Hey guys, Scott here.
I got some speeches and events and things to tell you guys about.
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All right, y'all, introducing Ghassan Abu-Char from Doctors Without Borders.
Welcome to the show.
How are you doing?
Thank you.
I'm doing well, thank you.
Good, good.
Very happy to have you on the show today.
And we were put in touch by Doctors Without Borders because I was looking to talk with Claire Minera again, but apparently she's no longer in Yemen and they recommended you instead.
Are you in Yemen today?
Yes, I'm currently in Sana'a.
Yes, I'm the head of mission for Doctors Without Borders for Yemen.
Claire Minera was indeed part of my team.
She was the project coordinator for Amran project.
Now, unfortunately, she left and we have a replacement for her.
Well, all right.
Listen, so okay, great.
Head of mission.
Appreciate that.
All right.
So I guess, well, overall, my first question is if you could just give us an update on the cholera epidemic.
The Red Cross, I guess, says that a million people or approximately a million people have been infected with cholera there.
Well, since the last information we get from Claire, around August, September, we have started to close down our specialized cholera treatment centers in Yemen, one after the other.
However, the hospitals have kept running, receiving all sorts of diarrhea diseases from the population.
We at Doctors Without Borders think today that there are still cases of cholera inside of Yemen, although the epidemic has decreased a lot.
It's now a dry season.
There's not enough of transmission of the of the diarrhea within the population.
However, the situation is still the same.
From before the cholera started and during the cholera epidemic.
So today, diarrhea cases are still very high.
It could be this due to the cholera video or to other factors, including non-safe water or no access to water at all.
So we still receive a lot of diarrhea cases all over the country.
And and we think that between all those cases, they might be some cases of cholera.
What we are doing now is that we are already starting to prepare for for the rain season when it's going to start in a couple of months and again in Yemen, where we are afraid that that the cases of cholera can increase again, like last year, worse or less.
We don't know.
OK, so a few things to go back over there, if I understand you right, you're saying really the epidemic is over just because the the the rainy season is over there.
So that helps.
But then I guess and this is something that I'd spoken with Jamie McGoldrick from the United Nations a few weeks ago, and he was saying that that really all cases of diarrhea being presented basically were being categorized as cholera because there was no real way to test everyone to see exactly what they had.
So they were all just being basically treated the same.
So I wonder whether you think that there's a real discrepancy in there, that maybe there are a lot of different maybe waterborne diseases other than cholera.
Sounds like you're still dealing with some other than cholera at this point.
Yeah, it's the same whether it's called cholera or not.
People can still, especially children, can still and their life is still at risk from diarrhea, from normal diarrhea.
It's not treated on time.
So whether it's true what Jamie said is that is that due to the situation of the health system today, the needs are so big and the national health system is being crippled by the situation, by the war in Yemen.
So even with all the input coming from the humanitarian agencies and from Doctors Without Borders, it is difficult maybe for the humanitarian agency to test all the cases to know if cholera or not.
So surely everything is being treated as severe, which is good.
This decreases the death rate from the diarrhea.
But what's more worrying is that whether it's cholera or not, there is a high number of diarrhea.
Right.
Well, and this is something that Scott Paul from Oxfam has emphasized as well, is that when people are going hungry, then they can die from the common cold or they're much more likely to die from the kinds of diseases that otherwise would be easily preventable and hardly ever lethal.
Well, it's many factors.
It's many factors because, yes, people are getting hungry.
We are seeing an increased number of malnutrition in our centers.
But also we have to take into consideration that more than half of the health centers inside the country are not functioning.
So families with very basic diseases like a common cold or other symptoms don't have access to health care near them.
And in addition to that, due to the economic situation, cannot afford to be transported to get transport, actually to pay for transport to get to the hospitals like our hospitals and different governorates.
So the people wait.
A normal disease, a normal symptom, the families don't react to it directly because they don't have the possibilities to treat it.
So they wait until the situation is very critical until they seek medical care, which is very understandable.
