While COVID-19 dominates global headlines, Yemen, a country located on the Arabian Peninsula in the Middle East, has been experiencing years of multiple intense and extremely deadly disease outbreaks since 2015.

The roots of Yemen’s health and humanitarian crises date back to the Arab Spring uprising in 2011, as Yemen, like many Middle Eastern countries, was shaken by widespread demonstrations. The protests eventually ousted Yemen’s authoritarian ruler, and leadership was given to his deputy, Abdrabbuh Mansur Hadi. Despite hopeful predictions about his rule, Hadi failed to address many of the problems that Yemen faced. Eventually, the main separatist group, the Houthis, fought the government in 2014 and 2015, taking control of the capital, Sanaa. Since then, Yemen has seen five long years of devastating civil war, instigating the largest humanitarian crisis on the globe in both 2018 and 2019. The United Nations has estimated that around 80 percent of the population in the country needs aid and protection, with no real signs of relief for the Yemenis. Over the last two years, epidemics of diphtheria, cholera, dengue, and rabies have all taken an immense toll on those in Yemen, killing thousands.


Yemen saw a massive outbreak of diphtheria in 2018, an infectious disease that attaches to the respiratory system and produces a poison that can kill the healthy tissue or get into the bloodstream and cause lasting damage to the body, or even death. In 2018, Yemen saw hundreds of cases and dozens of deaths, making it the worst diphtheria outbreak in the country in over 30 years.


During this time, Yemen was also struggling with a cholera epidemic. Cholera is an infectious disease that is caused by ingesting food or water contaminated with the cholera bacterium, or in other words, feces. Yemen still has the world’s largest cholera outbreak, with 2,036,960 cases and 3,716 deaths recorded from October 2016 to August 2019. The outbreak was so severe that in August of 2019, the Centers for Disease Control issued a travel notice for Yemen. The disease has claimed thousands of lives in the country, and even though case numbers have dropped, cholera still remains a grave medical concern in the country.


Adding yet another complex layer to the situation, Yemen experienced a significant spike in dengue fever in 2019. Dengue fever is a virus that is transmitted to a human through the bite of an infected mosquito and can often be deadly within a few hours, frequently requiring hospitalization. There were 52,000 confirmed cases of dengue in Yemen last year, which lead to 192 deaths. The virus was so widespread that almost every one of Yemen’s governorates reported cases, and is still a significant medical threat in the country to date.


Finally, as if these diseases weren’t enough for a struggling Yemen, there was and still is a huge surge of rabies in the country, especially in the capital, Sanaa. Rabies is a viral disease that is transmitted when an infected animal bites or scratches a human, causing the rabies virus to attack the central nervous system, eventually making its way to the brain, which causes death. Considering there is a vaccine for rabies, Yemen again saw very high numbers of cases in 2018 at 7,000. In 2019, though, rabies infections in just the capital of Sanaa were estimated to be in the thousands, and even though only 50 deaths were officially announced, health officials suspected that hundreds, most of whom were women and children, died.


Why is Yemen battling all of these different diseases and why are they so widespread and lethal comparative to most other regions in the world? Well, for one, Yemen’s civil war has been raging for years, with no end in sight, and with war, especially civil war in a poor and developing nation, comes a myriad of negative consequences, including poor healthcare and rampant diseases. At this point, Yemen is considered a failed state, and there is no clear government to provide goods or care for the Yemeni people. Additionally, the humanitarian aid that does find its way to Yemen is often blocked, manipulated, or stolen by Houthi rebels in the country, using the aid strategically in the war rather than allowing it to reach millions of people who so desperately need it. Due to the conflict and economic status of Yemen, the healthcare infrastructure in the country is abysmal. This, coupled with the displacement of millions, a lack of clean water, and no sanitation infrastructure, creates an optimal situation for the spread of diphtheria, contamination which causes cholera, an environment which breeds infected mosquitos, and a shortage of vaccines or animal control which causes massive outbreaks of rabies.

If these diseases are such a threat in Yemen, are Americans at risk? With excellent medical infrastructure, an absence of civil conflict, and the world’s largest economy, the short answer is, no, not really. Of course, diseases are diseases and there is always the chance that they spread and make their way to the U.S., but as far the risk of these outbreaks even reaching a fraction of a percent in volume in America as they have in Yemen is very unlikely. Cholera is so prominent in Yemen because of a lack of a government-provided sanitation system, infrastructure, and clean drinking water, which leads to millions ingesting contaminated water- an issue that the U.S. just doesn’t face. Yemen is so prone to dengue fever for the same reason, because as a result of the contaminated water, the Yemeni people try and collect rainwater to drink, but instead create sitting pools of water which, coupled with high amounts of rainfall, provide the perfect breeding zone for infected mosquitos. Finally, the U.S. only sees a few rabies cases every year, because even in the rare instance that an individual is bitten by an infected animal, the rabies vaccine can be administered. In Sanaa, though, there is only one medical facility in the entire capital that can treat rabies, but severely lacks a supply of the vaccine, as Houthi rebels loot financial allocations for the vaccine, causing a shortage.

In summary, Yemen faces the worst humanitarian crisis in the world, which comes with severe medical threats and widespread disease. The situation in Yemen looks bleak, as there is not enough aid to reach millions in the country who need it. With a solution to the conflict nowhere in sight and a severe lack of medical infrastructure to help those affected, disease will likely continue to persist and spread at high rates throughout the country. If you or your traveling companion wind up in a medical emergency situation in the Middle East or the Arabian Peninsula or anywhere else in the world, VIGILINT offers a comprehensive Global MedAssist Program (GMAP) including personalized travel medical kit, medical evacuation to your home hospital if medically necessary, access to our 24/7 Medical Operations Center, and access within 30 seconds to a board-certified Emergency Medicine Physician. Contact VIGILINT for more information: 1 (919) 914-0900.