Portal de Periódicos da CAPES

Yemen's hunger crisis

2012; Elsevier BV; Volume: 380; Issue: 9842 Linguagem: Inglês

10.1016/s0140-6736(12)61356-7

1474-547X

Talha Burki,

Health and Conflict Studies

Political instability and soaring food prices have exacerbated the health problems for Yemen's already impoverished and malnourished population. Talha Khan Burki reports. With unemployment more than 50%, separatists in the south, insurgents in the north, rapidly dwindling water supplies, and around 500 000 of its population internally displaced, Yemen's transitional government faces a formidable array of problems. President Abd Rabbu Mansour Hadi took office in late February, succeeding Ali Abdullah Saleh, who was forced out of power by the country's version of the Arab Spring. Yemen is scheduled for full elections in 2014. In the meantime, Hadi must wrestle with security concerns—a suicide bombing in May killed more than 100 soldiers; more recently police cadets have been targeted—and address a humanitarian crisis that, if unchecked, could have severe consequences. 44% of Yemen's population, some 10 million people, lack access to sufficient, nutritious food. Of these, roughly 5 million people are in extreme difficulty—without assistance, they will not have enough sustenance to survive. It is a long-running problem. Yemen is reliant on imports for virtually all its staple foods, leaving it peculiarly vulnerable to the rising food prices that have characterised the past few years. Hence, even before the present turmoil some 7·5 million Yemenis did not have enough to eat. But the recent strife has exacerbated matters. The immediate cause was the cutting of a major oil pipeline last year. Fuel prices shot up by more than 500%; fishermen were unable to power their boats and farmers could not irrigate their crops. Businesses shut down and inflation and unemployment began to rise. A breakdown in already rudimentary health services compounded the problem. To make things worse, the rains failed. Food prices spiked. In a nation where almost half the population live on less than US$2 per day, and one in ten children do not reach the age of 5 years, such a turn of events is catastrophic. Families have been forced to start selling assets, skipping meals, and removing children from school. Many fall into debt in order to purchase food. Water scarcity compounds the problem: over the past 3 months, the price of the resource has risen by a factor of five. “Families are being forced to make some very tough decisions”, explains USAID's Nancy Lindborg. The result is around 267 000 children with acute malnutrition. “There are pockets of the country—Hodeida or Hajjah, and some places in the south—where we have levels of acute malnutrition of over 30%”, UNICEF's Geert Cappelaere told The Lancet. 15% is the UN benchmark for a crisis. Around a quarter of Yemeni women of child-bearing age are acutely malnourished, which makes them more likely to give birth to malnourished children and plays a part in the country's steep maternal mortality rate. As yet there do not seem to be widespread reports of mortality. Yemen has a poor system of registering births and deaths, but this probably does not explain it. It is more likely that reasonable (though not ideal) levels of immunisation and relatively low levels of malaria and HIV, have stopped matters from spiralling out of control. But this situation could easily change, warns Cappelaere. “One of the biggest impacts of the political crisis from a health perspective was the huge drop in immunisation coverage”, he said, citing as a consequence last November's measles outbreak. Added to this is the problem of chronic malnutrition; levels of which are second only to Afghanistan. More than 2 million children in Yemen, 58% of the total number of children in the country, are chronically malnourished. Aside from stunting growth, malnourishment leads to impaired cognitive ability and low IQ. So there is a very real risk of a lost generation of Yemenis. And this is the generation that will be expected to address the serious medium-term problems faced by a country that is both running out of the oil that provides two-thirds of government revenues and settling into democracy. “We have calculated that on a yearly basis the cost of inaction against malnutrition to Yemen is $1·5 billion”, affirmed Cappelaere. The solution to the food and malnutrition crisis, paradoxically, is not as simple as transporting masses of food to the country. “The markets are full of food, both in rural and urban areas”, explains Oxfam's Joy Sinhal. The issue is that people cannot afford to buy it. In such circumstances, distributing food may diminish the depth of the problem but broaden its width by dampening the market system, forcing down prices and thereby affecting the livelihoods of those involved in producing and transporting food. Oxfam advocates transferring cash to the needy, while USAID is involved in delivering food vouchers. “A very small part of the problem of malnutrition is related to a problem of access to food”, stresses Cappelaere. There are a range of infrastructure