So what we see in our hospitals in the last two months that there are just cases being presented to the hospital.
But the cases that are coming to our hospitals are very severe.
So the people leave it to the last moment to come to the hospital.
And this is basically due to the economic situation of the country.
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Well, I guess, you know, there's some confusion when we hear reports that we're going from tens of thousands to hundreds of thousands to right around a million cases of cholera.
And then the numbers are that a few thousand have died that, you know, it sounds strange.
And so it sounds like really, well, I don't know.
So what is to account for that?
Or how many people do you think or do you know how many people have died of cholera or other waterborne type diseases in, say, the last year?
I mean, the cholera outbreak started last spring, right?
Yes, we think that the numbers presented of death due to the cholera epidemic, the last one, are approximately true.
There are some villages and some areas in Yemen that are not accessible, especially the ones very close to the front line where there is a lot of airstrikes or there's ongoing fighting where the people are trapped inside, actually.
The death rate of this epidemic of cholera, it's good that the death rate was low, not like other epidemics.
But this, we think, could be from the reaction, a quick reaction.
I know from our side to set up cholera treatment centers, but also possibly because not all the cases presented were really cholera.
So it could be a combination of many factors.
But unfortunately today, we didn't yet study to know why the death rate had been so low.
Well, and not to play down the deaths that have occurred, but yeah, you're right.
If it's an overestimation in the first place, then I guess that's forgivable once it gets all straightened out.
But the real bottom line, of course, is the number of lives saved.
And you know, you guys there have been doing everything you can.
I know from talking with Claire ever since last spring that you guys are really working as hard as you can to distribute.
The main medicine for cholera treatment is just a bag of saline, right?
It's just to keep people hydrated, is that correct?
Yeah, it's very easy to treat.
It's very easy to treat.
It's very easy to treat as a disease as long as the people get to a health facility in time.
Because once the debris gets active, the dehydration could happen in six, actually in four to eight hours, especially for children or for older people who have already another disease.
And death could be in that time as well.
So this is always related to how fast can you get the treatment, which is hydration, basically.
But yes, I think this represents this overall estimation where some agencies are not able, or the Ministry of Health here is not able to differentiate between cholera and non-cholera.
It represents somehow the huge needs inside the country where all organizations, including us, are not able to deal with.
It's today, every month it gets bigger and bigger, and more factors, negative factors are included.
Today, Dr. Rourad Borders, the Yemen mission here is one of the biggest around the world.
We are deployed in 10 governments.
We have more than 2,000 people working with us inside the country.
And we cannot say that our work is enough for the needs that are existing.
And this applies, I think, to many other organizations and the Ministry of Health.
Right.
Yeah.
After all, even 1,000 cases of cholera is a huge outbreak if you're one of the thousand, or it's somebody you care about is one of the thousands.
So, yeah, I mean, and of course, we're now at almost three years of the war.
And I mean, the U.S. had been bombing the south of the country, al-Qaeda targets prior to that.
But we've had, you know, real war going on there for three years now.
So obviously, all the methods of distribution, all the markets and everything are all disrupted in a terrible way.
And of course, you know, with the move of the central bank from the capital city down to Aden and the cutting off of the pay of all the civil servants in Sana'a and north of there, that has, of course, had a huge toll.
And, you know, it's my understanding that that's a big part of what led to the cholera outbreak in the first place was no one's paying the garbage men.
And, you know, that's assuming and I don't know if the Saudis have bombed the waterworks or not.
But, you know, certainly the locals' ability to maintain all the previous systems of water and garbage service and these basics have been compromised by the war.
Yeah, what we see around us is that in terms of water supply, so pipes, wells, and other mechanisms are not exposed to water, but also the health facility is the same.
What has not been destroyed through the war, during fighting or due to airstrikes, is today not functioning because salaries are not paid for the people who make those repairs or maintenance or make it function on a daily basis, like, for example, health staff, even cleaners in health centers.
And so what is there, it's most of the time not working.
So it's a crippling factor for the health system, but also for the water and hygiene system altogether.
