An outbreak of cholera began in Yemen in October 2016. The outbreak peaked in 2017 with over 2,000 reported deaths in that year alone. In 2017 and 2019, war-torn Yemen accounted for 84% and 93% of all cholera cases in the world, with children constituting the majority of reported cases. As of November 2021, there have been more than 2.5 million cases reported, and more than 4,000 people have died in the Yemen cholera outbreak, which the United Nations deemed the worst humanitarian crisis in the world at that time. However, the outbreak has substantially decreased by 2021, with a successful vaccination program implemented and only 5,676 suspected cases with two deaths reported between January 1 and March 6 of 2021.
Vulnerable to water-borne diseases before the conflict, 16 months went by before a program of oral vaccines was started. The cholera outbreak was worsened as a result of the ongoing civil war and the Saudi Arabian-led intervention in Yemen against the Houthi movement that began in March 2015. Airstrikes damaged hospital infrastructure, and water supply and sanitation in Yemen were affected by the ongoing conflict. The government of Yemen stopped funding public health in 2016; sanitation workers were not paid by the government, causing garbage to accumulate, and healthcare workers either fled the country or were not paid.
The UNICEF and World Health Organization (WHO) executive directors stated: "This deadly cholera outbreak is the direct consequence of two years of heavy conflict. Collapsing health, water and sanitation systems have cut off 14.5 million people from regular access to clean water and sanitation, increasing the ability of the disease to spread. Rising rates of malnutrition have weakened children's health and made them more vulnerable to disease. An estimated 30,000 dedicated local health workers who play the largest role in ending this outbreak have not been paid their salaries for nearly ten months."
Background
As of 2017, Yemen had a population of 25 million and was geographically divided into 22 governorates.
The Yemeni Civil War is an ongoing conflict that began in 2015 between two factions: the internationally recognized Yemeni government, led by Abdrabbuh Mansur Hadi, and the Houthi armed movement, along with their supporters and allies. Both claim to constitute the official government of Yemen. Houthi forces controlling the capital Sanaʽa, and allied with forces loyal to the former president Ali Abdullah Saleh, have clashed with forces loyal to the government of Abdrabbuh Mansur Hadi, based in Aden. A Saudi Arabian-led intervention in Yemen was launched in 2015, with Saudi Arabia leading a coalition of nine countries from the Middle East and Africa, in response to calls from President Abdrabbuh Mansur Hadi for military support.
Cholera is an infection of the small intestine by strains of the bacterium Vibrio cholerae. It is spread mostly by unsafe water and unsafe food that has been contaminated with human feces containing the bacteria. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea lasting a few days. Diarrhea can be so severe that it leads, within hours, to severe dehydration and electrolyte imbalance. The primary treatment is oral rehydration therapy—the replacement of fluids with slightly sweet and salty solutions. In severe cases, intravenous fluids may be required, and antibiotics may be beneficial.
Prevention methods against cholera include improved sanitation and access to clean water. Cholera vaccines that are given by mouth provide reasonable protection for about six months. Two oral killed vaccines are available: Dukoral and Shanchol. Total cost, including delivery costs, of oral cholera vaccination is under US$10 per person.
Outbreak
Following "on the heels of civil conflict between Houthi rebels and the internationally recognized Yemeni regime", the Yemen cholera outbreak began in early October 2016, and by January 2017, the WHO Regional Office for the Eastern Mediterranean (WHO EMRO) considered the outbreak to be unusual in its rapid and wide geographical spread. The serotype of vibrio cholerae O1 involved is Ougawa.
