After the start of a second wave of Covid-19 in Yemen in March 2021, the number of confirmed cases doubled, according to a statement by the United Nations Under-Secretary-General for Humanitarian Affairs, Mark Lowcock, on April 15. Nevertheless, the Houthi authorities in Sanaa have maintained a policy of withholding data on cases and deaths. No vaccines have reached areas under Houthi control. Houthi authorities should take immediate steps to facilitate efforts to provide vaccines in northern Yemen and stop spreading disinformation about the virus.
“The deliberate decision of the Houthi authorities’ to keep the real number of cases of Covid-19 under wraps and their opposition to vaccines are putting Yemeni lives at risk,” said Michael Page, deputy Middle East director at Human Rights Watch. “Pretending Covid-19 does not exist is not a mitigation strategy and will only lead to mass suffering.”
Between mid-April and early May, Human Rights Watch interviewed four Yemeni health workers based in Sanaa, three based abroad who have close knowledge of the Covid-19 crisis in Yemen, Yemeni doctors living abroad, and one international health worker involved in Covid-19 response efforts. All asked not to have their identities revealed for fear of reprisal. Human Rights Watch also reviewed and verified videos in which Houthi officials appear to spread disinformation about the virus and vaccines.
Human Rights Watch reached out to Houthi Health Ministry and Foreign Ministry officials requesting a comment but have not received a response.
As of early 2021, the Houthi-controlled Health Ministry in Sanaa, Yemen’s capital, has reported only one Covid-19-related death, four confirmed cases, and two recoveries since the pandemic began. The UN Office for the Coordination of Humanitarian Affairs (OCHA) said that informal indications are that cases are rising in the north. Doctors without Borders reported in March that their teams in Yemen were seeing a drastic rise in the number of people seriously ill with Covid-19.
Yemen’s healthcare system is in tatters after six years of war. Through the Covid-19 Vaccines Global Access program (COVAX Facility), Yemen should receive 14 million doses of Covid-19 vaccines, which could vaccinate 23 percent of the population across the country, according to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA).
Yemen received 360,000 doses of the AstraZeneca vaccine on March 31 as the first batch, part of 1.9 million doses that Yemen is due to receive throughout 2021. According to the Yemen Covid-19 National Vaccination Plan, the priority groups during the first phase are healthcare workers, people age 55 and over, people with comorbidities, and social groups unable to practice physical distancing, such as internally displaced people and refugees.
The plan envisages that the Houthi authorities would receive vaccines to distribute in areas under its control; including Sanaa, Ibb governorate, and Hodeida governorate. However, one medical source interviewed who has direct knowledge of the circumstances said the group’s failure to cooperate with the World Health Organization (WHO) and the Yemeni government has prevented any vaccines from reaching the north. As a result, as of writing, vaccinations are only occurring in the south.
On April 23, in a virtual conference, Yemen Covid-19 Response, organized by HPY-UK, a UK-based charity organization, the WHO’s representative to Yemen, Adham Rashad Abdel-Moneim, said that the Houthi authorities initially agreed under pressure to accept 10,000 doses of vaccine, but the vaccines could not be delivered after the Houthi authorities set a condition that the vaccines could only be distributed by the group without WHO’s supervision. The WHO refused, because WHO would need to ensure there was no risk of diverting the vaccines.
The following day, the WHO stated in a post on its Facebook page that the Houthi authorities asked to only accept 1,000 doses instead of 10,000 provided that the share of doses to the north will be increased in the next batch of the vaccines. In May 8, the internationally-recognized Yemeni government’s Health Ministry in Aden governorate reportedly delivered 10,000 doses to the WHO to vaccinate health personnel in Houthi-controlled areas.
Numerous Houthi officials have spread disinformation about Covid-19 stating that the virus is a “conspiracy.” Abdul Malik Al-Houthi, the Houthi leader, said in a televised speech in March 2020 on the Houthi-funded TV channel, Al-Masirah, that the virus was an American conspiracy. “America bears the primary responsibility for Covid-19 epidemic,” he said. “Some experts in biological warfare say that Americans have worked for years to benefit from the coronavirus and have worked to spread it in certain societies.”
Several Houthi officials reportedly have died with Covid-19-associated symptoms over the past few months.
International media reported in 2020 that the Houthis were hiding the truth about the scale of the pandemic in the areas under their control through suppression of information and intimidation. The Houthi armed group also reportedly created a black market for Covid-19 testing while refusing to take precautionary measures against the virus.
