to prepare for future emergencies.

We now call on the international community to redouble its support for the people of Yemen. If we fail to do so, the catastrophe we have seen unfolding before our eyes will not only continue to claim lives but will scar future generations and the country for years to come.

Download multimedia material: http://bit.ly/2vYhlOm

About WFP

WFP is the world’s largest humanitarian agency fighting hunger worldwide, delivering food assistance in emergencies and working with communities to improve nutrition and build resilience. Each year, WFP assists some 80 million people in around 80 countries.

Follow us on Twitter: @wfp_media and @wfp_mena

Abeer Etefa, WFP/Yemen, Mob. +201066634352
Reem Nada, WFP/Yemen, Mob. +967 739 555 099

About UNICEF

UNICEF promotes the rights and wellbeing of every child, in everything we do. Together with our partners, we work in 190 countries and territories to translate that commitment into practical action, focusing special effort on reaching the most vulnerable and excluded children, to the benefit of all children, everywhere.
For more information about UNICEF and its work for children, visit www.unicef.org

For more information, please contact:
Bismarck Swangin, UNICEF Yemen, +967 712 223161, bswangin@unicef.org Toby Fricker, UNICEF MENA Regional Office, +962-79-9-54-48040, tfricker@unicef.org
Juliette Touma, UNICEF MENA Regional Office, +962, 79-867-4628, jtouma@unicef.org

About WHO

WHO helps countries prepare for, prevent, respond to and recover from emergencies quickly, whether these are caused by disease outbreaks, disasters or conflict. WHO’s Health Emergencies Programme is comprehensive, addressing all hazards, flexibly, rapidly and responsively, with a principle of ‘no regrets’. It works synergistically with other WHO programmes and partners to address the full cycle of health emergency preparedness, response and recovery.

For more information on WHO’s work in emergencies, visit www.who.int/emergencies Follow WHO Yemen on Twitter and Facebook
For more information, please contact:
Lauren O’Connor, WHO Yemen, +967 739 888 991, oconnorl@who.int
Christian Lindmeier, WHO Headquarters, +41 79 500 6552, lindmeierch@who.int

Implementation of Event Based Surveillance in Jordan

Jordan is conducting a training workshop for the launch of event based surveillance (EBS) for acute respiratory infections. The workshop to be conducted in Amman, Jordan, from 24 to 27 July 2017 will target public health officers responsible for surveillance and response at governorate level and health professionals from all secondary and tertiary level hospitals in the country.

Editorial note

EBS is defined as the organized collection, monitoring, assessment and interpretation of mainly unstructured ad hoc information regarding health events or risks, which may represent an acute risk to human health. It is a component of a comprehensive early warning surveillance system.

The establishment of EBS for acute respiratory infections in Jordan was based on recognition of the need to complement and enhance capacity for early warning of its surveillance system for severe acute respiratory infections (SARI) that Jordan has implemented for many years. Jordan has been reporting Influenza data to FluNet and EMFLU in a sustainable way during the past few years (Please see the table).

Massive urbanization, increased population movements, increased international travel and trade has created conditions for rapid spread of emerging and reemerging infectious hazards such as MERS and influenza. Recent examples in Jordan include the MERS-CoV outbreak in 2015 which had an imported index case.To respond to these new challenges and public health threats, the International Health Regulations (IHR) of 2005 have underscored the need for countries to strengthen early warning surveillance systems through implementation on event based surveillance (EBS) systems to ensure early detection and timely response to health events.

Through a collaborative effort between the Ministry of Health, CDC and WHO, Jordan will go a long way towards ensuring timely detection of emerging and dangerous respiratory infections such as MERS and Influenza.

Through lectures, case studies, practical exercises and discussions, the training workshop will introduce participants to the new national EBS guidelines for acute respiratory events, priority acute respiratory events for reporting, EBS procedures and information flow at all levels, available tools for EBS activities at all levels including electronic tools for reporting sites, from the detection and reporting level in private and public hospitals to central coordination level.

By enhancing the capacity for early warning of the national surveillance system of Jordan, the country is expected to detect early signals of any epidemic-prone acute respiratory infections in humans that is associated with illness in animals, unexplained SARI that occurs in a healthcare worker who takes care of patients with respiratory illness, increased ICU admissions for respiratory illness, or increase in apparent mortality or unexplained deaths. It is expected that the EBS will increase the sensitivity of the surveillance system in the country to provide early warning and consequently rapid response to any acute respiratory infections that are potentially a threat to the population.

Highlights

From 27 April to 26 July 2017, 408,583 suspected cholera cases and 1,885 deaths (CFR: 0.4%) have been reported in 91.3% (21/23) of Yemen governorates, and 88.9% (296/333) of the districts.

Geographical distribution of cases

The five most affected governorates were Al Hudaydah , Amanat Al Asima, Hajjah, Amran and Dhamar with 53% (216,874/408,583) of the cases reported since 27 April 2017.

• Al Mahwit, Al Dhaele’e, and Amran governorates had the highest attack rates (31.3‰, 30.4‰ and 27.2‰ respectively)

• Raymah ,Hajjah and Ibb governorates reported the highest case fatality ratios (1.2% ,0.8% and 0.8% respectively) (see table).

Number of suspected cholera cases & deaths, AR and CFR by governorate, Yemen, 27 April – 26 July 2017

27 July 2017 – The Ministry of Public Health and Population of Yemen has reported a cumulative total of 408 583 suspected cases of cholera including 1885 associated deaths as of 26 July for the outbreak which started in October 2016.

The overall case-fatality rate of 0.5% remains below the emergency threshold of 1%. However it is higher in Raymah (1.2%), Ibb (0.8%) and Hajjah (0.8%). The number of suspected cholera cases and deaths has declined compared to previous weeks, although there is a backlog of case information currently under review, and these numbers could change.

WHO and health partners support the Ministry through the cholera task force to improve cholera response efforts at the national and local levels. This includes the establishment of 47 diarrhoea treatment facilities and 278 oral dehydration centres in 16 governorates; training of health workers to manage cases, water purification in communities, deployment of rapid response team to manage cholera cases investigations and respond to the outbreak, and enhancement of Yemen’s disease early warning surveillance systems. Since 27 April, WHO has provided more than 788 000 bags of intravenous fluids, 525 beds with cleaning supplies and 112 kits containing supplies for the treatment of cholera and diarrhoeal diseases.

A reactive cholera vaccination campaign using 1 million single doses of vaccine has been postponed at the request of health authorities in favour of a two-dose preventative vaccination campaign next year targeting more people in the highest risk districts, based on the availability of the vaccine in the global stockpile.

While cholera is endemic in Yemen, the country has experienced a surge in cholera cases since April, with nearly 5000 cases reported per day. Ongoing conflict, destroyed health, water and sanitation infrastructure and malnutrition have caused the people to be more vulnerable to diseases, including cholera.