The outbreak of cholera in Yemen
Abstract
Yemen has faced one of the largest outbreaks of cholera, which began from 2016 to date. It has the lowest level of poverty in the Middle East and the world. The civil war infested the country from 2015 to date. The war destroyed the critical infrastructure such as water supply system, key bridges, the port, and healthcare facilities. As a result, an outbreak of cholera occurred in the country because of the lack of water and unhygienic conditions. The paper is a literature review of the strategies used to address the outbreak of cholera in Yemen by international humanitarian organizations such as World Health Organization. The strategies used in the treatment of cholera included the use of antibiotics, oral and intravenous rehydration therapies. The future prevention strategies used involved repair of water supply systems, the providence of medical equipment and funds to run health care facilities and the establishment of water, sanitation, and hygiene (WaSH) intervention programs. Some of the recommendations suggested in the paper to carry out interventions in future include putting more presence of laboratories in different parts of the country to confirm cases of cholera, using intervention systems such as dipstick assays and decentralizing WaSH intervention programs.
Introduction
Yemen is a country found in the Middle East. It is a desert country which is bordered by Saudi Arabia to the North, Oman to the North East, red sea to the West and Bab-el-Mandeb Strait. Yemen has neighbors such as Somalia, Eritrea, and Djibouti across the Indian Ocean. Yemen became a national republic in 1990. Yemen had a population of 26,000, 000 in 2017 (Dureab, et al., 2018). According to Dereab, et al. (2018), Yemen has one of the lowest poverty levels in the Arabian Peninsula. Yemen is divided into 23 governatories (Dureab, et al., 2018). About 35 percent of the Yemen population is below the poverty line. Besides, the country is characterized by low literacy levels, high levels of food insecurity, malnutrition, and poor governance. Yemen has been tackling one of the world most massive Cholera outbreaks since 2016 to date. Until recent 21,865 suspected cases of cholera have been reported. This outbreak has affected 299 districts out of the 333 districts in Yemen. WHO has been on the forefront of fighting the worst cholera outbreak in history since 2016, Other Countries such as Saudi Arabia and the United Emirates have contributed financially to support WHO on its ongoing efforts to stop the spread of cholera in Yemen.
The ongoing conflict has deteriorated the living conditions of the population in Yemen. The country is currently involved with a civil war which commenced in 2015. The civil war has two warring sides, which include the government of President Abdrabbuh Mansur Hadi and Houthi led rebels. In 2015, the rebels laid a siege in Sana’a the capital city of Yemen. The conflict paralyzed the economic activities of Yemen, such as agricultural irrigation. The war also displaced a lot of citizens rendering most of the population homeless. The bombings and airstrikes destroyed the remaining infrastructure, such as the red seaport, water supply pipes, health facilities, and industries. Therefore, the country became inaccessible by sea. Also, the destruction of water pipes prevented 14.4 million from accessing safe water for drinking and sanitation (Dureab et al., 2018). Besides, about 14.8 million people had little or lacked access to healthcare facilities. The ongoing conflict made the government to lack resources for paying health professionals such as doctors and nurses. As a result, many Yemen citizens lacked access to proper healthcare.
Yemen started to experience a national crisis from 2016 to date due to an outbreak of cholera in the country. It is one of the worst epidemics in the current world. Even before the war began, the country had a suitable environment for the thriving of Vibrio cholera the agent that causes cholera. For instance, some cities in Yemen experienced water shortages for months. Besides, Yemen had a high rate of malnutrition, which weakened the immune system of children and adults in Yemen (Rabaan, 2019). When the war began in 2015, healthcare and water supply infrastructure became destroyed through airstrikes and bombing. As a result, the citizens lacked safe and clean water for drinking and cleaning and sanitation. Lack of water facilitated the prevalence of Vibrio cholera due to the accumulation of human waste. Besides, the Yemen government failed to pay health and sanitation workers, making most of them resign. The resignation of health workers made the Yemen population lack healthcare services. Besides, the resignation of sanitation workers resulted in the accumulation of garbage and human waste.
First wave of cholera epidemic hit Yemen in October 2016 (Kuna & Gajewski, 2017). When the civil war began, the government failed to pay sanitation workers World Health Organization (WHO) removed garbage wastes from the residential areas. Besides, the bombings destroyed water supply pipes. The garbage and human wastes contaminated water sources such as wells (Almosawa & Youssef, 2017). They were used by Yemenis to get water for drinking and cooking. The first wave of cholera outbreak majorly hit the city of Sana’a and Aden. The second wave of cholera epidemic took place on April 2017. It hit 22 of the 23 governorates. The heavy rains of April caused floods which spread the pathogens further. There have been other consecutive waves of the cholera outbreak which have continued hitting the country to date. Statistics from the World Health Organizations reported more than one million cases of cholera from the beginning of the epidemic. Besides, the outbreak has caused about 2385 deaths (Camacho, et al., 2018). Lack of access to safe water, adequate healthcare, and the destruction of infrastructures such as roads, bridges, ports, and health facilities have resulted to the high number of suspected cases and deaths caused by cholera.
Literature Review
Federspiel & Ali (2018) conducted a study to find out the strategies used by global humanitarian organizations to manage the cholera outbreak in Yemen. The study showed five humanitarians organizations which were the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), International Rescue Committee (IRC), International Committee of the Red Cross (ICRC) and Médecins Sans Frontières (MSF). These organizations used several strategies to deal with the cholera pandemic in Yemen. For instance, they deployed mobile teams which provided victims with nutrition and health services as well as drug and medical supplies. Besides, they established centers for the treatment of cholera and oral rehydration. They also sustained and supported the functioning of healthcare facilities and the treatment of cholera. Moreover, they disseminated about 2,000,000 liters of fuel for ambulances and hospital generators. Also, they delivered ambulances, cholera cots, and kits, IV fluids, diarrhea kits, Oral Rehydration Solution, medicine, chlorine tablets, antibiotics to prevent and treat cholera. They also supplied more than 1,000,000 people with clean and safe drinking water and conducted awareness campaigns to educate people about cholera. Besides, the organizations employed engineers to repair and restore the systems of water supply in Yemen.
