Why you should care
Because cholera has had a devastating effect on the conflict-ravaged country and can be used as a tool of war.
For nearly four years, Yemen, one of the Arab world’s poorest countries, has been ravaged by war. With on-the-ground reporting still difficult, the death toll from fighting and bombing — currently over 60,000 — is thought to be vastly underestimated. Beyond that, starvation and disease have killed 85,000 children, and cholera alone has cost 2,600 lives.
Since October 2016, Yemen has been in the grips of one of the worst epidemics of cholera seen in modern history: From April 27, 2017, to Oct. 31, 2018, 1.3 million suspected cases were reported, and as recently as October 2018 the WHO estimated about 10,000 new cases were added every week. Cholera is caused by a water-borne bacteria, meaning water, sanitation and hygiene (WASH) programming is essential to stopping its spread. But that means such projects can be effective extremely quickly. In fact:
A $395,000 water treatment plant restoration, along with programs targeting the region’s infrastructure, sent cholera cases in the region plummeting by an estimated 92 percent.
Those figures were taken from the electronic disease early warning system (eDEWS), which showed that in the month of August 2017 there were 15,020 suspected cases of cholera, 59 deaths and 958,668 people thought to be at risk. The plant became fully operational in September 2017, and by January 2018, these numbers had dropped to 164 cholera cases and zero deaths.
Explore inside the restored water plant in Yemen with this 360 VR video:
Al Barzakh is one of around 10 water treatment centers in Yemen, and it serves four different districts in Aden, in southern Yemen, as well as the Lahij and Abyan governorates. After conflict damage in 2015, however, it was only partly operating, meaning just a portion of the population was getting served and that the water wasn’t getting thoroughly cleaned. UNICEF undertook the plant’s restoration two years ago, while also analyzing the infrastructure needs of the region.
As Aref Ahmed Abdullah, the supervisor of chlorination at Al Barzakh, explains, his main task is to chlorinate and sterilize the water tanks daily. Previously tablets were added to the main water tanks — but it wasn’t enough to eradicate germs, so now they add chlorine, which eradicates all forms of cholera-forming bacteria.
Matteo Minasi, filmmaker for OCHA, the U.N.’s humanitarian agency, explains, “Cholera can spread from both water and food and even just very basic household practices like not washing a container properly.” That means education is key, and UNICEF’s $2 million program also involved going door to door to show people how they should wash their dishes. While Minasi says these efforts may have contributed to reducing the spread of water-borne disease, the new chlorination system killed 90 percent of the germs.
The project began in 2016 but encountered a number of difficulties and delays. The country is still in conflict, with Houthi rebels fighting the Saudi-backed government with the help of coalition forces, recently the subject of a recent U.S. Senate vote overwhelmingly favoring the withdrawal of American support. Government bans on essential materials like adequately-sized water pipes or chlorine meant U.N. advocacy was required to get basic supplies, according to UNICEF’s Robert Kizito Ojok, a water and sanitation specialist in Aden. But now there are more hiccups: “The willingness of the population to pay their water bill is one [issue] that is dragging on,” Ojok says, so his team is working to establish what affordable tariffs the general public might be willing to pay to help sustain it. The WHO recorded cholera outbreaks in several other countries in 2018 — Zimbabwe, Cameroon and Somalia among them — and the plant’s success in Yemen underscores the importance of water maintenance in other affected regions.
Meanwhile, Ojok notes that internally displaced persons have been fleeing the north of Yemen for Aden, settling in the fields from which the plant extracts water. Their presence ups the risk of contaminating ground water, so the U.N. is working to advocate for an alternative space for them. Further next steps for the WASH program will depend on the next round of donor funding.
While peace talks to attempt to resolve conflict in Yemen have taken place in Sweden, water isn’t an issue that can wait. It’s increasingly used as a tool of war that can be used strategically to target the enemy, by poisoning or destroying infrastructure — as in Syria, where the government has been accused of war crimes for bombing the water supply of rebel-held Damascus in 2016. Aden is currently stable, but Al Barzakh is guarded by the Yemeni government’s military. Should it be targeted again, the entire region could be back to square one on fighting disease.
In collaboration with U.N. OCHA