Malnutrition remains one of the major challenges in reducing child deaths, including in conflict-affected countries like Yemen. The six-year war in the country has had severe consequences for children.
"The child was sick. He was suffering from diarrhoea and weakness in the body,” says Ismail. Ismail is the father of Abdo, a one-year-old child with malnutrition who was admitted to the intensive care unit of the Ad Dahi rural hospital.
Ad Dahi lies about 50 kilometres from Hodeidah city, and Médecins Sans Frontières/Doctors Without Borders (MSF) supports the hospital here to provide medical services for people living in the city and its neighbouring areas. In the Hodeidah region, the war has disrupted people’s access to care.
Poverty, lack of transportation and a fuel crisis have increased the challenges for people who live in rural areas and need to attend a hospital. Many cannot reach one in time.
Abdo’s family was able to reach Ad Dahi, but not without challenges. “We [were] in the desert in the Moor Valley where we live, [and] we struggled a lot to reach the main road to bring him to this hospital where doctors treated him,” says Ismail. “We have been here for a week.
“Now, thank God, his health has improved a little and we are waiting for him to fully improve. But we are tired of going home and back.”
Seven out of ten child patients are underweight with malnutrition
Dr Duha Shamsaddin is the Medical Activity Manager for MSF at Ad Dahi hospital. She says malnutrition is one of the most common conditions among children treated by the Ad Dahi medical staff.
"Meningitis, diarrhoea, and severe acute malnutrition with complications are still… the main morbidities (illnesses),” says Dr Shamsaddin. “Seven out of ten paediatric patients admitted to the hospital are underweight and suffering from malnutrition with health complications.”
Young mothers also face challenges that can affect the health of their newborns. “Many of the mothers, they are less than 18 years old, they weigh less than 40 kilograms, they are malnourished, they lack antenatal care, and they deliver their babies at home. All of this is contributing to increase the pre-term labour and the mortality and morbidity for both mothers and children.”
“Prices are constantly rising: without humanitarian aid, many families would not eat at all.”
More children needing care in Abs
In Abs town, Hajjah governorate, MSF has seen an annual peak in malnutrition due to a number of factors, but this year’s is worse than previous years. In a six-month period, there has been a 41 per cent increase in cases of severe malnutrition compared to the same period a year ago.
Hamdi is one of the 100 children that our teams treated in our inpatient therapeutic feeding centre in Abs in January and February. When our teams admit him for care, he is not yet two years old—but it is the second time he has been a patient at the hospital.
“He is suffering from severe malnutrition with pneumonia,” says Muriel Bouriser, MSF Head of Mission in Yemen. “His eyelids are swollen, he has a constant cough and he has a hard time breathing.”
“Most [of the children here] are under five years old and all are suffering from severe malnutrition. We always see a spike in cases in the hospital around this time of year, but these days it’s worse,” says Boursier.
There are many reasons why MSF is seeing malnourished children in Abs, but most of them are connected to the brutal, six-year long conflict that has affected Yemen since 2015.
“The war has decimated the economy, destroying livelihoods so that people can no longer afford food to feed their families, or fuel to travel to seek work or medical care,” says Boursier. “Many public sector staff, including medical workers, haven’t been paid in years. Prices are constantly rising: without humanitarian aid, many families would not eat at all.”
Most Yemenis around the country rely on humanitarian aid to sustain themselves, but the humanitarian response in the country lacks continuity and is insufficient and underfunded. Despite families’ efforts to find work and provide food, many children go hungry.
How MSF assists children with malnutrition
Malnutrition is the underlying contributing factor in nearly half the deaths of children under five years of age globally. Children with malnutrition experience a weakened immune system, making them more susceptible to respiratory infections and illnesses like measles.
MSF’s malnutrition work involves:
- Prevention: MSF teams distribute nutrition supplements to at-risk children and ensure other disease prevention initiatives like vaccinations and malaria chemoprophylaxis are implemented in situations where malnutrition could become severe, and in some cases to reduce the effects of seasonal food scarcity.
- Screening: We assess children for malnutrition by comparing their weight-for-height ratio to international World Health Organization standards, and/or by measuring a child’s mid-upper-arm circumference (MUAC).
- Treatment: Our staff provide children with ready-to-use therapeutic food, which can usually be given to children by their family at home with follow-up appointments at a health clinic. Children with more severe forms of acute malnutrition or with complications must be treated in a hospital.
In 2019, MSF treated 7,330 children for malnutrition in inpatient feeding programs in Hajjah, Sa’ada, Amran, Ibb and Taiz governorates. There is an urgent need for greater humanitarian assistance in Yemen, to provide families with food and essential services including medical care. Lasting nutritional support programs and improved water access would also help reduce the number of children facing malnutrition.
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