Health workers interviewed said they believed that the Houthis were refusing to acknowledge the pandemic to keep the economy fully open and to allow the political elite to syphon off exorbitant fees imposed on businesses. The Houthis have sharply increased revenues over the past two years by engaging in a number of predatory and corrupt practices, according to the Sanaa Center for Strategic Studies.
Unlike the Houthi authorities, the Yemeni government-backed health authorities operating in the south and east of the country have regularly reported the number of confirmed cases and warned during 2020 about a possible second wave. OCHA said in April 2021 that the Yemeni government has reported 4,119 confirmed cases and 864 deaths, with more than half of total cases reported during the first quarter of 2021.
On April 20, the Yemeni government began a vaccination campaign funded by the WHO, UNICEF, and King Salman Humanitarian Aid and Relief Center in areas controlled by the Yemeni government (covering 13 governorates). Despite some public distrust of the vaccine, the Yemeni government said on May 26 that it had so far vaccinated more than 53,000 citizens. Yemen is a member of the Least Developed Countries group at the World Trade Organization, which has supported India and South Africa’s TRIPS Council proposal that would temporarily waive certain intellectual property rules on Covid-19-related vaccines, therapeutics, and other medical products to facilitate increased manufacturing to make them available and affordable globally. The United States and New Zealand have recently indicated their support for the TRIPS waiver. Other influential governments such as the United Kingdom, Japan, Australia, and the European Union should drop their opposition, Human Rights Watch said.
“Given the weakened healthcare system in Yemen, Houthi authorities should at least ensure transparency so that civilians living in their areas can understand the scale of the pandemic and facilitate an international vaccination plan that meets the needs on the ground,” Page said.
Houthi Disinformation and Failure to Adequately Address the Pandemic
Health workers interviewed by Human Rights Watch said that the Houthi authorities’ lack of transparency and disinformation have put civilians’ health at risk and prevented efforts to protect against the spread of the virus. Two health workers said that after the start of the first wave in Sanaa in May 2020, the Houthis placed a special intelligence unit under the command of the group’s political security apparatus in medical facilities, apparently to intimidate and threaten health care staff as well as to limit the information they can provide to the media or international organizations.
In early 2021, the WHO asked Houthi authorities to apply to the organization for vaccines, but the Houthis delayed and missed the deadline, one medical source with direct knowledge of the circumstances of the process said. “The Houthi authorities did not cooperate on time with the international community to secure the allocated vaccines to the north of Yemen,” he said. “The Yemeni government’s application included the allocation of vaccines to south and east of Yemen, and the government later agreed to share some of those vaccines with the north.”
The source said that it required intense negotiations to reach a deal under which the Houthi authorities would accept 10,000 vaccine doses. One of the conditions the Houthi authorities set was that there should be no media coverage or social mobilization for a vaccination campaign. As of writing, the vaccination campaign hasn’t happened in the north.
Seven health workers said that the Houthi authorities’ failure to provide a plan or program to combat Covid-19 made the pandemic worse. Even prior to the pandemic, some prominent Houthis said that they believe all vaccines are a conspiracy, the medical workers said. Local media reported in 2013 that Houthi forces prevented vaccination teams from carrying out their immunization work against measles and polio in some remote areas of Yemen’s Saadah governorate under the pretext that the vaccine was “American.”
Three health workers said that the Houthi authorities placed unqualified members of Houthi families belonging to the sayyed class of direct descendants of the Prophet Muhammad in senior positions at medical facilities in Sanaa.
Some Houthi officials spread disinformation about the virus and the vaccine. The leader of the group, Abdul Malik Al-Houthi, said in a televised speech carried by the Houthi-funded TV channel Al-Masirah in March 2020 that the virus was an “American conspiracy.” “America bears the primary responsibility for the Covid-19 epidemic,” he said. “Some experts in biological warfare say that Americans have worked for years to benefit from the coronavirus and have worked to spread it in certain societies.” He warned the public not to panic and said that the pandemic aimed at frustrating and terrifying people.
During a news conference in Sanaa in May 2020, al-Mutawakel, the Houthi health minister, justified his group’s policy of not providing data on the spread of the Covid-19 epidemic in Yemen, stating, “We deal with patients on the basis of their human right to health care and not as numbers on the stock exchange that the media are racing to address.” He said in the same conference that medicine for Covid-19 would come from Yemen. Al-Mutawakel said on May 1, 2020, that there was no coronavirus in Yemen, and that if variants appeared in Yemen the UAE would bear responsibility for its transmission.
