July 28, 2017

Highlights

• Yemen’s cholera caseload exceeds 408,000 suspected cases with 1,885 related deaths
• Security-related access constraints impede cholera response
• High-level UN delegation and ICRC president visit Yemen

Key Developments

As of July 26, health agencies had recorded more than 408,000 suspected cholera cases and 1,885 associated deaths in Yemen, according to the UN World Health Organization (WHO). UN agencies, in coordination with humanitarian partners, have scaled up cholera response efforts to address widespread health and water, sanitation, and hygiene (WASH) needs throughout cholera-affected areas.

A high-level UN delegation traveled to Yemen in late July to meet with Yemeni officials, including Republic of Yemen Government (RoYG) Prime Minister Ahmed bin Dagher, and health workers to discuss cholera response efforts.

International Committee of the Red Cross (ICRC) President Peter Maurer also visited Yemen in late July and met with community leaders and local authorities on all sides of the conflict to stress the importance of protecting civilians and civilian infrastructure, in accordance with international humanitarian law.

Between July 2–8, USAID/FFP partner the UN World Food Program (WFP) delivered three shipments of emergency food assistance to Yemen. WFP reached approximately 2.4 million people with in-kind food distributions from July 1–18, according to the UN agency.

INSECURITY, DISPLACEMENT, AND HUMANITARIAN ACCESS

Recent military activity in Al Bayda’, Hajjah, Al Jawf, Marib, Sa’dah, Sana’a, and Ta’izz governorates has limited humanitarian access and delayed the delivery of emergency assistance, according to the UN. In addition, jet fuel shortages in Yemen’s capital city of Sana’a have prompted the UN Humanitarian Air Service (UNHAS) to reroute flights between Amman, Jordan, and Sana’a through Djibouti for refueling, delaying and complicating humanitarian staff travel.

In July, the Kingdom of Saudi Arabia (KSA)-led Coalition and RoYG officials denied entry of four oil tankers, cumulatively transporting more than 71,000 metric tons (MT) of fuel, into Al Hudaydah Port, according to international media. This follows the suspension of operations at Ras Isa Port, which is primarily a fuel port, in early June. Fuel supplies are limited throughout Yemen, which received less than 17 percent of its estimated fuel needs of 544,000 MT per month in June, the UN reports. Fuel imports through Ras Isa are essential to maintain the efficient flow of electricity to critical civilian infrastructure, including water supply networks that support public health systems and provide safe drinking water to cholera-affected populations, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA).

In a recent statement to the UN Security Council (UNSC), Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator (ERC) Stephen O’Brien highlighted the importance of all ports and land routes remaining open to allow for humanitarian access and delivery of relief commodities.

On July 21, a task force comprising representatives from human rights advocacy groups and non-governmental organizations (NGOs) issued a letter to the UNSC urging members to hold parties to the Yemen conflict accountable for violations of international humanitarian law. In addition, the NGOs requested that the UN facilitate the reopening of Sana’a Airport to allow for commercial flight service, medical evacuations, and the delivery of humanitarian supplies. Furthermore, the task force emphasized the importance of human rights researchers and journalists gaining authorization to board UNHAS flights bound for Yemen.

A July 18 airstrike in Ta’izz Governorate’s Mawza District, allegedly conducted by the KSA-led Coalition, resulted in at least 20 civilian deaths and six injuries, international media report. The casualties included women and children, all of whom had fled to Mawza from nearby Al Mokha District, Ta’izz, due to conflict. Ta’izz currently hosts approximately 15 percent of the country’s internally displaced population, according to the Office of the UN High Commissioner for Refugees (UNHCR). UNHCR appealed to parties to the conflict to respect international humanitarian law, including the protection of civilians and relief workers.

HEALTH AND WASH

Cholera continues to spread in Yemen, affecting nearly every governorate across the country. As of July 26, health agencies had recorded more than 408,000 suspected cases and 1,885 related deaths since the outbreak’s second wave began in late April, according to WHO. UN agencies, in coordination with humanitarian partners, have scaled up cholera response efforts to address widespread health and WASH needs throughout cholera-affected areas.

