Ruth Conde has just returned from managing nursing activities in Abs hospital, at the epicentre of Yemen’s cholera epidemic. She describes her team’s efforts to avert the impending catastrophe.
“When the first test came back positive for cholera, I remember the unhappy look on the faces of our team in Abs hospital. We were already overwhelmed with work. There had been outbreaks of measles, whooping cough and a peak of malaria, and we were treating a large number of people with injuries from the war. Cholera was the last thing we needed. When you think of the things that make people vulnerable to cholera, you realise that Yemen has them all. You’ve got a health system which has largely collapsed after more than two years of war. There are too few medical staff, who have received no salaries for months and have limited resources. You’ve also got displaced, impoverished people with little clean drinking water, not enough food and who are already suffering from a host of other illnesses.
"It doesn’t matter if you’re rich or poor, male or female, old or young, cholera is indiscriminate."
At the beginning, cholera started in a sporadic way with a limited number of patients who all came from the same area. Regardless, it was clear that we had to work quickly. We did exploratory missions, established networks in the area, donated medical supplies and trained staff from health centres and health posts in the region to ensure that moderate cases, at least, could be treated in outlying areas. But then, in May, the situation exploded and we felt this was getting out of hand. We started receiving between 20 and 30 patients a day. We stepped up our efforts and set up a cholera treatment centre in a nearby school, in addition to the hospital. It currently has 100 beds and we have employed 100 additional staff. There have been more than 1,600 deaths and the cholera outbreak has affected more than 269,000 people in all of Yemen. In late June, the Abs hospital received an average of more than 400 patients with suspected cholera each day.
It doesn’t matter if you’re rich or poor, male or female, old or young, cholera is indiscriminate. Without proper treatment administered in time, cholera can have a mortality rate of up to 50 percent. Working around the clock, the teams have managed to keep mortality rates down to between one and two percent. A patient can be discharged within a few hours if admitted early enough, and even those patients who arrive in the most serious state don’t stay longer than about four days. I remember one day when suddenly we received an avalanche of patients. Among them was a young girl of about 16 who was in a state of shock. On arrival, she collapsed and stopped breathing. We had to put her on a ventilator, but as soon as the team injected fluids into her, she started breathing by herself again. By the next morning, she could already look after herself.
I have the feeling that the situation would be catastrophic if we had not been working in Yemen. Yemen needs a much greater effort and better coordination among the humanitarian community. Cholera has been a warning call in a forgotten crisis that will persist long after the last cholera patient has been treated.”