This paper sheds light on the state of the coronavirus epidemic in Yemen, and whether this country has really passed the risk stage. The paper also reviews the nature of the Yemeni authorities' response (the legitimate government and the Houthis) to the pandemic and fears of a resurgence of the epidemic in the country.
Herd immunity or absence of data?
Media reports have recently been circulated indicating that the coronavirus epidemic has receded in Yemen and that it no longer constitutes a source of concern in the country. This was based on the fact that the numbers of infections and deaths remain modest, at least compared to the expectations of the international community. For example, United Nations (UN) officials indicated the possibility that nearly 16 million people, or 55 percent of the population, could get infected, given that official statistics indicate very modest numbers of cases of infection and death due to the coronavirus in the second wave of the epidemic, and that while countries of the world recorded during the period 1-10 October 2020 more than 3 million infections and 50 thousand deaths, only 18 infections and 8 deaths were recorded in the legitimate government areas during the same period. In the context of demonstrating the decline of the epidemic, reference is also made to the suspension of measures and precautions taken by the authorities to confront and prevent the epidemic, and to the fact that the population no longer adheres to measures of social distancing or to personal preventive measures, such as wearing masks, and life has returned to normal, including the return of public and private gatherings, such as weddings and funerals.
These reports seek to explain their unproved assumptions. Some have quoted some doctors as saying that the absence of obesity and the fact that the people from young age groups constitute the largest proportion of the country’s population have helped prevent the epidemic from spreading. A report by the British newspaper The Times quoted experts as saying that many Yemenis have already contracted the epidemic and have developed autoimmunity (herd immunity).
It is difficult to acknowledge the argument of such reports. On the one hand, the available official statistics that are cited are inaccurate and, on the other hand, they do not include areas of dense population in the country, i.e. the Houthi-controlled areas. In the absence of accurate statistics, it is difficult to determine the number of cases, given that there are people who may be infected with the virus without showing symptoms of the disease.
It is almost certain that thousands of people have died due to the epidemic, given the inability of the health facilities to admit all suspected cases, and that a large number, if not the vast majority, of cases, were forced to stay at home under the care of their relatives pending recovery or death, and given also the data on obituaries and condolences that filled the social media and the verbal reports that people continued to share about cases of infection and death due to the virus, especially during the first months of the pandemic, in addition to the fact that the majority of the population (nearly 70 percent) live in rural areas and scattered communities in the plains and mountain enclaves, which are areas and clusters far from official statistics and the media where it is difficult to know what is going on in them. As for abandoning precautionary measures, it is no evidence that the epidemic has receded, and it can be attributed to the difficult economic and political conditions, something which is not limited to Yemen and is seen in other countries as well.
It is also difficult to accept the assumption of the emergence of group or herd immunity. This type of immunity occurs when a proportion of the population acquires immunity against the disease, either through the administration of vaccines or through the formation by the patients’ bodies of antibodies against it. Reaching such an immunity requires that a certain percentage of the population be infected, recover and gain immunity against the disease. This percentage varies from one disease to another. Experts estimate that reaching this immunity in the US, for example, requires that 70 percent of the population acquire immunity against the virus. Accordingly, proving the development of this immunity requires the performance of large-scale examinations, which would be difficult to do in the current circumstances of Yemen, especially given the position of the Houthi authorities that control the areas where the majority of the population is located. In this context, the Ministry of Health of the legitimate government stated that it is already conducting a serological survey to measure antibodies. For its part, the World Health Organization (WHO) said that it is planning to take blood samples from 2,000 Yemenis to ascertain the presence of antibodies, but the scope of such surveys remains insufficient.
Relying on such an unproven assumption and acknowledgement of the existence of group immunity continue to carry great risks. It makes the society vulnerable to health exposure to the virus in any subsequent wave. The seriousness of this matter becomes clearer in view of the experts’ assertion of the absence of any scientific evidence so far that proves that those who have been infected with the virus and recovered from it would not be re-infected. The Ministry of Health of the legitimate government seems to be aware of this issue. On 10 December 2020, it warned of getting carried away by what it said were unscientific speculation regarding acquisition by the Yemenis of this type of immunity.
