User:Amyh0119/2016–2020 Yemen cholera outbreak

 The COVID-19 Pandemic in Yemen (Hannah) 

The COVID-19 pandemic in Yemen is part of the worldwide pandemic of coronavirus disease 2019 (COVID-19). As of November 9, 2020, there were 2,070 confirmed cases and 602 deaths (1). The COVID-19 pandemic has further burdened the already overwhelmed healthcare system in Yemen fighting cholera, dengue fever, and malaria (2). Half of existing health facilities are fully functioning while more than 17.9 million people of a total population of 30 million need health care services in 2020 (2). In addition, those that remain open lack medical personnel, basic medicine, and essential supplies such as masks and gloves (2).


 * 1) https://covid19.who.int/region/emro/country/ye
 * 2) http://www.emro.who.int/yemen/news/who-and-ksrelief-renew-partnership-to-continue-sustaining-yemens-health-system.html?format=html

 Wastewater and Solid Waste Management in Yemen (Erin) 

Yemen’s wastewater and solid waste management systems are the least developed among Middle Eastern countries, which has been a major contributor to the cholera outbreak [1]. With 16 functional sewage treatment plants (STPs) and a growing population [1,2], the country’s sewage systems are ill-equipped to meet the needs of citizens and serve just 7% of the population [1]. Actual flow rates through the STPs in Yemen exceed the flow rates they were designed to accommodate, which reduces their efficiency [1].

The treatment processes used are also suboptimal, with 68% of STPs using only stabilization ponds [hyperlink to Wikipedia article on stabilization ponds] - which are generally intended as a primary treatment - to remove pathogens from sewage [1]. This has resulted in high quantities of infectious agents in effluent [hyperlink to Wikipedia article on effluent], which is hazardous to health and can enable the spread of cholera [1].

Moreover, wastewater in Yemen is frequently reused for irrigation purposes by farmers due to a lack of awareness about safety risks [3,4]. High concentrations of Escherichia coli, Streptococcus faecalis, Klebsiella pneumonia, Enterobacter aerogenes, Salmonella  typhi, S. typhimurium, and Shigella sonni - among other harmful fecal coliforms - are present in this wastewater, and transmit to humans when they consume foods irrigated by it [5].

Official dumping sites for solid waste are being created increasingly close to communities, which has increased the risk for infection and general health issues among citizens [6]. This is especially true for the roughly 70% of citizens without access to potable water, who consume water from wells near dumping sites [1].

[1] https://pubmed.ncbi.nlm.nih.gov/30285950/

[2] https://data.worldbank.org/indicator/SP.POP.GROW?locations=YE

[3] Al-Gheethi, A. A., Mohamed, R. M. S. R. & Efaq, A. N.aManagement of wet market wastewater in Yemen. A glance on the world.Waste Management51,I–III.

[4] Al-Gheethi, A. A., Mohamed, R. M., Efaq, A. N. & Norli, I.bReduction of bacteria in storage system of sewage effluents.J. Sustain. Water Resour. Manage.3, 193–203.

[5] Al-Gheethi, A. A., Abdul-Monem, M. O., Al-Zubeiry, A. H., Efaq,A. N., Shamar, A. M. & Al-Amery, R.Effectiveness of selected wastewater treatment plants in Yemen for reduction of faecal indicators and pathogenic bacteria in secondary effluents and sludge.Water Practice Technol.3, 293–306

