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Yemen: As COVID-19 spreads, fear drives people away from hospital

Many Yemenis are not seeking medical care in hospitals due to fear of contracting the virus, of stigmatization by the community or because of rumours circulating around the quality of care and protocols implemented in COVID-19 centers.

Sana’a, Yemen – As COVID-19 spreads through Yemen, widespread fear of the virus is preventing people from seeking medical care, says international medical organisation Médecins Sans Frontières/Doctors Without Borders (MSF), which started recently supporting a new COVID-19 treatment centre in Sheikh Zayed hospital in the Yemeni capital Sana’a.

Only half of the 20 beds for patients with moderate coronavirus symptoms in Sheikh Zayed hospital are currently occupied. According to MSF staff, many people regard hospitals as a source of infection, while some believe sinister rumours about what happens in hospitals for patients who have symptoms of COVID-19. Others are fearful of being stigmatised by their communities if they test positive for the disease. As a result, many Yemenis are not seeking medical care until their condition is serious.

“We are seeing at first hand the detrimental impact of misinformation that is being circulated all over the country, augmenting fear of the virus in society,” says MSF’s Dr. Abdulrahman, who works in Sheikh Zayed hospital. “Hospitals are safe places for patients, and the earlier that patients come to hospital, the better the chances we have to treat their symptoms.”

Many patients arriving at Sheikh Zayed hospital’s emergency room are in a critical condition and need immediate breathing support. All six beds are occupied in the intensive care unit, where patients in severe respiratory distress receive around-the-clock care, dependent on black and red oxygen cylinders that need to be changed every three hours.

75-year-old Khairiya, at Sheikh Zayed COVID-19 center

“I first started having headaches and felt dizzy. I lost my balance and fell to the ground. That is when my son brought me to Sheikh Zayed hospital, and I was taken immediately to the intensive care unit (ICU), where I stayed for about three days,” says 75-year-old Khairiya, a patient who was discharged from the MSF-supported Sheikh Zayed COVID-19 center in Sana’a. [© MSF/Maya Abu Ata ]

“We are concerned over what we see in the hospital, but an even greater concern is the patients we don’t see – those who choose not to seek medical treatment until their condition deteriorates considerably,” says Caroline Ducarme, MSF’s Head of Mission in Yemen.

Like a number of other hospitals in the country, Sheikh Zayed hospital was designated by health authorities as a COVID-19 treatment centre and shifted from providing maternity services and trauma care to tackling a pandemic that has challenged some of the world’s most developed health systems.

Yemen has very limited testing capabilities for COVID-19 and so the virus is spreading across the country untraced. After years of war, the health system was already under considerable stress before the pandemic. Now it appears that people have lost trust in the health system and health staff.

Recent reports that health workers are at high risk of falling ill with the virus have also raised serious concerns about their safety among medical staff across the country, leading many to quit their jobs and stay at home, leaving hospitals short-staffed.

“One of the consistent challenges we face is finding skilled medical staff willing to work in a COVID-19 treatment centre, where they are needed most,” says MSF’s Ducarme. “This is despite the use of personal protective equipment and the strict implementation of infection prevention and control measures in this hospital. The departure of health workers is further weakening the Yemeni health system.”

Dr. Abdulrahman, MSF doctor working in the Sheikh Zayed COVID-19

“As a doctor working in a COVID-19 treatment center, certainly there was concern of possible infection, especially with news of healthcare workers increasingly contracting the virus. But I am a doctor, it is impossible for me to stay home. It is my duty to come to this hospital every day and provide a meaningful service to the people while I can. Contracting the disease can happen anywhere, inside or outside the hospital, what we can do is to protect ourselves is to follow the health guidelines and preventative measures,” says Dr. Abdulrahman, MSF doctor working in the Sheikh Zayed COVID-19 center in Sana’a [© MSF/Maya Abu Ata ]

Sheikh Zayed hospital is the second COVID-19 treatment facility in Sana’a supported by MSF, along with Al-Kuwait hospital. Some of MSF’s patients have travelled long distances to get treatment in the capital, suggesting that there are many unmet medical needs elsewhere.

“A number of our patients in Sheikh Zayed hospital come from governorates as far as Taiz and Ad Dhale in search of essential medical care that may be inaccessible in their areas,” explains Roger Gutiérrez, MSF’s Head of Emergencies in Yemen. “The patients we see have the means to travel, but what about those who are seriously ill with no means to travel and no other medical options around?”

MSF says that more resources are desperately needed in Yemen, both for COVID-19 patients and for those with other health needs. It is calling on the international community to mobilise resources to help Yemen cope with this crisis, and calling on Yemeni authorities to facilitate the implementation of lifesaving programmes.

“A massive scale-up of the overall health response is required to urgently address the silent needs,” says Ducarme. “Instead of cutting down support at such a critical time, the international community should be mobilising maximum resources to maintain humanitarian interventions in Yemen, while local authorities must exert all efforts to facilitate the implementation of lifesaving programmes and ensure that people can safely access humanitarian aid.”


MSF is treating patients with respiratory symptoms in four COVID-19 centres it supports in Sana’a and Aden, and is receiving patients with similar symptoms in the various health facilities it manages and supports in Hodeidah, Khamer, Haydan, Ibb, Hajjah and Taiz governorates. MSF has trained health workers and staff on COVID-19 health awareness, enhanced infection prevention and control measures and established hygiene facilities, adapting its projects across the country to respond to the novel coronavirus.

Keywords

COVID-19 Coronavirus

Most of the world's countries have reported cases of coronavirus disease COVID-19 and MSF teams in over 70 countries are now racing to respond to the pandemic.  

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