How War Created the Cholera Epidemic in Yemen


Alia Allana – The New York Times

A boy rinses a bucket for collecting well water that is believed to be contaminated with the bacteria that causes cholera, on the outskirts of Sana, Yemen, in July.
Credit Hani Mohammed/Associated Press

12 Nov 2017 – The quality of mercy is strained in the Middle East. Last week, Saudi Arabia closed off the highways, sea routes and airports in war-torn Yemen, forbidding humanitarian groups from even shipping chlorine tablets for the Yemenis suffering from a cholera epidemic. More than 500,000 Yemenis have been infected with cholera this year and nearly 2,000, mostly children, have died, according to the World Health Organization. The International Red Cross expects about a million people to be infected by cholera in Yemen by December.

The spread of cholera in Yemen glaringly illustrates how disease follows in the wake of bombs.

The seeds of the epidemic were planted in 2015, when a military coalition led by Saudi Arabia and the United Arab Emirates and backed by the United States joined the fighting in Yemen on behalf of the ousted president, Abdu Rabbu Mansour Hadi, who had been forced out by Houthi rebels. The rebels, who are backed by Iran, today control the capital, Sana, and most of the territory along the country’s Red Sea coast. Saudi Arabia imposed the most recent blockade after the Houthis fired a missile at Riyadh.

When the war began on March 26, 2015, workers on the night shift at a wastewater treatment plant in Sana watched Saudi jets bomb airplanes, runways and buildings at the adjacent international airport. A boundary wall was all that separated the airport and the treatment plant. The terrified workers took refuge in a nearby mosque.

The next morning all of the 26 employees of the wastewater treatment plant showed up for work. They knew if human waste wasn’t disposed of properly, waterborne disease could sicken hundreds of thousands.

The workers left the lights on at the plant hoping the coalition pilots would read it as a sign that the plant wasn’t a military target. “Little did we know that all of Yemen was a military target,” said an engineer at the plant, who asked to remain anonymous for his safety. On another night, the coalition bombed a crane at the plant.

On April 17, 2015, the Saudi-led coalition jets bombed the central electricity grid supplying Sana. The capital lost all electricity. The workers kept the plant running with diesel fuel. A week later, as the diesel began running out, they reduced operations to eight hours, to six, to two.

By late May 2015, the fuel was gone and the plant shut down.

Soon after the coalition imposed a naval blockade, ostensibly to prevent weapons from reaching Houthi rebels, reducing the supply of food, medicine and fuel to a trickle. Yemen imports more than 85 percent of its food and medicine, most of it by sea.

Coalition forces turned away or stopped ships heading for Yemeni ports for weeks. Fighting around ports such as Hodeida, the country’s largest cargo port, worsened shortages.

With the treatment plant out of power, wastewater flowed down canals and into the valleys around Sana. Dirty water spread over miles of farmland. Flies hovered above the raw sewage. Cucumbers, tomatoes and leafy greens grown in the contaminated water made their way to markets around Sana. Many cases of acute diarrhea were reported.

Infusions of fuel from the United Nations Children’s Fund helped the sewage plant return to operation, but not full time. Every week bought more people displaced by war into Sana. The treatment plant was built to serve 500,000 people but began handling the waste of nearly 1.5 million. An increasing number of patients sick with acute diarrhea arrived at the Kuwait Hospital in Sana.

In October 2016, tests confirmed cholera in Sana and cases began to be reported around the country. International organizations helped set up and run cholera testing and treatment centers across the city.

War brought even more displaced people to Sana and its population increased to about three million. With no fuel, the plant closed once again in January, for 40 days. It restarted after a small power station in Sana supplied it with six hours of electricity a day. It wasn’t enough. The quantity of untreated wastewater was increasing every day.

In April, cholera was spreading with unprecedented speed across 18 out of 23 governorates of Yemen. In two weeks, more than 20,000 people had been infected and 242 killed by this bout of the disease. Unicef stepped in again to help with the sewage plant’s operation. Since May, the plant has been in service.

Cholera in Yemen is a man-made disaster, and its spread and casualties are tied to the politics of the war. Aerial bombing by the Saudi-led coalition in Houthi-held areas have damaged hospitals, public water systems and sewage plants.

More than half of health care facilities have fully or partly closed. Doctors, nurses and ambulance drivers have gone without salaries for months. Sanitation has worsened. People live amid sewage. Acute watery diarrhea has been more fatal in areas controlled by the rebels than in areas controlled by the government.

According to The Lancet, 78 percent of cholera cases and 81 percent of deaths from cholera have occurred in Houthi-controlled governorates. Governorates controlled by Mr. Hadi’s government have reported 67,346 cases of cholera; the Houthi-rebel-controlled governorates have reported 339,061 cases.

The Saudi-led coalition has delayed or turned away numerous ships carrying fuel and supplies to ports controlled by the rebels. Between May and September alone, according to Human Rights Watch, seven fuel tankers were delayed or diverted.

It has eased the blockade intermittently, allowed varying amounts of fuel, food supplies and medicine. Saudi Arabia and the United States, its leading supporter in the war, have offered $236 million and $427 million for the United Nations humanitarian aid effort in Yemen in 2017. In the summer, Saudi Arabia pledged $33.7 million specifically to help fight cholera.

But severe shortages of food and medicine remain. The United Nations estimates that about seven million people are on the brink of famine in Yemen and nearly 900,000 are infected with cholera. An unrelenting blockade threatens a catastrophic increase in both disease and hunger.


Alia Allana is a writer for Fountain Ink magazine.

A version of this op-ed appears in print on November 13, 2017, in The International New York Times.

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