Armed conflicts have always contributed to the rapid spread of infectious diseases among redeployed troops and displaced and vulnerable populations uprooted during wars. The World Health Organization (WHO) acknowledges that such changes create an excellent environment for communicable diseases to flourish, including viruses. Widespread destruction of physical and economic infrastructure in areas affected usually exacerbates the risk for people exposed. In this context, Yemen is highly vulnerable to the spread of Coronavirus.

In light of the Covid-19 pandemic, the detection and control of emerging infectious diseases in conflict situations and unstable areas become a major challenge due to multiple risk factors. Among those is the risk of rapid transmission of infectious diseases due to inadequate surveillance and response systems, destroyed infrastructure, collapsed health systems and disruption of disease control programs. Inferior infection control practices in resource-poor settings also test the resilience of local populations. Lack of security and poor coordination among humanitarian agencies further foster the spread of disease in conflict areas.

With the first case in the country confirmed in the Hadhramaut province on 10 April, Covid-19 pandemic could prove to be extremely dangerous for embattled Yemen. Doctors without Borders (MSF), the United Nations (UN), and other humanitarian organizations have warned that Yemeni authorities have no real capacity to provide an effective response to the pandemic, as the five-year conflict has crippled the country’s ability to respond to the coronavirus outbreak.

Following a two-week unilateral cessation of violence by the coalition forces, a ceasefire declaration by Saudi Arabia that came into effect on Thursday, April 9, has been welcomed by Antonio Guterres, the United Nations Secretary-General, as a concrete step toward promoting peace and slowing the advance of the virus in the country. The pause in hostilities could become crucial given that Yemen remains drastically unprepared to face the virus outbreak.

Crippled health infrastructure

Even before the most recent ceasefire was announced on April 8, Yemen’s health infrastructure was reduced to shambles because of years of conflict rendering the country incapable of handling a disease as basic as cholera.

In the year 2017, the outbreak of cholera infected around a million people in the country and left thousands dead. According to the International Committee of the Red Cross (ICRC), other contagious diseases aside from cholera, including diphtheria, have been spreading in Yemen.

According to reports, rampant corruption among the Houthis has limited Yemen’s ability to cover healthcare expenses, with the result that most residents in the areas under Houthi control need humanitarian assistance. According to one such report, millions are on the verge of famine, making it one of the world’s worst humanitarian disasters. A total collapse of the Yemeni health sector has led to a major decline in the quality of private and public hospital services.

Map 01 represents Geographic distribution of recent emerging or re-emerging infectious disease outbreaks and countries affected by conflict, 1990–2006 (sources: Office for the Coordination of Humanitarian Affairs, WHO, and Epidemic and Pandemic Alert and Response, WHO)

Map 01 represents Geographic distribution of recent emerging or re-emerging infectious disease outbreaks and countries affected by conflict, 1990–2006 (sources: Office for the Coordination of Humanitarian Affairs, WHO, and Epidemic and Pandemic Alert and Response, WHO)

Even without taking into account the Covid-19 pandemic, it is obvious that appropriate measures are needed to prevent a virus outbreak given that Yemen’s basic healthcare infrastructure is in dire need of assistance. While the United Nations has been urging all sides to abide by the 2018 Stockholm Agreement, endorsed by the UN Security Council Resolution 2451 (2018), the focus remains on the prisoner exchange mechanism, the contested zone of Taiz, and the agreement on the key ports of Hudeydah, Salif and Ras Issa.

Abiding by the earlier UN-brokered agreement is crucial for preventing an open battle for the Red Sea port of Hudeydah, which may block the prospects of success for the latest ceasefire despite the threat of the virus outbreak. The Saudi-led coalition has been urging the Aden-based Southern Transitional Council (STC) to continue implementing the latest peace dialogue, also known as the 2019 Riyadh Agreement, between the Sana’a-based Yemeni government and the STC to strengthen political, economic and security arrangements in southern Yemen.

