Nema Báker remains very still on the stretcher.
This Yemeni mother is a regular at the Al Jumhuriya hospital hemodialysis center in Aden.
She has been coming twice a week from Radfan, a village in neighboring Dhalea province, for treatment for several years now.
“I have only missed when there were fights,” she says.
Now the city is apparently calm, but the effects of a war that has entered its eighth year have put the last straw in Yemen's weak health system.
With no electricity, no clean water, and no funds, hospitals struggle to care for the sick and injured.
International aid is her only hope.
Baker, 50, explains that dialysis requires added medication like calcium and vitamins.
“Before, the hospital provided it to us;
now we have to pay it and with inflation it has gone from 30,000 to 50,000 riyals a month [from 30 to 50 euros],” she says.
It is a fortune in a country where 80% of the population survives on less than three euros a day.
Still, she and the other patients in her neighborhood who occupy any of the 28 available beds are lucky because a benefactor pays for the minibus to take them to the hospital, a grueling three-hour trip each way.
Nabiha Bamagid, the head of the department, warns of the seriousness of the situation.
“We are seeing younger and younger patients who die because they cannot pay for complementary medicines to dialysis, including some cases of children under five years old,” he told a small group of journalists during a recent visit to Aden with the study center Sana'a Center.
To the insufficient capacity of the unit (overwhelmed because the neighboring provinces lack this service), has been added the lack of supplies since the outbreak of the war between the Huthi rebels and the internationally recognized government.
Nabiha Bamagid, the head of the dialysis department at Al Jumhuriya hospital in Aden, on February 23.
Sam Tarling (Sana'a Center for Strategic Studies)
“Our situation was complicated by covid, since it has affected people with kidney diseases, aggravating their condition.
We have had to improvise a specific isolation area, but we can't cope," Bamagid confides in the middle of a shift that started at five in the morning.
"Without the support of the International Committee of the Red Cross (ICRC) we would not be able to continue operating," he points out before adding that the King Salman Foundation (from Saudi Arabia) provides them with fuel for the generator.
The hospital's chief executive, Ahmed Salem al Shabahi, says the problems are not new.
"The war worsened seven years ago, but it started 30 years ago," he says, referring to the confrontation between southern and northern Yemen in 1994, just four years after the country's unification.
Since then, southern Yemenis have complained of marginalization in public investment and abandonment by the country's capital, Sanaa, in the hands of the Houthi rebels since late 2014.
Be that as it may, today public health is in a dilapidated state throughout the country.
According to the World Bank, at the end of last year barely half of the health centers were working and 80% of the population had difficulties accessing them.
The lack of human resources, equipment and supplies have deteriorated the services.
As a result, deaths in childbirth and newborns have increased, as have cases of child malnutrition, fewer children are vaccinated, and outbreaks of contagious diseases such as measles are resurfacing in some areas.
All this, in the midst of the pandemic and in a context of declining foreign financing.
This year the UN has barely obtained a third of the 4,300 million dollars (4,079 million euros) it was seeking to serve the most vulnerable population.
Donors fear that the aid will fall into the hands of the different groups in contention.
In 2019 alone, the Houthis appropriated some $1.8 billion in humanitarian assistance intended for civilians.
The two-month ceasefire between the government and the rebels that the UN announced in early April has opened a window of hope.
“It is difficult to speak in a general way because the situation is very heterogeneous.
It is not the same on the war fronts, like in Hajjah, where there is bombing and malnutrition, than in a province like Amran, where there is little violence and diseases are more linked to poverty”, explained an international aid worker from the sector before the truce.
Humanitarian organizations also face different problems in the north and in the south of the country.
While in the territory controlled by the Huthi they complain of difficulties of access and limitations of movement, in the south there is concern about the insecurity derived from the proliferation of militias and kidnappings.
The recognized government, based in Aden, does not pay the salaries of health personnel in the north, who are totally dependent on humanitarian aid.
In the south, salaries arrive irregularly.
At Al Jumhuriya, Aden's referral hospital with 450 beds, doctors barely earn the equivalent of 100 euros a month;
nurses, less than half.
This is a decreasing figure due to inflation.
The discouragement of the staff pales next to the state of the facilities.
Hallways and rooms are filthy.
There is no air conditioning, not even fans despite the sticky humidity.
The sheets haven't been changed for days.
In the accesses to the surgery area the light bulbs are burned out.
The director complains about the lack of help.
"During the covid pandemic, the international community has discriminated against us," he says before acknowledging that the facilities opened by the Southern Transitional Council (the separatist group that controls Aden) had the support of the World Health Organization and the ICRC.
He admits that even after the recent agreement between the
de facto
power and the government, the hospital's situation is very difficult.
Al Shasbahi, a convinced separatist and anti-colonialist, would like the center to recover the splendor it had during the British mandate.
“We still have the same facilities as when it opened in 1954 ″, he points out, indicating the old photograph that presides over his office, in which Princess Alexandra (a cousin of Queen Elizabeth II) is seen visiting the hospital.
"We need help from the international community, for donors to take action," he claims, helpless in the face of the political paralysis in his country.
The weight of Saudi money
10 minutes from Al Jumhuriya hospital in Aden, Saudi Arabia is putting the finishing touches on a new medical center equipped with modern equipment and what will be the first cardiology unit in the area.
It promises to offer almost 300 beds, in addition to external consultations of the main specialties.
It has laboratories, a physical therapy room, kitchens, a staff cafeteria, a laundry room, and even several apartments for visiting doctors.
“I didn't know something like this existed in Yemen;
they make you want to get sick to be admitted”, exclaims Mohamed, a Yemeni present during the visit.
Instead of upgrading existing health facilities and services, Saudi Arabia has preferred to rebuild the Aden hospital from scratch, which the kingdom gave away in 1990 and was looted in 2015 during clashes between the Houthis and pro-government forces.
It has cost 56 million dollars (about 51 million euros), according to figures provided by Ahmed Madkhali, head of the Saudi Development Project in Yemen.
Riyadh leads a military coalition that since 2015 has supported the Yemeni government against the rebels.
Madkhali explains that they do not trust the capacity of the Yemeni Ministry of Health and are going to hand over the management to a private company, although they will pay its costs for 15 years so that it offers free treatment like any public center.
She admits that they will have to establish some method to select patients, since the difference in services will make everyone want to go to the new center.
Mohamed fears that it will become a "hospital for the bosses".
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