Yemen- a neglected humanitarian crisis

This is article no. 3 in a series about global health injustices. Previous article: Civil war in Sudan. Next article: Injustices in Lebanon and Syria (coming soon).

Introduction

Welcome to the third article of the Global Health Injustices Series. Building on the last article on Sudan, the focus is now on Yemen, by analysing the health inequalities and inequities the broader Yemeni population encounters. Similar to Sudan, there is a civil war between the government and the Houthis, among other political factions in Yemen, producing detrimental population health outcomes that will be delved into after an overview of Yemen's history and current state.  

Yemen: a distinct past and its current challenges

Yemen is a country in the Middle East bordered by Saudi Arabia and Oman. Like Palestine and Sudan, Yemen is noteworthy for its distinct culture, languages and traditions. Moreover, Yemen has been part of trade routes with other surrounding countries for centuries and even now, as it is adjacent to the Red and Arabian Seas. However, as far back as the 1990s, when Yemen gained independence after varying degrees of resisting colonialism, internal friction within the government has led to civil wars even before this current one.   

At the moment, Yemen has one of the highest rates of mal- and undernutrition in the Middle East due to approximately half of the Yemeni people living in poverty and lacking access to clean water. Additionally, around 4.5 billion people are displaced in Yemen, and have been displaced in many instances since 2015. Furthermore, in spite of the ongoing civil war, Yemen has at least 97,000 asylum seekers and refugees from countries like Somalia and Ethiopia.

Taking into account this important context, it is vital to support the Yemeni population as well as the refugees and asylum seekers. This is because they are facing injustices, which then lead to worsening outcomes for numerous people in Yemen. Although this crisis is ongoing, the Yemeni people, the refugees and asylum seekers stay resilient within their communities.       

Civil war and the consequences of the arms trade

Unfortunately, Yemen has been noted by the WHO as an ignored humanitarian crisis, where approximately 20 million people need emergency healthcare. Specifically, 17.3 million people are driven to starvation, including 1.15 million children under 5 years old being acutely malnourished, having a 30-50% mortality risk. Although these statistics are driven by the ongoing civil war fueled by the arms trade between the Yemeni government, others in the Middle East and notably the United States, it is essential to highlight the other factors in Yemen driving childhood malnutrition. 

One study found that as maternal education, social and economic status increase, the likelihood of malnutrition in children decreases. Moreover, cigarette smoking during pregnancy increased the number of children with malnutrition. It could be inferred that there was a lot of internal instability within Yemen when this study occurred, leading to these health outcomes for the children, which have been currently worsened by the ongoing civil war, with further fuel from the arms trade.

Regarding mental health in Yemen, one article noted how the COVID-19 pandemic, on top of the civil war, has impacted access to mental health care. Approximately 20% of Yemenis suffer from at least one mental health disorder, which includes anxiety, depression and schizophrenia. However, seeking help for mental health has been hindered by stigma and superstition, notably how people with these concerns may be described as dangerous. These gaps underline a lack of resources and facilities in Yemen attributed to damage from the ongoing civil war.

Shifting to infectious diseases, the civil war in Yemen has contributed to a high burden of neglected tropical diseases (NTDs), which are diseases affecting low-income countries that lack healthcare resources, infrastructure and sanitation and hygiene facilities. The most notable include dengue fever, salmonella, and schistosomiasis (Figure 1). The exact epidemiological data of NTDs in Yemen is difficult to find because there is a lack of infectious disease surveillance, and the healthcare system is fractured. 

Focusing on Yemen’s healthcare system, one review noted six key areas from the World Health Organisation that are involved in a strong healthcare system: health information systems, health workforce, governance, service delivery, access to essential medicines, and financing. Each area is weakened by the civil war, but here is a glimpse of each area, with some of the steps forward. Firstly, the review suggested that health information systems are deficient, so the authors urged the creation of a health survey system for Yemen.

Since 2015, the health workforce has decreased by 50%, where more than half of workers left their jobs as they were not getting paid; retaining them could be through voucher programs and payment contracts. Also, access to essential medicines, particularly for chronic diseases, is scarce due to lack of funding, limited imports and damage to infrastructure. As for service delivery, at least 50% of healthcare buildings are operating, with airstrikes destroying more than 500 buildings, leaving vital services like emergency obstetric care very restricted. 