The humanitarian organizations used some evidence-based strategies in the treatment of cholera in Yemen. For instance, they supplied oral rehydration solutions and intravenous fluids to people suspected with cholera in Yemen. Rehydration therapy includes the use of intravenous fluids and oral rehydration solutions. According to Kuna & Gajewski (2017), rehydration therapy is one of the most effective methods for treating cholera. It can be effectively used to treat 80% of the cases of cholera. Intravenous treatment involves the application of fluid into the body through the veins and is used in more severe cases (Hsueh & Waters, 2019).On the other hand, oral rehydration therapy is used in cases where the cholera infection is not much severe. The humanitarian organizations also used antibiotics in the treatment of cholera in Yemen. Antibiotics are used to mitigate the severity of cholera and reduce the time of recovery. For instance, it is used to reduce the occurrence of losing fluids through shedding stools and diarrhea (Kuna & Gajewski, 2017). It also reduces the amount of fluids needed during rehydration therapy.
Similarly, there are evidence-based strategies which were used to prevent the further spread of cholera in Yemen by the global humanitarian organizations. First, the organizations supplied chlorine tablets to carry out chlorination to infected water sources (Federspiel & Ali, 2018) and at home. Chlorination is an effective method of disinfecting water. It kills pathogens which spread communicable diseases such as cholera and typhoid. The organizations also repaired and restored water supply systems to provide safe and clean water for drinking and cooking. Besides, the organizations restored health and sanitation services by deploying health and sanitation workers. During the outbreak of cholera in 2016, former workers had left their jobs because the government had failed to pay them. The World health organizations in harmony with UNICEF established water, sanitation, and hygiene (WaSH) interventions in Yemen. These interventions included providing safe and clean water for drinking, sanitation, and encouraging households and whole communities to uphold and practice hygiene. According to the World Health Organization (2017), the WaSH intervention program had only covered 88 districts out of the 333 in Yemen. Therefore, the world health organization aimed to expand the intervention program into the other remaining districts in Yemen.
The outbreak and prevalence of cholera in Yemen are primarily attributed by the civil war, which started in 2015 between the government and Houthi rebels (El Bcheraoui, et al., 2018). Besides, displacing citizens from their residence, the war has also caused inconveniences in the delivery of healthcare services. The war had also destroyed infrastructures such as water supply system, road bridges, ports, and healthcare facilities. Currently, humanitarian organizations addressing cholera in Yemen face challenges in delivering treatment and prevention programs to Yemenis. The world health organization, therefore, has a mission of solving the political conflict in Yemen to find a lasting solution for Yemen. The continuous presence of war will result in constant challenges in healthcare delivery as well as the development of critical infrastructure for the promotion of the health of Yemenis citizens.
Conclusion
The above discussed is not an exhaustive list of all the activities that strategies that were implemented by these organizations. The above provides an overview of some of the main focus areas in Yemen until the time of the review. The outbreak of cholera in Yemen is one of the most massive epidemics currently. Poverty, malnutrition, and the civil war, which started in 2015, caused the outbreak of cholera. The immune system of children and adults has deteriorated due to the high levels of malnutrition and poverty. Besides, the civil war destroyed infrastructures such as water supply systems and healthcare services, making the Yemen citizen live in unhygienic conditions and lack access to healthcare services. Also, the employees working in the healthcare and sanitation resigned and fled because of the government failure in paying their wages (El Bcheraoui, et al., 2018). Therefore, cholera continued to spread because of the lack of intervention from the government and institutions of Yemen.
International humanitarian organizations such as WHO, UNICEF, ICRC, IRC, and MSF took the role of addressing the cholera outbreak in Yemen. Some of the evidence-based strategies used by the humanitarian organization in the treatment included the use of rehydration therapies and antibiotics. Rehydration therapies used included oral rehydration therapy and intravenous therapy. Rehydration therapy is one of the most effective evidence-based practice used in the treatment of cholera. Antibiotics used in the treatment of cholera minimize dehydration of the patient through diarrhea and stool. The methods used the international humanitarian organizations to prevent further occurrence of cholera included repairing water supply, system, funding the operation of healthcare facilities, and promoting the water, sanitation, and hygiene (WaSH) intervention programs (Taylor, et al., 2015)
Recommendation
There are several evidence-based interventions which can be used to address the outbreak and spread of cholera in Yemen in the future. These interventions can be used by international humanitarian organizations such as WHO or the government of Yemen once it stabilizes. First, the government of Yemen can increase the presence of medical laboratories in different parts of the country. These laboratories can be fairly distributed all over the country and be used to confirm the cases of cholera (Friedrich, 2019). These laboratories would make the government, health institutions, and international health organizations aware of a cholera outbreak in the early stages.
Health institutions in Yemen can use surveillance systems such as dipsticks assays to monitor the presence of cholera pathogens (Debes, et al., 2014). The dipstick assay takes a period of about 10 to 15 minutes to carry a test and find out the presence or absence of cholera. They can be used to identify contaminated water sources and disinfect them in advance. Also, Yemen can decentralize the institutions in charge of providing water, sanitation, and hygiene interventions to ensure that all parts of the country of Yemen are covered. Besides, the decentralized institutions will assist the government in checking the spread of cholera in advance.
References
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