Chronic Health Crises and Emergency Medicine in War-torn Yemen, Exacerbated by the COVID-19 Pandemic.

introductionMuch of Yemen's infrastructure and healthcare system has been destroyed by the ongoing civil war that began in late 2014. This has created a dire situation that has led to food insecurity, water shortages, uncontrolled outbreaks of infectious disease and further failings within the healthcare system. This has greatly impacted the practice of emergency medicine (EM), and is now compounded by the coronavirus disease 2019 (COVID-19) global pandemic.

methodsWe conducted a systematic review of the current state of emergency and disaster medicine in Yemen, followed by unstructured qualitative interviews with EM workers, performed by either direct discussion or via phone calls, to capture their lived experience, observations on and perceptions of the challenges facing EM in Yemen. We summarize and present our findings in this paper.

resultsEmergency medical services (EMS) in Yemen are severely depleted. Across the country as a whole, there are only 10 healthcare workers for every 10,000 people - less than half of the WHO benchmark for basic health coverage - and only five physicians, less than one third the world average; 18% of the country's 333 districts have no qualified physicians at all. Ambulances and basic medical equipment are in short supply. As a result of the ongoing war, only 50% of the 5056 pre-war hospitals and health facilities are functional. In June 2020, Yemen recorded a 27% mortality rate of Yemenis who were confirmed to have COVID-19, more than five times the global average and among the highest in the world at that time.

conclusionIn recent years, serious efforts to develop an advanced EM presence in Yemen and cultivate improvements in EMS have been stymied or have failed outright due to the ongoing challenges. Yemen's chronically under-resourced healthcare sector is ill-equipped to deal with the additional strain of COVID-19.