Born nine weeks premature and weighing less than three pounds, Mohammed lies doll-like in a hospital incubator as he fights for his life.
The odds are not in his favour. In his postnatal intensive care unit in Mukalla, a former Al Qaeda stronghold in southern Yemen, one in five babies do not survive.
After eight years of a brutal civil war, the country’s healthcare system is on the brink of collapse as the country’s economy is in meltdown.
“Mothers and babies are the biggest victims of this war, children [have been] born into a world which feels devoid of hope for those who survive,” said Dr Suhair Saeed Omer, a specialist in family medicine in south Yemen.
According to Unicef, one mother and six babies die across the country every two hours, while one in 37 newborns do not survive beyond their first month of life. In the UK, 95 per cent of babies in intensive care units recover – in Yemen that figure is just 20 per cent.
“We are running more like an emergency services ward than a mother and baby unit,” said Dr Zakaria Bin Hadi, a GP at the Ibn Sina Teaching Hospital where Mohammed is being treated, in the heart of a region liberated by the United Arab Emirates armed forces in 2016.
“Around 10 per cent of births end up in intensive care and babies like Mohammed are fighting for their lives from the moment they come into the world, the majority of these from mothers under the age of 18,” he added.
Mohammed’s 26-year-old mother went into premature labour due to preeclampsia, a condition easily treated if caught early. But across the war-torn country, where the majority live on less than £1.60 a day, it is often too expensive for women to travel to a hospital or clinic for regular health checks during a pregnancy.
The cost of petrol is around 50p a litre, though it is surging as global inflation soars and drivers charge wildly differing prices in face of a worsening humanitarian crisis. As a result, simple conditions including high blood pressure can easily become fatal for the mother, baby – or both.
“The hardest thing for us is getting the women into the hospitals,” said Dr Bin Hadi. “These poor women cannot afford to pay for even the basic screenings such as blood tests, so don’t have regular ultrasounds, let alone anything more complex should things go wrong. For those who live in more remote regions, they cannot even afford to reach us for check-ups, so they simply don’t come.”
Infectious disease and an endemic culture of poor hygiene compound the situation, he said, especially when combined with widespread malnutrition and the stress of living in the midst of an eight-year war and abject poverty.
‘It’s a tragedy’
The Emirates Red Crescent’s Al Mahwar Clinic, which is funded by the UAE, is the only centre in the area offering free care. It now serves tens of thousands of women from three regions who travel for tens or hundreds of miles to access checkups and ultrasounds – which would usually cost the equivalent of £20.
“Anaemia and high blood pressure in mothers are the kinds of simple things which can lead to fatal consequences so this early intervention is key,” said Dr Omer, a specialist in family medicine at the centre. In more extreme cases, fatal abnormalities and congenital disorders are also missed without such intervention, Dr Omer added.
Staffing shortages are also acute. At the Ghail Bawazir General Hospital, four almost new incubators have sat idle for months, with nobody to operate them.
“It is painful to see this,” said Dr Faez Mohammed, the hospital’s general manager, gesturing at the empty room. “Many hospitals don’t have this life saving equipment. We have the equipment, but can’t pay the staff, which makes us feel very helpless. It’s a tragedy.”
Efforts to fill the gaps in Yemen’s healthcare system have fallen on NGOs, as the country’s fractured government struggles to find unity in the face of terror groups such as the Houthis and Al Qaeda – which still control major parts of the country.
Since 2015, the Emirates Red Crescent has either built or renovated 25 hospitals in southern Yemen alone, part of a $6.3 billion aid programme across the country.
Most of the mothers dying are between 13 and 15, some are even younger. Doctors said their bodies are too young to handle the traumas of labour, especially with limited healthcare. Many fall into maternal shock, which is potentially fatal for both mother and child.
“We see them fall into a coma and this is when things become very dangerous for both,” said Dr Bin Hadi. He added that a rapid reproduction rate can also take a toll on mothers, with many having children in quick succession due to a lack of contraception.
Religious leaders have become a vital tool in trying to educate men on the fatal risks of early marriage, and doctors have partnered with local mosques in the last three years. But changing long held views takes time, Dr Bin Hadi said, especially in rural areas.
“As the economic situation worsens, this trend is not improving,” he added. “Parents in the villages see marriage as a way to relieve the financial burdens they have in these big families of four or five children, where even providing food is a struggle. All the efforts [that are] being made to educate people to change these practices are failing.”
Doctors are also worried about the future for a healthcare system propped up by international donors, with few signs that an end to instability is in sight.
“Here in Mukalla we are in a much more privileged position than many other Yemenis as we have so much financial support from the UAE, in addition to much greater security than most other parts of Yemen, and their aid has created many more jobs for people like me,” said Dr Omer.
“Without a stable government to manage the hospitals the UAE is building and funding for things like staff, equipment and medicine, the long-term future feels very bleak. We cannot depend on the UAE forever. The question is, what happens when they leave?”
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