In addition to that, the people, due to the economic situation where goods inside the country are sometimes not getting in so easily, but also where people are losing their jobs.
Even if the goods are in the market, the people cannot afford to buy them anymore.
Since three months until today, the Yemeni Riyal has lost its value to around maybe 100, 200 percent.
The fuel, so petrol for cars, for generators, have doubled in price.
And so the people cannot afford basic commodities anymore.
Right now, and so what exactly is the state of the current water system in the capital and in the north of the country, or in the south for that matter?
I mean, are they able to get...
Yeah, it's the same all over the country.
It's the same situation.
We work in governorates considered as south and north.
The situation is the same.
All public services are struggling to function, mostly relying on aid from NGOs.
And a lot of it has been also destroyed or broken and needs to be replaced.
All right.
Yeah.
And now, so I mean, what's being done about that?
I guess I read that some new cranes were delivered to the Hodeida port.
Are they up and operating now?
Is anybody...
And then is the equipment and the things required to fix the water treatment, is that involved?
Is that part of what's coming in at all?
In terms of water, we don't have a daily, or like we don't have a daily section on that because we don't directly work in the normal water system.
We focus on health.
What we know related to bringing things inside the country, so yes, Hodeida port is open for humanitarian aid, which is a very good step.
Sana'a airport is open for humanitarian strike.
But still blocked for normal flight.
The problem is that the country cannot only survive on humanitarian aid.
The normal markets need to work.
There should be access for people to travel in and outside the country.
Example for people who need very complicated surgeries that they cannot get it inside Yemen and need to fly out, so they are blocked inside the country.
So, Hodeida port, Sana'a airport are only open for humanitarian aid, but not for normal ships and passengers.
Well now, the Saudis had previously bombed those cranes, but are the new ones up and operational again?
Actually, I don't know.
I cannot answer that.
Okay, fair enough.
And now, I guess, what were the, as far as you know, during the worst of the cholera and all that, what was the best estimate of the number of people who had died during that?
I think what has been reported, around 2,000 people who have died during the cholera epidemic is a good estimate.
Mm-hmm.
And I know that this is incredibly difficult to do.
It won't be until years later when they are able to measure all the excess death rates and all that kind of thing.
But we've heard from the beginning of the war, again, almost three years on now, that this is, one, the poorest country in the Middle East, and two, they're 80% to 90% or previously were 80% to 90% dependent on food imports.
And for complicated reasons.
But anyway, and so, there's been fear from the non-governmental organizations and some of the governmental ones all this time that there would be massive famine, that people would be dying even by the millions.
And so, it's three years on, and people are always saying, the brink of famine, the brink of famine.
And so, I just wonder whether there is a famine in Yemen, or if people are still getting by on just enough.
Again, as Scott Paul said, when people are hungry, they die of otherwise treatable diseases and that kind of thing.
But are they really starving?
Or how bad is it?
We do see, we cannot today, as we do without borders, assess to confirm or not confirm what the UN is saying about the famine.
Or the incoming famine in Yemen.
What we see in our hospitals, in different governorates in Yemen, that yes, there is an increased number of malnourished children inside the country, which is a big indicator for such type of declarations.
There is an increase.
But however, before this war started, there was already also cases of malnutrition within the society, especially in some pockets of some rural areas inside of Yemen.
Now the number is increasing.
What we see is that families are obliged to seek what we call negative coping mechanisms.
Example, a mother, instead of breastfeeding her child, would switch to milk, powdered milk, because she has to go and work the fields or work somewhere to get some basic income for the family.
Which means that a child from zero to six months is not adapted to get normal powdered milk.
And also the family cannot buy specialized children powdered milk, because this is a very expensive product.
So we see a lot of children are arriving malnourished in our facility because of negative coping mechanisms.
People have more difficulties to get access to diversified food, that's for sure.
And more children are today at risk of having to get malnourished due to lack of food, but also, and this is very important, due to another disease.