and sociological factors at play: lack of access to safe drinking water and sanitation; poor literacy rates and a consequent lack of awareness; and certain cultural traditions—less than one in five Yemeni mothers exclusively breastfeed their young children. “Reducing malnutrition in Yemen is not an easy or obvious thing to do; it requires a really integrated, multi-sector intervention”, Cappelaere con–cluded. Well-meaning gestures such as donating breast-milk substitute may even make things worse. All of this requires money, and the $460 million UN humanitarian appeal for Yemen is barely half full (the nutrition part of the appeal is only 30% funded, while the water, sanitation, and hygiene cluster is less than 25% funded). The country has never really captured the world's attention: from 2003–08, only Burma and Bangladesh received less aid per person than Yemen. Donors may have been put off from providing aid because of concerns over insecurity and the resultant difficulties in distribution. Nonetheless, Sinhal emphasises that Oxfam is able to reach people in most areas. The UN's World Food Programme (WFP) works through local non-governmental organisations to expand its efforts into no-go areas; while UNICEF has brokered an agreement with the Houthi rebels in the north that allows them to deliver the most essential interventions. “The issue of access for UNICEF is the least of our concerns”, adds Cappelaere. Indeed, some of the estimated 300 000 who fled American drone attacks and Al Qaeda separatists in the south may even have moved to areas in which health care and aid was easier to access than it had been previously. Still, there is much to be done. “Yemen remains a country where international non-governmental organisations have to be convinced to scale-up their operations”, Cappelaere said. The WFP is currently reaching 3·6 million Yemenis; it hopes to reach 5 million next year. It provides rations and specialised micronutrient products that act as a curative for acutely malnourished children and a preventive for moderately malnourished ones. Oxfam has hopes of delivering aid to 1 million people by the end of the year; it currently has funding to reach around a quarter of that figure. The USA has provided a good deal of aid to Yemen, both military and humanitarian, and the Gulf States have made large pledges—Saudi Arabia alone has said it will provide $3·25 billion. “We are looking for an increase in assistance from other donors, not only to deal with the humanitarian aspects but also for the longer term and financial issues that are facing the transitional government”, Lindborg told The Lancet. Yemen's Ministry of Health has acknowledged that malnutrition is a substantial problem, but it has limited capacity. Public awareness remains low—people are accustomed to seeing undersized children; those suffering from malnutrition are commonly diagnosed when they attend health clinics after a complication has arisen. An effective means of tackling the lack of awareness is to roll-out volunteer health workers in local communities, much as has been done to combat infectious diseases and educate people on the necessity of vaccination. “It is leading to an important change in the attitude of people around malnutrition”, Cappelaere said. The malnutrition problem in Yemen owes to decades of underdevelopment. The population is growing at a rapid pace (around 3%) and there is an influx of migrants from the Horn of Africa. Yemen has no permanent rivers and groundwater supplies are fast running out—some experts reckon that the country's reserves will be gone within a decade. The southern insurgency, in which the government briefly lost control of Abyan governorate, is spearheaded by a new Al Qaeda-linked group; the troubles in the north have continued for 6 years. President Hadi must also ensure that the security services and other institutions of state, where plenty of Saleh loyalists remain in key positions, do not fracture. It could easily add up to the perfect storm. Despite all this, there is optimism in the country. The people have jettisoned a dictator and expressed a clear desire to move towards democracy. Hadi was the sole candidate in February's election, yet 66% of the population turned out to vote. “Today, Yemen is on the radar because of the political and security crisis”, notes Cappelaere. “The humanitarian crisis has caught some attention but we are very much at risk that attention will disappear soon, we have to invest much more in Yemen right now than we have ever done in the past.” UK leads a global effort to tackle hunger and malnutritionA World Report in The Lancet this week highlights the food and malnutrition crisis in Yemen. Elsewhere, leading charities have warned that more than 1 million children in the Sahel region of west Africa are at risk of severe malnutrition. It was timely, therefore, that on the back of the euphoria of the London Olympics, the UK's Prime Minister, David Cameron, co-hosted a global hunger summit with the Vice President of Brazil, Michel Temer, to kickstart efforts to tackle undernutrition in children. Full-Text PDF