Despite the rapid rate of transmission, the overall case fatality rate (CFR) in Yemen had decreased to 0.4 percent as of July 26, which is below the WHO emergency threshold of 1 percent and indicates that 99.6 percent of people with suspected cholera who access health services are surviving.

On July 24, representatives from ICRC, WFP, WHO, and the UN Children’s Fund (UNICEF) arrived in Yemen to meet with health workers and local authorities regarding cholera response efforts. The UN delegation and ICRC representatives visited RoYG-controlled Aden Governorate and Al Houthi-controlled Sana’a to assess humanitarian conditions and reinforce the importance of protecting civilians and civilian infrastructure, such as water and electricity services essential to the cholera response, in accordance with international humanitarian law. Following the visits, ICRC representatives and UN leadership urged the international community to increase support for the people of Yemen.

As of mid-July, health agencies had established approximately 830 of 2,000 planned oral rehydration centers (ORCs) and provided approximately 3,000 of 5,000 planned beds in cholera treatment centers (CTCs) in affected areas, according to the Health Cluster—the coordinating body for humanitarian health activities, comprising UN agencies, NGOs, and other stakeholders. Amid access constraints, 29 humanitarian health care organizations were operating in 234 districts—more than 80 percent of affected districts—as of July 17, the Health Cluster reports.

WHO is currently leading the redesign of National Emergency Operations Centers (EOCs) in Aden and Sana'a governorates to facilitate greater operational support for the cholera response by local authorities, partners, and UN agencies. USAID/OFDA partners are providing technical staffing and resource assistance at each of the 10 governorate-level EOCs, which were partially functional as of late July.

ICRC is supporting 17 health facilities to treat severe cholera cases in eight governorates across Yemen. As of July 4, ICRC had provided more than 110,000 oral rehydration salt packets and antibiotics for pregnant women and children; distributed more than 200,000 chlorine tablets to health facilities and water distribution points; and educated approximately 221,000 people on cholera prevention techniques. Other relief agencies are increasing health response coverage at the household-level and are training local partners and volunteers to respond to the outbreak.

According to UNICEF, approximately 14.5 million people in Yemen do not have regular access to safe drinking water and sanitation and doctors are no longer present in 49 of Yemen’s 333 districts. While some doctors have fled the conflict-affected country, others have stopped working due to not receiving salaries, according to the UN. WHO and UNICEF—both U.S. Government (USG) partners—are supporting nearly 630 CTCs and ORCs in the most affected districts, with plans to scale up to more than 1,100 facilities in the coming months.

As of mid-July, UNICEF had reached approximately 4 million people with water and sanitation services, including disinfecting water sources, distributing chlorination tablets, and supporting the rehabilitation of water supply systems and waste water plants. UNICEF also supports WASH messaging at the community and household level.

During the week of July 10, the UN released a revised cholera response plan with a funding request of $254 million for six months—an increase from the $66.7 million requested in the original plan. The USG recently announced nearly $192 million in new funding for the Yemen humanitarian response, including $6 million in new cholera funding from USAID/OFDA. As of July 12, the UN had received approximately $50 million toward the cholera funding appeal.

FOOD SECURITY AND NUTRITION

High food prices, insufficient water supplies, and other conflict-related disruptions to Yemen’s agriculture sector continue to exacerbate acute food insecurity in Yemen, according to the UN Food and Agriculture Organization (FAO). Additionally, insecurity and access constraints, including the blockage of major ports, is limiting fishing opportunities in coastal areas of Hajjah, Al Hudaydah, and Ta’izz governorates, FAO reports.

In early July, three ships chartered by USAID/FFP partner WFP delivered shipments of emergency food assistance to Yemen. On July 2 and 3, two of the ships delivered 34,000 MT of bulk wheat to Al Hudaydah Port. On July 8, the third ship, carrying approximately 26,260 MT of U.S. in-kind bulk wheat sufficient to feed approximately 2 million people for one month, arrived at Al Hudaydah Port.