Medical Sector Shortcomings
Three Yemeni health workers said that over a year into the Covid-19 pandemic there remains a critical shortage in personal protective equipment for staff. One health worker said that the problems have been compounded by increasing health care costs, which have risen by more than 50 percent since the beginning of the conflict in Houthi-controlled areas for health facilities and patients because of the heavy restrictions and costly logistics on medical imports.
“Today in Sanaa, there is no difference between private and public hospitals,” he said. “In public hospitals, intensive care used to cost 500 Yemeni Rials (US$2) per day but now it costs 12,000 ($48).”
Three health workers said that the Houthi’s have three quarantine treatment centers for suspected Covid-19 cases in Sanaa. One is in Zaid hospital, one in Palestine hospital, and a third run by Doctors Without Borders in Kuwait hospital, but that the centers are not able to absorb all Covid-19 patients requiring hospitalization.
All of the health workers interviewed said that the ongoing second wave of Covid-19 in Sanaa is more aggressive in terms of the suspected cases rate and death toll than the first wave. They said that during the first wave there was a period when the Houthi authorities enforced precautionary measures, such as movement restrictions, and created sufficient quarantine centers to isolate and monitor possibly-infected people, contrary to the current situation.
Three health workers said that they see dozens of patients with symptoms consistent with Covid-19 every day, mainly people in their 30s and 40s. Lacking PCR testing capacity, the workers said that they can only use CT scans for clinical diagnosis.
Health workers have paid a heavy price both during the first wave and since the start of the second wave of the pandemic. According to the Yemeni Doctors Living Abroad Association, a network of Yemeni medical workers outside Yemen that works to raise awareness about the Covid-19 crisis in Yemen, at least 150 doctors in Yemen have died from Covid-19 in Yemen.
In April 2021, the association published an open letter appealing to authorities to prioritize the vaccination of medical staff, saying that vaccination is vital for combating the virus. The association told Human Rights Watch that there are at least two deaths of medical staff per day during the current second wave in Yemen, based on the association’s documentation, which the group publishes on its Facebook page.
Statements of Yemeni Medical Workers
Yemeni medical worker living abroad:
“The Houthi authorities continue to have no Covid-19 plan not because there are no competent doctors in Sanaa but rather because the Houthi armed group continues to deny the existence of the virus.
Testing is limited in Sanaa, so patients are registered with other diseases as a cause of death, like asthma or other lung diseases. Earlier this year, my uncle in Sanaa died [due] to Covid-19. I was medically following up his case remotely. My siblings did not follow my advice to not hold a funeral. One week later, all my siblings got sick. One of them had to be hospitalized and we nearly lost her. Two days ago, one of my cousins passed away and I am certain it was due to Covid-19 because my family sent me all her medical results and I, as a doctor, I understood that she had all Covid-19 symptoms.”
Yemeni medical worker in Sanaa:
“Over the past few years, I have witnessed meningitis disease’s first wave, the outbreak of bird flu, the Covid-19 first wave, and now the Covid-19 second wave. In the second wave, more and more people are becoming sick. We receive dozens of people every day, 70 percent of them come with Covid-19 symptoms but our medical facility is not equipped at all to receive Covid-19 cases.
We lack proper testing capacities, so instead we do clinical tests and CT scans to determine if the cases are linked Covid-19 or not.
Health workers used to receive salaries from the WHO of around $2,000 monthly during the peak of the first wave, but a Houthi official in the medical facility I work in took the money and gave us only $100 for every three months. My colleagues and I tried to strike. We reported the theft of our salaries to the Houthi Health Ministry, then the ministry decided to end the salaries to everyone.”
Yemeni medical worker in Sanaa:
“The health situation is terrible. We do not have medical capacities to handle the pandemic. Medicines reach us expired because it takes too long logistically to allow medical goods and other goods to reach Sanaa. We are overwhelmed by the surge in Covid-19 cases because there are not enough quarantine centers in Sanaa. In this second wave the authorities did not introduce any public health restrictions at all. We have to consider all suspected cases as Covid-19 considering how limited the testing capacity is. We ask patients to stay at home because our medical facility is overwhelmed with patients and our beds are always full.”