Map 02 – territorial control over Yemen’s south (source: Council of Foreign Relations, February 2020)

A 2019 UNDP report estimates that indirect deaths in Yemen, caused by lack of access to food, healthcare, and infrastructure services, will be five times greater than direct deaths by 2030, with most potential casualties being infants and children. According to the UNDP report, the incessant conflict has been destroying healthcare facilities, reducing the availability of health workers, diverting health spending and reducing access to health services.

According to the UNDP, “Critical intervention and vaccination programs may be disrupted leading to disease resurgence. Water and sanitation infrastructure – often already inadequate –may be further degraded. And many displaced populations are forced to live in overcrowded conditions with low vaccination coverage, encouraging the spread of infectious diseases.”

Since its inception, the war in Yemen has evolved into a multi-polar conflict involving distinctly different visions of the country’s future that will inevitably complicate peace efforts. The virus-induced ceasefire falls short of effectively addressing a self-sustainable political solution in the medium to long-term future. Moreover, the continued violence and conflict underscore the limits of the international community’s influence on meaningful negotiations. Especially now, the momentum to realize peace might be rendered increasingly difficult by the pandemic.

 Table 01: the 2020 conflict timeline in Yemen (various sources)

The proxy fallacy and external power-brokers

The involvement of external power-brokers, particularly Iran, in the Yemen conflict has ignited the byzantine on-ground situation, further minimizing any likelihood of sustainable peace in the short to medium-term future. The issue of “proxy fallacy” has been a complicating factor considering that local factions in Yemen have asserted their agendas.

The case of Houthis as Iran’s proxy in Yemen has been unique in many ways. Although the Houthis began as a primarily local movement, Iranian backing of the group appears to have increased over time. It is widely known that the group is part of a wide network of Tehran-supported armed factions in the Middle East.

In tackling the proxy fallacy, however, it cannot be assumed that on-ground factions are a virtual extension of external power brokers who dictate escalation and de-escalation within the country. While there have been occasions when the external actors have requested action under the pretext of serving a particular agenda, there have been many instances of divergence of opinion and a willingness by local forces to ignore their foreign sponsors.

The latest ceasefire, announced by the Arab Coalition, has come into effect and is likely to help focus on the fight against Covid-19. The Coalition said it wanted to support UN efforts for a political solution and help stop coronavirus spread. However, it is not clear whether the backers of the conflict in Iran are willing to abide by the ceasefire as that would be a crucial factor in determining the future of Yemen.

Nevertheless, in immediate proximity to the recent resurgence of active combat, representatives of the World Health Organization (WHO) in Yemen have been holding daily emergency meetings with the Yemeni government about the status of Covid-19. Medical supplies, drinking water, and sanitation all remain scarce commodities across the country, compounding the damage done to numerous medical facilities repeatedly attacked by all warring parties.

As the coronavirus spread rapidly across the region, there were reports that the Iranian IRGC, which has been involved in military conflicts across the Middle East, continues its activity, despite growing concerns that they may carry the virus to Syria, Yemen, and Iraq.

Given the widespread insecurity and sub-standard living conditions for the majority of Yemen’s populations, in addition to the fact that only 50 percent of the country’s healthcare facilities are operational, the WHO has increased distribution of vital medical gear and test kits and placed health teams on heightened alert to help the country’s fragile health system cope with a potential outbreak of Covid-19 by assisting local efforts to tackle the pandemic.

Ongoing regional and international support

Even before the onset of the coronavirus pandemic, and irrespective of the direction in which the conflict was going, countries in the region and beyond have been providing humanitarian assistance to the embattled people of Yemen.

In March 2020, the King Salman Humanitarian Aid and Relief Center (KSRelief) assessed Yemen’s health needs to confront the virus and helped Yemen by providing medicines, medical devices and equipment, and preventive supplies by land, sea, and air.

