Forms of Health System Fragmentation During Conflict: The Case of Yemen

Dureab, Fekri; Hussain, Taha; Sheikh, Rashad; Al-Dheeb, Najwa; Al-Awlaqi, Sameh; Jahn, Albrecht

doi:10.3389/fpubh.2021.659980

Cited by 16 publications

(22 citation statements)

References 20 publications

(24 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Analysis of collected data shows serious challenges and gaps in the health system at the governorate level across all building blocks. The study reinforces previous research findings on the harmful impact of the ongoing war and instability on Yemen’s health system structure [ 22 ]. However, this study documents health system issues at the decentralized level.…”

Section: Discussionsupporting

confidence: 90%

Analyzing Yemen’s health system at the governorate level amid the ongoing conflict: a case of Al Hodeida governorate

Al Waziza,

Sheikh,

Ahmed

et al. 2023

Discov Health Systems

Self Cite

View full text Add to dashboard Cite

Background Yemen is regarded as one of the Middle East’s poorest countries. Decades of political, economic, and social difficulties have culminated in the current protracted conflict. As a result, the globe experienced its worst humanitarian catastrophe. The ongoing war has affected several public services, notably the health sector, which is operating at less than half its capacity. This study aims to examine Yemen’s health system at the governorate level (Al Hodeida) amidst the current conflict. It analyzes current challenges and produces suggestions for enhancement. Methods The study used qualitative research methods such as Key Informant Interviews (KIIs) and document analysis. The study used WHO’s health systems framework to measure health system performance. Twelve KIIs were conducted via Skype with several health stakeholders. In addition, documents were analyzed to inform the subject guide, generate themes, and aid in the triangulation of results. Results According to the study findings, the governorate health system managed to offer a minimum level of healthcare services while making some advances in outbreak control jointly with other partners. One of the main difficulties confronting the governorate’s health system is a severe lack of financial resources forcing it to rely entirely on external aid. Furthermore, other significant deficiencies include inadequate health system organogram, low reporting capacities, insufficient funding, and scarcity of health professionals. Conclusion Yemen’s frail health system has been weakened by almost eight years of insecurity and conflict. If the current scenario continues, most of Yemen’s health system’s operations and indicators will likely deteriorate. On the other hand, progress in some areas, such as primary healthcare (PHC) services and disease management, is remarkable. However, for better performance, Yemen’s health system leadership and stakeholders should seek a holistic strategy to improve the entire dimensions of the health system.

show abstract

Section: Discussionsupporting

confidence: 90%

Analyzing Yemen’s health system at the governorate level amid the ongoing conflict: a case of Al Hodeida governorate

Al Waziza,

Sheikh,

Ahmed

et al. 2023

Discov Health Systems

Self Cite

View full text Add to dashboard Cite

show abstract

“…The protracted armed conflict resulted in targeting civilians, healthcare facilities and personnel, water and sanitation infrastructure, schools, roads and bridges thereby disrupting services and exacerbating poor living conditions experienced before the war [ 5 , 7 – 10 ]. In addition to frequent civilian casualties, the protracted conflict has resulted in widespread forced displacement, food insecurity, severe malnutrition and food insecurity bordering on potential famine [ 11 ], and a heavily disrupted and fragmented health system consisting of two ministries of health (controlled by two different authorities in the north and the south), one based in Sana’a and the other in Aden [ 8 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Adult mortality before and during the first wave of COVID-19 pandemic in nine communities of Yemen: a key informant study

