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Yemen: Aden's collapsed health system grapples with COVID-19

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Yemen
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MSF
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A car drives up to the low, white building that houses the Doctors Without Borders/Médecins Sans Frontières (MSF) COVID-19 treatment center in Aden, the capital of Yemen. Inside a man around 60 years old coughs and struggles to breathe. He manages to heave himself into a wheelchair and the MSF team rushes him to the intensive care unit (ICU) for oxygen. 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 novel coronavirus. “We have had a lot of people like that—a lot of people that die quickly,” says Thierry Durand, the MSF project coordinator who managed setup of the treatment center. “They arrive already in a serious condition, and it is too late. People are struggling to understand how they die so quickly.”

High death rates and dwindling supplies

From April 30 to May 24 the center admitted 228 patients, 99 of whom died. “We only see serious cases,” says Durand. “For us, the health care workers, it makes us feel helpless. We can’t do much but give them oxygen. There are days we have had 13 deaths in the same day.”

The death rate at the center is comparable to that of intensive care units in Europe and the United States. But in Aden, where five years of grinding conflict have caused the health system to collapse and frequent power cuts plunge the city into darkness, there is no network of well-financed medical facilities and services to support it. Occupying a hastily refurbished wing of an old cancer hospital on the edge of the city, the center is the only facility in the region dedicated to treating COVID-19, and supplies are running out.

“We are re-using personal protective equipment (PPE) because we don’t have enough,” said Dr. Khairil Musa, an MSF ICU specialist in Aden. “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.”

The center’s courtyard is packed with dense ranks of oxygen cylinders. Severe patients need a huge amount of oxygen per minute, posing a massive supply challenge. The team goes through 250 cylinders a day struggling to keep patients breathing.

“The oxygen requirements are scary,” says Durand. “There is no centralized oxygen, no liquid oxygen—and [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 Musa. “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.”

A spike in burials

Such high mortality rates means that the city is also struggling to keep up with burials. “We do not have a morgue in the center,” says Musa. “There is an imam that comes to collect the [bodies] and bring them back to the families, but there are not enough people to handle the bodies.” Drone footage taken by journalists elsewhere in the city shows row upon row of graves, freshly dug. Official figures show that daily burials in the city have increased from a pre-outbreak rate of 10 to 80 or even 90 in recent weeks.

The team in the center is working nonstop to care for patients, replenishing supplies as quickly as possible, organizing improved oxygen supplies, and extending the facility’s capacity to 72 beds. But the desperate situation is taking its toll. “The health care staff are suffering,” says Durand. “Suffering because they cannot save people, suffering because there are so many dead.”

Yemen’s health care systems urgently needs more help from the United Nations and other donor states to bolster the response to COVID-19 and avoid further collapse. “The problem is too big to solve on our own,” says Musa.