In the Yemeni capital Sana’a, Médecins sans Frontières (MSF) is supporting the Ministry of Health in running the city’s main COVID-19 treatment centre in al-Kuwait hospital. With most patients arriving at the centre only once their symptoms have become severe, the healthcare staff remaining face a challenging task in bringing the outbreak under control.
A car drives up to the low, white building that is the Médecins sans Frontières COVID-19 treatment centre in Aden, Yemen. In it, a man around 60 years old coughs and struggles for breath. He manages to heave himself into a wheelchair, and team quickly transports him to the intensive care unit to start giving him oxygen.
Only four hours later, he is dead. Such is the speed and savagery of COVID-19 in Aden, a city in the grip of a catastrophic outbreak of the virus.
“We have had a lot of people like that,” says Thierry Durand, the project coordinator who set up the Aden treatment centre. “A lot of people die quickly. They arrive already in a serious condition, and it is too late. People are struggling to understand how they die so quickly.
“There has been a strange mixture of fear and denial about the virus here,” says Claire HaDuong, MSF’s Head of Mission in Yemen. “People haven’t wanted to accept the possibility that it could arrive, or that it was already circulating. But as soon as people have been faced with a case, it has caused panic."
The treatment centre in Aden is a hastily-refurbished wing of an old cancer hospital. The centre sits on the edge of a city whose healthcare system has collapsed after five years of war, and where its inhabitants endure frequent power cuts and regularly plunged into darkness. The centre has been the only centre dedicated to treating coronavirus patients, and the intensive care unit, with only 15 beds, has been full for weeks.
“I have been working in intensive care units for more than 14 years, and what’s new to me is the dramatic way in which people are dying here," says Dr Nizar Jahlan, MSF’s Medical Activity Manager for the COVID-19 project in Yemen. “They enter the emergency room walking, but they are already deeply deprived of oxygen without being aware of it, and they die in a surprisingly short amount of time. That is shocking.”
Dr Jahlan knows all too well how the patients feel: after weeks of working in the treatment centre with seriously ill patients, he became unwell himself, and experienced "the most difficult time" of his life. His wife looked after him before contracting the virus herself, and while thankfully they have both recovered, the experience left Dr Jahlen with first-hand knowledge of the severity of COVID-19.
“I felt that I was just gasping for breath," he says, "I worried that I was dying. I had such a high fever...a lot of my friends, especially those of them who are doctors, have been sick, too.”
"We are re-using personal protective equipment because we don’t have enough."
The courtyard of the centre is packed with oxygen cylinders – the centre needs 250 every day to keep the patients inside breathing. The significant oxygen needs are posing a massive supply challenge for healthcare workers in Aden.
“The oxygen requirements are scary,” says Durand. “There is no centralised oxygen, no liquid oxygen, and here we are in Aden which has a certain level in terms of the availability of resources, in terms of material and personnel. I’ll let you imagine the other places in Yemen.”
“We do rounds to check the patients’ oxygen levels,” explains Dr Khairil Musa, an Australian ICU specialist working with MSF in Aden. “Sometimes patients look fine, then you go round again a moment later and they’re dead. Others are gasping, gasping, and they are the ones that die quickly. They just get tired and stop breathing.”
The severe lack of resources is causing difficulties across MSF projects—while teams are doing their best to keep regular healthcare programs open during the COVID-19 outbreak, the lack of personal protective equipment and basic medical supplies is compounding an already dangerous situation.
“We are re-using personal protective equipment because we don’t have enough,” says Musa. “There is incredibly limited access to testing. We don’t have enough ventilators, we need more oxygen concentrators and a reliable supply chain. Regulators, tubing, masks; all these things we don’t have enough of. It’s an enormous challenge.”
Such a level of death means that it becomes a problem also to manage the corpses. Drone footage taken by journalists throughout the city shows row upon row of graves, freshly dug. Figures from the authorities show that burials in the city have increased from a pre-outbreak normal of ten per day to 80-90 daily in recent weeks.
“We do not have a morgue in the centre,” said Musa. “There is an imam [an Islamic cleric] that comes to collect the corpses and bring them back to the families, but there are not enough people to handle the bodies, so they can be there for a while.”
“The healthcare staff are suffering,” said Durand. “Suffering because they cannot save people, and suffering because there are so many dead.”
We cannot face this crisis alone.
Despite the trauma, teams are working nonstop to do all they can for their patients. MSF teams are organising improved oxygen supply and working to extending the capacity of the centre to 72 beds.
But to be able to respond to COVID-19 and avoid further collapse, the Yemeni healthcare system urgently needs more help from the United Nations and donor states.
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