It has also been reported that Saudi Arabia will contribute $500 million (Dh1.84 billion) to the United Nations humanitarian response plan for Yemen in 2020 and another $25 million to help combat the spread of the new coronavirus. This came within hours of the announcement by the Arab Coalition about the suspension in fighting to avoid a potential outbreak of Covid-19.

In February, Yemen thanked the UAE for its collaboration in the evacuation of Yemeni students in China’s Wuhan, where the coronavirus first surfaced. Late last month, around 215 people – from various Arab countries including Yemen – were flown to the UAE capital in a plane equipped with medical facilities. These students were tested and then accompanied by a specialist medical team provided by the UAE health authorities as a precautionary measure.

On March 23, the Director-General of the WHO thanked Saudi Arabia after it airlifted coronavirus protection supplies to Yemen and commented that it was important to remain united during the crisis. The shipment from Saudi Arabia included personal protective items for health workers and laboratory screening tests for Aden and Sana’a and trauma meds and supplies to support the ongoing response to the crisis.

Immediate problems

With the continuation of violence and the consolidation of armed groups on the ground, however, in addition to the emergence of new local power-brokers, Yemen’s response to the virus outbreak may still prove to be inadequate. Although the spread of the virus may potentially slow down direct clashes, the extensive use of airstrikes and non-direct means of combat may mean that the conflict will continue unabated.

Given that the relationship between domestic factions and external power brokers is increasingly complex, there is a high chance of violence persisting even with the sharp decrease of weapons inflow into Yemen, thereby undermining medical relief efforts. The potential spread of Covid-19 only adds to the danger that awaits the country in the coming months.

Moreover, in late January this year, a month after UN envoy Martin Griffiths described as one of the conflict’s quietest periods, the Yemeni government accused the Houthis of launching a missile attack at one of its military camps in the Ma’rib governorate. The Houthis refused to take responsibility, which has put a strain on a very fragile ceasefire deal lasting long enough for the country to tackle the virus outbreak.

In addition to a ceaseless cycle of violence and human rights violations, such as the use of child soldiers by Houthis, what might catalyze the further and faster spread of Covid-19 in Yemen is the overwhelming level of starvation among the country’s civilian population, measured in tens of millions. There is an urgent and obvious need for a coordinated, multi-track effort that will ensure peace and a re-oriented focus on fortifying healthcare facilities in areas most affected.

Yemen, like Afghanistan, might experience the consequences of the current conflict for generations to come. Malaria had virtually been eliminated in Afghanistan by the late 1970s after massive improvements in the country’s healthcare system at the time. The civil war that started in 1978 paralyzed what had been an effective eradication program and resulted in the re-emergence of malaria.

As of 2007, more than 50 percent of Afghanistan’s population lived in malaria-endemic areas. Given the current status quo and risk that global assistance efforts being shifted to fight Covid-19 in other regions, Yemen’s scenario might be potentially worse.

Future scenarios and the path forward

The threat Covid-19 poses to war-torn Yemen has added a potentially lethal new dimension to the ongoing conflict that plagues the country. The danger posed by the pandemic highlights the need to end protracted violence. Persistent factionalism has effectively crippled Yemen’s public health and medical infrastructure, with the likely result that the system will fail to even minimally resist the virus spread within the country. Therefore, despite the latest ceasefire, the short- to medium-future for Yemen remains uncertain.

The deterioration of Yemen’s geopolitical status and the potential impact of Covid-19 threaten to compound the poor condition of its population and leave the country’s political future and unity hanging on a thread. As the civil conflict marks its fifth year, the WHO continues to warn that a healthcare explosion awaits Yemen in the coming weeks given the current status quo. Considering that around 93 percent of the country’s medical equipment is out of service, few resources can be utilized to fight the Covid-19 outbreak once it reaches Yemen’s borders.

The only way forward is for greater efforts to catalyze sustained local peace talks and build trust, as well as a greater focus on finding alternative avenues for tackling the potential spread of Covid-19 across the country. If this is not done, the damage to Yemen will only deepen the negative impacts of the situation on neighboring countries and the wider region.