Measles has killed 126 children in Yemen since mid-2011, a consequence of the breakdown of basic health services during the year-long political crisis. In response to the big increase in reported cases and deaths due to measles, the Yemeni government has appealed for international assistance and an outbreak-response vaccination campaign will begin in the hardest-hit regions on 10 March.
“It's very sad that we were talking about elimination in 2010, and now we are dealing with an outbreak,” said Arwa Baider, a child health programme officer at the UN Children’s Fund (UNICEF).
The latest statistics from the Health Ministry at the end of February report that 3,767 cases of measles have been confirmed, resulting in 126 deaths, since mid-2011. By comparison, in the three years from the beginning of 2007 until the end of 2009, the ministry reported a total of 211 cases and no deaths due to measles.
Seventy percent of these cases, and all of the deaths, were among children under five years of age. Most of the cases and deaths have occurred in the last four months. Measles has been reported across the country, but has been concentrated in Abyan, Aden, Al Bayda, Shabwa, Dhamar, Lahj, Amran and Sa'dah governorates.
“The disease is spreading fast, reaching highly populated areas as well as areas with high levels of acute malnutrition,” Geert Cappelaere, a representative of UNICEF in Yemen, told IRIN. “There is a very valid concern of many more deaths if a massive country-wide immunization campaign is not started immediately.”
Exacerbated by conflict…
According to the World Health Organization (WHO), measles outbreaks can be particularly deadly in countries recovering from conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps increases the risk of infection.
“The outbreak is a direct result of a decrease in routine immunization services during 2011; which is a direct result of the 2011 conflicts,” added Cappelaere.
In conflict-affected areas doctors reported being unable to deliver vaccinations because they were stopped at checkpoints, short of staff, or the refrigerated vaccines spoiled due to electricity cuts. In July 2011, WHO reported that fuel shortages had disrupted the cold chain supply system, resulting in the closure of 30 percent of immunization facilities.
|The outbreak is a direct result of a decrease in routine immunization services during 2011; which is a direct result of the 2011 conflicts|
Immunization rates also decreased in some areas, such as Abyan, due to a “resurgence of radical religious views - negative views - about vaccination,” said the Ministry of Health's director-general of family health, Ali Jahhaf. “Radical religious groups say that vaccination is not needed, it's against God's will and so on. Some communities believe this and started to resist or not accept vaccination. This is one of the reasons why in those areas we see pockets of lower vaccination coverage.”
Jahhaf added that the political crisis and armed confrontations of 2011 had increased the “immunity gap”, or the number of children who are not immunized, to a level large enough to cause outbreaks. “Our routine coverage is now not up to the level where you can have general community immunity.”
Measles is a highly contagious viral disease. Most measles-related deaths are caused by complications associated with the disease, more common in children under the age of five. Complications include blindness, encephalitis, severe diarrhoea and dehydration, ear infections, and severe respiratory infections such as pneumonia.
In Yemen, the measles crisis is more acute because of the country's high levels of malnutrition. Severe measles is more likely to develop among poorly nourished children, whose weakened immunity leaves them vulnerable to the complications caused by measles. According to UNICEF, 58 percent of Yemeni children are stunted and are chronically malnourished - the second highest rate in the world after Afghanistan. In the worst-affected parts of the country, 30 percent of children suffer from acute malnutrition, a level twice as high as the internationally recognized emergency threshold, and on a par with parts of southern Somalia.
The Yemeni government has appealed for international assistance to help the country cope with its humanitarian crisis. In January Prime Minister Mohammed Basindwa toured Gulf capitals to appeal for humanitarian aid during Yemen's political transition.
In response to the measles outbreaks, UNICEF in partnership with the Ministry of Health, WHO, and the US Agency for International Development, will launch the first phase of an outbreak-response vaccination campaign on 10 March in seven of the worst-affected governorates: Abyan, Aden, Lahj, Shabwa, Dahmar, Al Bayda, and Sa’dah. The second phase of the campaign will broaden vaccination across the country, but is dependent on additional funding. The cost of vaccinating eight million children is about US$9 million.
“It's preventable,” said UNICEF's Baider. “That's why we should fight for this.”