The incidence of malnutrition continues to increase in Yemen, while insecurity and access challenges continue to hinder the ability of relief agencies to adequately reach populations in need of emergency food and nutrition assistance, according to the Nutrition Cluster. As of June 30, community-based management of acute malnutrition (CMAM) programs, which provide treatment for severe and moderate acute malnutrition, had reached vulnerable populations in more than 300 of Yemen’s 333 districts, according to the Nutrition Cluster. Between January and June, Nutrition Cluster members screened more than 891,000 children between six and 59 months of age—approximately 20 percent of the target population—for severe acute malnutrition (SAM).

In June, relief organizations successfully treated nearly 80 percent of children suffering from SAM and reported a CFR of approximately 0.3 percent, according to the Nutrition Cluster. The rate of default—patients who are absent for two consecutive follow-up visits—was more than 20 percent, which exceeds the Sphere minimum standard of 15 percent.4 The high incidence of default is likely due to long travel times to health facilities, high transport costs, and limited follow-up visits due to inadequate coverage of nutrition services in remote communities, nutrition experts report. However, the current default rate is an improvement from late 2016, when the rate reached more than 26 percent, the cluster reports.

In a July 11 statement, the UN indicated that it may reallocate resources allotted for malnutrition toward the cholera response if the humanitarian community does not receive an additional $200 million to address the outbreak.

As of July 2017, USAID had provided more than $313 million to FAO, implementing partners, UNICEF, and WFP for emergency food and nutrition assistance in Yemen in FY 2017.

LOGISTICS AND RELIEF COMMODITIES

USAID/OFDA field and logistics staff recently completed a logistics assessment trip to Djibouti, where USAID partners pre-position, store, and transship relief commodities, including food and medical supplies, to Yemen. As a primary port for neighboring countries, storage capacity in Djibouti is limited, particularly temperature-controlled warehousing space. The Logistics Cluster noted partner requests for assistance with shipping commodities requiring cold-chain storage capacity and is scaling up accordingly to meet these needs.

PROTECTION AND SHELTER

UNHCR continues to provide rental subsidies to vulnerable internally displaced households and returnees. In the conflict-affected governorate of Hajjah, 1,000 households had received the subsidy through a UNHCR partner as of mid-July, ensuring access to safe and dignified shelter for affected households. Additionally, more than 2,000 households had received the subsidy in Amran, Dhamar, Al Hudaydah, Marib, Sa’dah, and Sana’a governorates as of mid-July, UNHCR reports.

OTHER HUMANITARIAN ASSISTANCE

As of July 28, the 2017 Yemen Humanitarian Response Plan (YHRP) had received $899 million, or approximately 43 percent of the $2.1 billion requested, according to the UN. In addition, donors had contributed $107 million to organizations working in Yemen outside the framework of the YHRP.

In July, international donors provided several new contributions for the humanitarian response in Yemen including approximately $27 million from the European Union to support the UN Development Program and local organizations providing livelihood assistance and maintaining health care facilities; approximately $5 million from the Government of China to support WFP emergency food response efforts; more than $2 million from the Government of Kuwait to support UNICEF response efforts targeting cholera-affected children in Yemen; and relief commodities provided by the King Salman Humanitarian Aid and Relief Center to conflict-affected people in Aden, Hadramawt, and Lahij governorates.

PUBLIC DONATION INFORMATION

The most effective way people can assist relief efforts is by making cash contributions to humanitarian organizations that are conducting relief operations. A list of humanitarian organizations that are accepting cash donations for disaster responses around the world can be found at www.interaction.org.

USAID encourages cash donations because they allow aid professionals to procure the exact items needed (often in the affected region); reduce the burden on scarce resources (such as transportation routes, staff time, and warehouse space); can be transferred very quickly and without transportation costs; support the economy of the disaster-stricken region; and ensure culturally, dietary, and environmentally appropriate assistance.

More information can be found at:
- USAID Center for International Disaster Information: www.cidi.org or +1.202.821.1999.
- Information on relief activities of the humanitarian community can be found at www.reliefweb.int.