Although financing on healthcare has increased from 0.8% in 2004 to approximately 2.9-4.1%, with further investment to up to 12%, the population still has to pay out-of-pocket for healthcare. To move forward, the author noted how crucial it is to increase government spending on health. However, enhancing these areas must begin with improving governance, or the key leaders in Yemen congregating to make decisions that lead to a more robust healthcare system. Currently, there are issues due to bureaucracy, top-down management and friction between the Yemeni government, the Houthis and the other political factions.

As mentioned above, one area of service delivery severely impacted by the ongoing war is obstetric care, along with newborn and child health. One case study noted that although these areas are a priority, there were instances, like tackling cholera outbreaks (Figure 2) and treating malnutrition, which were offered priority over other forms of care. This imbalance reflects that more funding is required for all of the healthcare service areas to run optimally. One way forward is to include not only the leaders in Yemen, but also international NGOs to bring in their expertise to support the re-development of the healthcare system. 

The role of NGOs in supporting the Yemeni population

At this present moment, NGOs have a vital role in supporting vulnerable populations, especially in Yemen. In a 2023 report from Amnesty International, they noted several breaches of international law and human rights:

Other NGOs, such as the UNHCR, stated their provision of lifesaving aid to refugees, asylum seekers and displaced Yemenis, along with other forms of support through cash and essential supplies. The first way forward towards upholding the health and wellbeing of the broader population is to establish clearer governance among the leaders in Yemen. This could be facilitated by NGOs and other stakeholders, perhaps the other governments too, by stopping arms trade and increasing humanitarian aid. 

Conclusion: looking ahead at clearer governance

Throughout this article, evidence indicates that the civil war in Yemen has devastating impacts on the health and wellbeing of the population. From individuals unable to seek appropriate mental health support, to a divided healthcare system with limited funding and other deficits. Consequently, the leaders in Yemen must come together to uphold international law and human rights, while NGOs are vital in facilitating this dynamic. 

My previous words on holding people in power worldwide accountable to human rights and international law are very relevant for Yemen. This is because they are responsible for enabling the ongoing civil war through the arms trade, so urging these people in power, particularly in Western countries, to stop would be a major step forward in de-escalating the humanitarian crisis.   

For the next article in the Global Health Injustices Series, it will be a collaborative endeavour that focuses on both Syria and Lebanon, two bordering countries that have diverging yet connected struggles; by understanding them, we can ensure that the populations in both countries obtain as much support as possible to improve their health outcomes.     

Written by Sam Jarada

REFERENCES

UNHCR. Yemen Crisis Explained. 2024. Available from: https://www.unrefugees.org/news/yemen-crisis-explained/ 

WHO. Achieving health for all in Yemen. 2023. Available from: https://www.emro.who.int/images/stories/yemen/achieving-health-for-all-in-yemen.pdf 

‌Capitalizing on Conflict: How U.S. arm sales fuel the humanitarian crisis in Yemen. OpenSecrets. 2024. Available from: https://www.opensecrets.org/news/reports/capitalizing-on-conflict/yemen-case-study 

‌Sunil TS. Effects of socio‐economic and behavioural factors on childhood malnutrition in Yemen. Maternal and Child Nutrition. 2009 Feb 3;5(3):251–9. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1740-8709.2008.00174.xm 

‌Waleed Alhariri, Mcnally A, Knuckey S. The Right to Mental Health in Yemen: A Distressed and Ignored Foundation for Peace. Health and Human Rights. 2021 Jun;23(1):43. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8233030/ 

‌Ahmed A, Rahmat Dapari, Dom NC. Neglected tropical diseases in Yemen: a systematic review of epidemiology and public health challenges. BMC Public Health. 2025 Feb 7;25(1). Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-025-21700-z#Fig3‌

Ali Alraimi A, Shelke A. Strengthening Health Systems in Conflict: Evidence-Based Policies for Quality Care in Yemen. Journal of Cardiovascular and Cardiology. 2024 Mar 31;1–4. Available from: https://oaskpublishers.com/assets/article-pdf/strengthening-health-systems-in-conflict-evidence-based-policies-for-quality-care-in-yemen.pdf 

Tappis H, Elaraby S, Shatha Elnakib, Abdulghani A, Huda BaSaleem, Saleh A, et al. Reproductive, maternal, newborn and child health service delivery during conflict in Yemen: a case study. Conflict and Health. 2020 May 27;14(1). Available from: https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-020-00269-x 

‌Human rights in Yemen. Amnesty International. 2023. Available from: https://www.amnesty.org/en/location/middle-east-and-north-africa/middle-east/yemen/report-yemen/