As a result, it is difficult to say that Yemen has overcome the danger posed by this epidemic. There is justification for the continuity of the fears that emerged at the beginning of the pandemic that the epidemic would cause large numbers of victims, and that the country would turn into a dangerous epicentre of the epidemic in the region and the world. The UN continues to warn against the second wave of the epidemic, indicating that it may be more severe than its predecessor, especially in the light of the emergence of a new strain of the virus with an ability to spread 70 percent faster. Besides, concern continues about the virus’s ability to develop more genetic mutations.
While finding a vaccine for the virus reduced fears and reassured the world, given its circumstances, Yemen will certainly nevertheless face difficulty in obtaining the required quantity of vaccines, even under the umbrella of the international COVAX Initiative. Indeed, Yemen may at best get only 20 percent of its needs. The way the official authorities respond to this epidemic remains a decisive factor for the country to overcome the threat of the epidemic.
Regarding the nature of the Yemeni authorities' response
There are major factors that initially governed how the Yemeni authorities responded to the epidemic, the most important of which are the following:
1. An unqualified health sector. The health sector was neither prepared nor qualified to face the epidemic. Besides the fact that more than half of the health facilities in Yemen have been closed or partially functioning since 2015, hospitals and health centres suffer from a severe shortage of medical equipment and supplies, along with a severe shortage in the number of medical specialists. Indeed, in many cases, this deficit has led to the closure of some hospitals.
2. Lack of resources. The country depends for its current situation on foreign aid and is experiencing a critical situation in this regard due to the decline in the international community’s interest in the humanitarian situation and the curtailment of its humanitarian aid even as most countries are preoccupied with facing the epidemic on their own territories. As a result of the state of the health sector and the lack of resources, health facilities were either full or unable to provide treatment for the infected. Therefore, both suspected and confirmed cases had to be rejected, and those patients had no choice but to return to their homes.
3. The continuation of the conflict. The war continues to waste the available resources and impede the activity of health facilities and damage them. It has contributed to blocking health supplies from some areas. In addition to the resulting large displacements, it made the delivery of health services more difficult.
4. Mismanagement. Represented by the legitimate government and the Houthis, the Yemeni authorities showed a mixed attitude of indifference, politicisation and mismanagement, in addition to failure to deal with the epidemic pursuant to their responsibilities. It was clear that they have not understood the seriousness of this epidemic. While the epidemic constitutes a common threat, they have not shown any readiness to make the necessary concessions towards cooperation and coordination in confronting it. On the contrary, they considered it a pretext and an opportunity to exchange accusations of incompetence and endangering the country. One of the most prominent examples of poor management, failure and wrong policies is that the two authorities have continued in various ways to hinder non-governmental and international efforts in facing the epidemic. In addition to the legal and bureaucratic obstacles and the complicated procedures, there have been attempts to control aid, divert its destination, impose lists of beneficiaries, and interfere in assessments.
The conflict in Yemen has resulted in different areas of political and military control. The division of power has reflected itself in the different policies and plans to combat the epidemic. Below is a review of how the authorities of the legitimacy and the Houthis responded to the pandemic:
A. The Houthis
The Houthi authorities live in a constant state of denial of the crisis, and the domination of politicisation over the way they deal with the crisis. For example, they have considered the epidemic a US-Zionist conspiracy, accused the coalition countries of introducing the virus into the country, and accused the international organisations and their employees of helping to spread it.