Draft/brainstorm: https://pubmed.ncbi.nlm.nih.gov/30285950/


 * There has been a rapid growth in Yemen’s population in the past 2 decades (1990-2010), which has contributed to the inadequate health and wastewater systems available to citizens
 * Yemen-sourced statistic: Parliament Water and Environment Committee (2006)
 * Water-borne diseases affect 75% of the population, 55,000 child deaths per year
 * > 3 million people have hepatitis due to consumption of polluted water
 * Lack of data - useful to mention:
 * Search conducted between 2008 and 2017, 61 articles on cholera but none were based/conducted in Yemen
 * About Yemen’s wastewater management system:
 * Least developed country in Middle East for its waste management system
 * 16 functional sewage treatment plants (STPs), 9 under construction
 * Sana’a (Yemen’s capital, with the highest amount of cholera outbreaks)’s actual flow rate exceeds the flow rate it has been designed for, which detriments the efficiency of the STP
 * No maintenance on the STPs  -> less effective in reducing pathogens
 * Effluents and biosolids are used in agriculture - risk of contamination via vegetables used for consumption
 * 68% of STPs depend on only stabilization ponds, which are generally used as only primary-line treatment since they are not as effective at removing pathogens, and removal for pathogens is “overlooked” from the requirements for minimum/standard sewage treatment

 Global Responses (Amy) 

Canada

As of June 2, 2020, Canada has decided to pledge $40 million in humanitarian aid for Yemen as the politically unstable country copes with cholera, malaria, dengue fever, and diphtheria along with COVID-19. This brings Canada’s total contributions to Yemen since 2015 to $220 million, which contributes towards the goal of $2.4 billion USD for underfunded humanitarian programs run by UN agencies and humanitarian organizations in Yemen.

US

On April 3, 2018, the United States announced $87 million in additional humanitarian assistance to help the people of Yemen, bringing the U.S. total assistance since 2017 to more than $854 million. This money will be used for food assistance, safe drinking water, emergency shelter, and medical supplies. The U.S. is also planning to provide $55 million in economic and development assistance, including programs to support livelihoods, rebuild infrastructure, and restore access to education.

On March 27, 2020, the Trump administration cut $70 million in assistance destined for northern Yemen, framing the decreased funding as a response to the interference of Houthi rebels. The U.S. officials were concerned that the assistance was directed to fighters instead of civilians. South Yemen, which is less populous, still received aid dollars.

Societal factors
On 23 June 2017, Saudi Arabia's crown prince, Mohammed bin Salman, authorized a donation in excess of $66 million for cholera relief in Yemen, while continuing its airstrikes and military operations in Yemen.

An aid conference was held in Geneva in April 2017 that raised half of the US$2.1 billion that the UN estimated was needed.

Many Yemeni people could not afford transportation to treatment centers.

Saudi Arabia

Saudi Arabia has been backing the Yemen government in the fight against the Houthi rebels, and they are also one of the top donors for UN humanitarian aid operations in Yemen. Mohammed al-Jaber, the Saudi ambassador to Yemen, has announced half a billion dollars from Saudi Arabia to support UN programs in 2020.

UN

As of July 8, 2019, the UN and partners are running 1200 cholera treatment facilities around the country, however, funding is an issue. The 2019 Yemen Humanitarian Response Plan required $4.2 billion to deliver assistance, but they ended up receiving $3.6 billion. For the 2020 plan, the UN has so far received 15% of the necessary $3.5 billion needed.

World Bank

On August 25, 2017, the World Bank announced $200 million U.S. to support Yemen as it struggles to contain the cholera outbreak. This money is used to strengthen the country’s health, water, and sanitation systems.

 El Nino - cause of cholera (Amy) 

El Nino Southern Oscillation phenomenon is a major driver of climate variability associated with health outcomes, including influencing cholera dynamics due to changes in rainfall. For example, in East Africa, there was an upsurge in cholera cases in areas with increased rainfall, along with increase in cases in areas with decreased rainfall. In the 2015-2016 El Nino event, there were an additional 50 000 cases of cholera in East Africa. Based on genomic approaches, there was a linkage found between the epidemic in Yemen starting in 2016 and the earlier outbreaks in East Africa. This alludes to a possible connection between cholera in East Africa and Yemen. Chironomids are natural reservoirs and carriers of the Vibrio cholerae bacterium. It has been suggested that adult chironomids may aerially carry the bacterium between bodies of water, assisting in the transmission of cholera. Based on this evidence, it is hypothesized that the El Nino conditions over the Gulf of Aden may have contributed to the transmission of cholera from the Horn of Africa to Yemen through wind effects on cholera-contaminated flying insects.

Images: map of where we are talking about, pic of the specific insect