Yemen's Taiz turns tide against cholera - but poor still bear the brunt

TAIZ, Yemen - When Awsan Mukhtar arrived at the cholera camp at Taiz's Republican hospital on 1 August she was luckier than most.

The five-year-old had a bed, medicine and doctors to take care of her - a possible sign that medics may be winning the fight against the disease in some parts of Yemen.

Awsan lives in Jabal Habashi district, about 20km away, where there are no facilities to treat cholera. So she came to the city.

Irtizaq, her mother, told MEE: "Some of my neighbours came to this hospital last month and they did not get a bed to sleep in. When I arrived at the hospital, I found not only free rooms but also beds.

"I thought that I had come to another camp, but staff in the hospital told me that the number of patients has decreased by more than half this month."

Awsan is now receiving free medicine: social organisations are supporting the camps with medical supplies as well as educating the population.

A product of war

Yemen's conflict has severely weakened its health system, allowing cholera and famine to flourish.

More than 463,000 suspected cholera cases and 1,940 associated deaths were reported between 27 April and 6 August 2017, according to the World Health Organisation. In Taiz province itself, more than 31,600 suspected cholera cases were reported in the same period.

But the tide may be starting to turn in areas such as Taiz. Bothaina al-Tayar, a medical supervisor at the camp, tells MEE that they used to take in dozens of people every day afflicted with the disease. But of late there have been much fewer cases, with none at all on some days.

She says the main reason cholera spreads among crowded societies is a lack of personal cleanliness, aggravated by sewage, and believes that public education has helped counter the outbreak.

Apart from the war, the spread of the disease in Taiz has been aided by a two-year pay strike by bin men, leaving areas of the city full of rubbish.

This month, city authorities began removing the rubbish thanks to funding from Kuwait, whose support is acknowledged on bumper stickers on Yemeni bulldozers and trucks sent in to clear up the mess.

"Cholera will disappear from Yemen in few months," al-Tayar says. But not everyone has been taught the basic guidance on avoiding the disease.

Cholera will disappear from Yemen in few months

- Bothaina al-Tayar, medical supervisor

The poor still suffer

Awsan's family belongs to the Muhamashin, usually called the Akhdam, a marginalised group in Yemeni society, who occupy the lowest rung of the social ladder and tend to work as street sweepers, rubbish collectors and panhandlers.

The Muhamashin live in crowded rural areas that education campaigns have yet to reach. There are no official figures on their numbers: estimates vary from one to three million, in a country of about 28 million people.

"We are Muhamashin and we usually treat our patients with folk medicines," says Irtizaq. "But when I went to take folk medicine from one of our neighbours, he told me that my child suffers from cholera and I should take her to the Republican hospital."

She says that they could not afford transport to Taiz but that she found a bus driver who took them to Taiz city for free. "We found proper care in this hospital, but I wish that our government would build camps like this in the rural areas."

Awsan's condition improved but she has also fallen victim to another epidemic that has swept Yemen: famine.

More than 460,000 children face severe malnutrition, according to UNICEF, while 3.3 million children and pregnant or lactating women suffer from acute malnutrition.

But the hospital cannot treat her malnutrition and there is little food for her to eat – so her mother is thinking of taking her home.

"It is difficult for us to stay more in the hospital," says Irtizaq. "If there is an organisation that will help us, we will stay, otherwise we will return."

Malnutrition threat to recovery

Tayar tells MEE that most of the cholera patients in the camp, if not all, are Muhamashin from rural areas in Taiz province.

"The poverty, crowded societies and lack of education are the main reasons for  the spread of cholera among Muhamashin," she says. "The best solution to contain cholera is education.

"The children, who suffer from malnutrition, are more likely to contract cholera. Many malnourished children arrived at the hospital during the last months."

But most of the ill children who came with cholera could not then be treated for malnutrition because they cannot afford the medicine or to live in Taiz, says Tayar.

Islam Abdullah, 35, a close neighbour of Awsan's family, contracted cholera two days after the little girl and also headed for the Republican hospital. She is now being treated in the same room.

Abdullah lives with 13 other family members inside a small house: Muhamashin usually do not have enough land to build houses or set up tents.

She says they do not know enough about cholera to avoid it. "Cholera hit five members of the family and we struggled so much to reach the camp. I learnt about cholera and how to avoid it only when I was in the hospital."

While Yemen has had cholera education initiatives, they have failed to reach much of the population in rural areas.

Afnan al-Sorori, an independent social activist, says that much of the work has focused on Taiz city. "We received a positive reaction and people started to clean their neighbourhoods and keep them healthy," she tells MEE.

If there was education in my area, we would not be victims of cholera

- Irtizaq Mukhtar 

But the activists need more money for transportation and living to reach remote areas.

Irtizaq and her family may live only 20km from the city but the route is not surfaced: instead travellers have to drive for about 10km along a rough road, then walk by foot for the rest of the way.

She says that the residents of Jabal Habashi are in dire need of education – but that none exists.

"If there was education in my area, we would not be victims of cholera," she says. "When I return to my house, I will try to enlighten my neighbours."