A lot of diseases for children from six months to five years can cause malnutrition, which makes the situation very complicated to treat and also for the child to get out of.
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All right.
Now, I'm sorry.
I'm just way over here in Austin, Texas, and I just have no idea what questions I should ask that I don't know to ask.
Is there anything else that you can tell us that you think the audience needs to hear?
I can say what we are feeling here, what we are feeling at the pool with our board is that the situation is just getting more and more complicated because in addition to the ongoing fighting inside the country, which has been going on for three years, the danger for people to move.
Sometimes they die in their houses.
They die in their houses because of bombing, because they are caught in crossfire.
Same what we saw in Aden two days ago, where we saw a whole family all together that was caught in the crossfire.
In addition to all of that, there's so many external and internal factors that make the situation worse.
Getting aid in Yemen today is getting more difficult due to bureaucratic procedures that are being put by the different parties of the conflict, which is delaying the delivery of aid, medical aid and other aid, but also making it for us more difficult to deliver this aid and raising also the operational cost, which is a non-essential cost to get this aid inside the country.
So everything is coming back to the civilians at the end, especially to the women and children, where for them getting for themselves basic commodities is difficult, but also receiving aid is more difficult.
So this is a very worrying situation where we are always in contact with the different parties of the conflict.
We are always trying to negotiate a better way and a more easy way to get aid in and to move inside the country.
But unfortunately, it looks like we are going towards an opposite direction.
Yeah, well, and I know that this is a bit outside of your expertise, and you may not want to comment on it, but I wonder if you have a feeling that things are getting better politically in any way in London, in D.C., in Paris, anywhere where it matters, where someone might be able to, you know, decide that enough is enough and call the Saudis American war off here.
Or is it just on autopilot?
Because nobody really talks about Yemen at all.
It didn't even merit one word in the president's State of the Union speech last night.
We do follow the news.
We do follow the news for sure on what discussions are happening or initiatives that are happening in different countries of statements that are being done by different countries, especially about the humanitarian situation in the country.
However, I cannot share the feeling of my colleagues here who are Yemeni and the population that we treat, that I talk to when I go to the hospitals.
It's just loss of hope.
After three years, there have been initiatives.
There have been a lot of talks, but no real action.
The only action that we've been taking is to make our work more difficult.
Yeah.
All right.
Well, listen, I can't tell you how much I appreciate your time on the show today, Ghassan.
Yeah.
Thanks a lot for having me as well.
All right, you guys.
That is Ghassan Abu Char.
He is the head of mission for Doctors Without Borders in Yemen.
And in fact, are you still there, sir?
Are you still there on the line, Ghassan?
I'm sorry.
You know, I almost forgot, I very nearly forgot to ask you, how can people get involved and help?
I mean, politically, that's one thing.
But in terms of getting involved with Doctors Without Borders, helping support specifically y'all's efforts in Yemen, please.
You can always visit our website, the Doctors Without Borders website.
On it, you can find all the information you want about our mission in Yemen regarding to what we do and what is the situation there.
So we always put updates on the current situation inside the country.
And also on the website, you can find a donate button where you can have a one-time donation, or you can also have a subscription where you donate on a monthly basis, or also join different campaigns that are led by the organization as well.
Great.
And then, by the way, is there a way people donate?
Can they say, I want this money to be earmarked specifically for Yemen or specifically for Palestinian refugees or whoever it's going to?
Yes, usually we prefer that the money being donated is not earmarked.
This is so that we continue to have our impartiality and neutrality in the actions we do.
If you donate to us, however, we will always keep sending you information of how the donation is being used on our different missions in the world.
It could be Yemen or elsewhere.
However, you can always put your wish on where this money you want to go.
Okay, great.
Listen, I really appreciate that very much again.
Thanks for having me.
All right, you guys.
Again, that is Ghassan Abu-Char.
And of course, the website is doctorswithoutborders.org.
And you know me, the show is at scotthorton.org.
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Follow me on Twitter, at Scott Horton Show.
Thanks, guys.