The Houthis adopted a policy based on a media blackout. Thus, they withheld data regarding the spread of the epidemic, prevented medical workers from talking about what was going on in hospitals, and forced them to cover up. They also controlled the tests and did not announce the results unless they were negative, justifying such a policy on the pretext of avoiding the occurrence of a panic wave among the population and avoiding the "serious impact" on people's mental health. They also adopted a violent policy in tracking suspected cases, given that they would send armed militias to the homes of people suffering from symptoms and have turned infection with the virus in general into a stigma. All this raised the population’s fears and made them reluctant to report suspected cases.
While the Houthis imposed comprehensive restrictions on all areas under their control at the beginning of the outbreak of the pandemic, they quickly abandoned those restrictions and stopped all measures of social distancing on the pretext that the virus no longer constituted a threat. There was no recourse to any measures even with the emergence of the second wave of the epidemic. The Houthis have a long history of obstructing the work of aid agencies, extorting them, and seizing aid.
B. the government
The legitimate government was quick to take the main traditional actions and measures taken by the authorities in the countries of the world, such as closing ports and establishing quarantines. It continues to show interest in and interaction with the developments of the epidemic, given that it has recently taken measures with the emergence of the second wave, which was not done by the Houthis. It was more transparent than the Houthis, continuing, through the National Committee that it formed, to issue daily reports on the developments regarding the epidemic.
However, the problem of the government, in addition to the lack of resources, is that its ability to control was weaker in its regions, especially given its conflict with the Southern Transitional Council (STC). While the Houthi’s policy is characterised by excessive control, the government appeared to have poor control, which is evident, for example, in its failure to control the activities of health institutions and the inaction of their employees. For example, those institutions would close or open their doors without referral to higher officials, and the employees would remain at work or leave it depending on their mood and without fear of accountability. It is also evident in the failure by some directors of the Ministry of Awqaf (Religious Affairs) offices in the legitimacy areas to abide by the government's instructions and measures, and in the violation by many mosques of the decision to suspend prayers therein.
Poor control, indifference, mismanagement, and inadequate sense of responsibility were evident in the actions of higher officials. For example, the Minister of Health Nasser Baoum remained outside the country and did not return to manage the crisis. Health officials and institutions showed clear inaction, and media reports spoke of great corruption practised by health officials and those responsible for the allocated funds to cope with the epidemic. Relief activities and international efforts to combat the epidemic faced obstacles and complications in the government areas, which affected their activities, albeit to a lesser degree than in the Houthi case. Indeed, Doctors Without Borders, for example, had to halt its activities in Aden, although at that time, it was the only agency addressing the epidemic.
In the conflictual context, the entry of the epidemic into the country and the risks it entailed did not change the calculations and interests of the parties to the conflict, despite the UN efforts that saw it as an opportunity to de-escalate.
 According to the Supreme National Emergency Committee for Coronavirus Covid-19, affiliated with the legitimate government, as of 17 December 2020, the total number of confirmed cases reached 2087 cases, including 606 deaths and 1384 recoveries, while the active cases reached 98 cases. This number excludes the regions under Houthi control.
 These projections are based on several factors, including the population of nearly 30 million people, the political and economic conditions in Yemen, and the state of the health sector that does not enable facing the epidemic, as well as considering the spread of other epidemics such as cholera, malaria and dengue fever in the Yemeni environment.
 According to the UN Humanitarian Coordinator, for example, the country has only 200 ventilators. One media report indicates that the majority of deaths in an Aden hospital were the result of a lack of oxygen supplies.
 Many of them left Yemen because of the war, or left the service due to fears of the epidemic itself, especially with the lack of personal protective equipment available to them, or because they did not get their salaries.
 A week before the announcement of the first infection case in the country, for example, the WHO had stopped incentive payments for ten thousand health workers in the country. In late July 2020, aid agencies had already seen significant cuts in many of their most important services.
 See, for example, the Human Rights Watch report entitled "Deadly Consequences: Obstruction of Aid in Yemen During Covid-19", 14 September 2020.
EPC | 27 Jul 2021
EPC | 14 Jul 2021
Diyari Salih | 13 Jul 2021