Yemen: War in Saada, renders access to injured impossible…

24 June 2008

One month ago, war returned yet again to the governorate of Saada, with numerous clashes involving heavy weaponry. For the time being, access is impossible, yet we suspect that the area contains injured casualties...

On Tuesday 17 June, MSF's teams working in the governorate of Saada were evacuated to Sanaa, the Yemeni capital. The decision to suspend our activities in this region of North Yemen comes at a time of heavy fighting. Since 10 May, we had been unable to deploy our assistance in satisfactory conditions, whether for treating injured, or assisting displaced persons.

It is difficult to know precisely what is happening in the areas of fighting, or areas controlled by the rebellion: access is prohibited for security reasons, there are no independent observers present, and most communication networks are severed. No numbers are available concerning dead or injured. However, the use of heavy weapons, aerial bombardment of villages, and information from other sources all leads to concern over civilian casualties…
Yet most civilians have no access to adequate care structures. Civilians cannot always get to a hospital, either on account of the danger of travelling through the fighting, or because they fear being accused of supporting the rebellion, therefore of being arrested. Even for medical staff, access to hospitals and health centres is complicated, sometimes impossible – this compounds the problems of access to care for the injured.

Difficult field conditions...
Over the month between 10 May and 8 June, only 56 injured, including 36 civilians, were treated in hospitals assisted by MSF, in often-difficult conditions.
At Haydan, which received the majority of the injured cases treated by MSF (49, including 31 civilians), the expatriate and delocalised (i.e. Yemenis from other regions) members of our team had to evacuate to safety. The local staff continued to provide care, but with limited means and in perilous conditions. On 27 May, even these staff had to abandon the hospital, managing nonetheless to take with them a limited quantity of equipment to allow improvising a treatment room in a shop in the village. Since 9 June, the only staff left at Haydan are a medical assistant and two nurses, of whom we have no news; the most qualified staff managed to reach Saada.

Furthermore, where we did receive precise information concerning injury victims requiring treatment, we found it impossible to bring them in: this was notably the case at Dahyan, a village under rebel control, located a ten-minute drive from Al Tahl (which lies in the government zone). Before the war restarted, we used to give consultations six days a week in the village. On 11 May, our Yemeni team treated 25 women and children there, who had been injured in shelling. Since their condition demanded evacuation, two ambulances left Al Tahl to pick them up, after obtaining permission from the authorities. However, on account of heavy firing in the vicinity, the team was unable to evacuate them. The injured were aware that the ambulance had gone back... We later learned that seven of these patients died over the next 24 hours. Since then, we remain without news of the situation in Dahyan.

Several displaced-persons camps
Another consequence of the war, the most visible so far, is the number of people streaming out towards Saada or Al Malaheed, another town in the west of the governorate. These movements took place once tension started rising in the region, or in the first days of the war.
In Saada and the surroundings, the ICRC and Yemeni Red Crescent estimate the number of IDP’s at over 35,000. Some have rented houses or are staying with relations; others are installed in six camps around the town. Additionally, in the vicinity of Al Malaheed, we have recorded just over 1000 families, dispersed in small groups. We have also received information concerning movements towards the north of the governorate, but cannot ourselves travel to that area...
Where our teams have been able to assess the situation, at Al Malaheed and Saada, we were unable to provide assistance to IDP’s, for safety reasons and because our discussions with the authorities and other aid agencies in situ were not successful.

Given the context -- war, and the impossibility of deploying suitable aid to meet the needs of injured and IDP’s -- we therefore took the decision to temporarily withdraw the expatriate and delocalised members of our teams in North Yemen. At Haydan, the local team has been scaled back heavily, and we have no more information, while at Razeh and Al Tahl, the local staff continues to provide medical care for patients managing to reach the respective hospitals. We continue to negotiate with all sides, to obtain access to areas which we think will contain injured. Discussions with military leaders and all other authorities in Saada have not so far produced results, and other talks continue at the highest level in Sanaa.