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A medic wearing a protective suit attends to a patient at the emergency ward of a hospital amid concerns about the spread of the coronavirus disease, COVID-19, in Aden, Yemen

Conflict

With test kits so scarce, doctors in Yemen are flying blind

Yemen has a population of nearly 30 million. Fewer than 1,000 have been tested for COVID-19. An emergency room doctor explains how he treats patients for the novel coronavirus without the tools and equipment to make diagnoses — or protect himself.

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A medic wearing a protective suit attends to a patient at the emergency ward of a hospital amid concerns about the spread of the coronavirus disease (COVID-19) in Aden, Yemen.

Credit:

Wael al-Qubati/Reuters

Yemen has been the scene of a regional war since 2014. The humanitarian situation there is dire, with millions of people living on the edge of starvation. It is not ready for the coronavirus pandemic.

As of May 11, only 803 coronavirus tests have been conducted countrywide, a World Health Organization spokesperson told The World. Yemen, the Arab nation located to the south of Saudi Arabia, has a population of nearly 30 million people.

Related: Researchers in Senegal are developing a coronavirus test kit to be used across Africa

With test kits so scarce, doctors in a warzone are flying blind. They don’t know for sure whether patients have the virus, even though hospitals are already seeing patients with COVID-19 symptoms. 

“Most of them complain of fever, dry cough,” said Dr. Nader al-Durafi, an emergency room doctor at al-Saber hospital in Aden. “Some of them have difficulty breathing.” 

Aden, a port city located strategically at the mouth of the Red Sea, is the site of violent conflict between the Saudi-backed Yemeni government and the local Southern Transitional Council (STC), backed by the United Arab Emirates. Currently, the STC runs the city. Divisions in Aden are a microcosm of Yemen’s increasing political fragmentation. The nation’s health system — broken by more than five years of war —  will likely be tested over the coming months. 

Related: WHO fills gaps to fight COVID-19 in countries with weak systems

Yemen saw its first confirmed case of COVID-19 five weeks ago with a 60-year old man in Ash Shihr, a port city in the Hadhramout region. That patient has since recovered, and authorities have traced his contacts. For weeks, he was Yemen’s only known COVID-19 case. The WHO reported on May 11 that nearly three dozen other cases have since been confirmed in the major Yemeni cities of Sana’a and Aden. Seven people have died.

“Yemen has a very small problem, in the sense of the number of cases that have been reported. ... But we believe that the virus is spreading at the community level, and we need to focus on providing essential health services — and COVID-19 services — to all people in Yemen.”

Michael Ryan, executive director of  the World Health Organization's health emergencies program

“Yemen has a very small problem, in the sense of the number of cases that have been reported,” said Michael Ryan, executive director of the World Health Organization's health emergencies program, in a May 6 press conference. “But we believe that the virus is spreading at the community level, and we need to focus on providing essential health services — and COVID-19 services — to all people in Yemen.”

Durafi says diagnosing COVID-19 is no simple matter in Yemen. 

“There are two other epidemics here in Aden: Dengue fever and Chikungunya,” he says. Both of those illnesses are marked by high fevers — just like COVID-19. 

“Most of the people here are suffering from a fever these days. And with the lack of test kits, we can't determine who has COVID-19 and who hasn't.”

Dr. Nader al-Durafi works in the emergency room of al-Saber hospital in Aden, Yemen

“Most of the people here are suffering from a fever these days. And with the lack of test kits, we can't determine who has COVID-19 and who hasn't.

In April, the International Initiative on COVID-19, a consortium of humanitarian groups, said it was sending a shipment that contained tens of thousands of test kits. But to date, there have been no reports of their distribution in Yemen.

The efficient distribution of aid is one of the casualties of Yemen’s war. Rival authorities control its seaports. Yemen’s roads are frequently blocked by soldiers or militia groups who have been known to delay whole fleets of trucks. 

Related: COVID-19 impact could be as 'serious as a world war'

“The medical staff, the doctors, nurses, everybody, they don't have enough protection for themselves against a virus,” Durafi says. “Honestly, I don't feel secure at all. That's because people are careless. There's thinking that the virus is not coming through Yemen.”  

And without tests, Durafi says, there is no way to be sure: “We'll never know the actual number of the infected people.” 

Durafi says he assumes that he is being exposed to the coronavirus, and takes precautions to protect himself and his family. 

“Bringing home the virus — that is my major fear, especially [as] we live in an apartment with my father who has a history of heart disease,” he says.  “What we do for protection: the masks, the eyeglasses, the full uniform, I mean. I keep sanitizing my hands every five minutes, keep a safe distance while examining the patients. But 100% protection is not guaranteed.”

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