et al. 2022

View full text Add to dashboard Cite

Introduction Widespread armed conflict has affected Yemen since 2014. To date, the mortality toll of seven years of crisis, and any excess due to the COVID-19 pandemic, are not well quantified. We attempted to estimate population mortality during the pre-pandemic and pandemic periods in nine purposively selected urban and rural communities of southern and central Yemen (Aden and Ta’iz governorates), totalling > 100,000 people. Methods Within each study site, we collected lists of decedents between January 2014–March 2021 by interviewing different categories of key community informants, including community leaders, imams, healthcare workers, senior citizens and others. After linking records across lists based on key variables, we applied two-, three- or four-list capture-recapture analysis to estimate total death tolls. We also computed death rates by combining these estimates with population denominators, themselves subject to estimation. Results After interviewing 138 disproportionately (74.6%) male informants, we identified 2445 unique decedents. While informants recalled deaths throughout the study period, reported deaths among children were sparse: we thus restricted analysis to persons aged ≥ 15 years old. We noted a peak in reported deaths during May–July 2020, plausibly coinciding with the first COVID-19 wave. Death rate estimates featured uninformatively large confidence intervals, but appeared elevated compared to the non-crisis baseline, particularly in two sites where a large proportion of deaths were attributed to war injuries. There was no clear-cut evidence of excess mortality during the pandemic period. Conclusions We found some evidence of a peak in mortality during the early phase of the pandemic, but death rate estimates were otherwise too imprecise to enable strong inference on trends. Estimates suggested substantial mortality elevations from baseline during the crisis period, but are subject to serious potential biases. The study highlighted challenges of data collection in this insecure, politically contested environment.

show abstract

“…conflict has resulted in widespread forced displacement, food insecurity, severe malnutrition and food insecurity bordering on potential famine [11], and a heavily disrupted and fragmented health system consisting of two ministries of health (controlled by two different authorities in the north and the south), one based in Sana'a and the other in Aden [8,12].…”

mentioning

confidence: 99%

Adult mortality before and during the COVID-19 pandemic in nine communities of Yemen: a key informant study

Alhaffar

Basaleem

Othman

et al. 2022

Preprint

View full text Add to dashboard Cite

IntroductionWidespread armed conflict has affected Yemen since 2014. To date, the mortality toll of seven years of crisis, and any excess due to the COVID-19 pandemic, are not well quantified. We attempted to estimate population mortality during the pre-pandemic and pandemic periods in nine purposively selected urban and rural communities of southern and central Yemen (Aden and Ta’iz governorates), totalling > 100,000 people.MethodsWithin each study site, we collected lists of decedents between January 2014-March 2021 by interviewing different categories of key community informants, including community leaders, imams, healthcare workers, senior citizens and others. After linking records across lists based on key variables, we applied two-, three- or four-list capture-recapture analysis to estimate total death tolls. We also computed death rates by combining these estimates with population denominators, themselves subject to estimation.ResultsAfter interviewing 138 disproportionately (74.6%) male informants, we identified 2445 unique decedents. While informants recalled deaths throughout the study period, reported deaths among children were sparse: we thus restricted analysis to persons aged ≥15 years old. We noted a peak in reported deaths during May-July 2020, plausibly coinciding with the first COVID-19 wave. Death rate estimates featured uninformatively large confidence intervals, but appeared elevated compared to the non-crisis baseline, particularly in two sites where a large proportion of deaths were attributed to war injuries. There was no clear-cut evidence of excess mortality during the pandemic period.ConclusionsWe found some evidence of a peak in mortality during the early phase of the pandemic, but death rate estimates were otherwise too imprecise to enable strong inference on trends. Estimates suggested substantial mortality elevations from baseline during the crisis period, but are subject to serious potential biases. The study highlighted challenges of data collection in this insecure, politically contested environment.

show abstract

Forms of Health System Fragmentation During Conflict: The Case of Yemen

Cited by 16 publications

References 20 publications

Analyzing Yemen’s health system at the governorate level amid the ongoing conflict: a case of Al Hodeida governorate

Analyzing Yemen’s health system at the governorate level amid the ongoing conflict: a case of Al Hodeida governorate

Adult mortality before and during the first wave of COVID-19 pandemic in nine communities of Yemen: a key informant study

Adult mortality before and during the COVID-19 pandemic in nine communities of Yemen: a key informant study

Contact Info

Product

Resources

About