The Regional Director of the World Health Organization in the Middle East, Dr. Ahmed Al-Mandhari, does not hide his great fears that the spread of Covid-19 disease in Yemen may lead to catastrophic effects, given the humanitarian crisis and the collapse of the health sector due to conflict, epidemics and widespread diseases such as cholera, malnutrition and dengue fever.
The regional director of the organization says that half of the population of Yemen with the virus (16 million) is infected with the virus, "more than just assumptions, these estimates are based on facts we are witnessing in the Yemeni reality."
In an exclusive interview with "Al-Masdar Online" via the Internet, Al-Mandhari points to the dangers of covering up and lack of transparency in announcing the true numbers of the injured, and says that concealing it is not in the interest of the local authorities, who demanded cooperation from them, and stressed that they are concerned with announcing cases of injury and death.
He stressed that the situation in Aden and in other governorates is "alarmingly dangerous", noting the efforts made by the World Health Organization and the equipment and support it has provided - until today - to the local authorities, refuting all allegations and accusations leveled against the organization.
Al-Mandhari called on the parties to the conflict and Yemenis to cooperate and unify efforts to confront the pandemic, noting the difficulties faced by the organization on the ground, which call for cooperation and work together.
He pointed out that the emergence of the Corona virus in Yemen is a natural matter and the theory of conspiracies is not true, and this is confirmed by the arrival of the pandemic to all rich and poor countries and the lack of differentiation of the virus between people according to color, race or lineage.
In the special interview conducted by colleague Moaz Rajeh from Al-Masdar Online with the Regional Director of Global Health in the Middle East, Al-Mandhari expressed his hope that Yemenis will overcome the unprecedented Corona pandemic, and that security and peace will return to Yemen, which is rooted in time.
Interview text:
* At first, Dr. Ahmed, if we look at the latest developments related to the outbreak of Corona in the Middle East region? The Eastern Mediterranean region is the fourth region in the world in terms of the numbers of confirmed cases and deaths caused by Covid-19. The epidemiological curve in most countries of the Region is rising, while it is declining relatively in a few countries. What is worrying is the accelerating rate of spread of the virus. Over the past weeks, the total number of cases has increased more than tenfold. There is a noticeable increase in the number of deaths, although the death rate varies greatly between countries where the rate is less than 1% and countries where the death rate is higher than the global rate of up to 7%.
Are there positive indications of curbing the outbreak of the epidemic in the countries of the region?
Countries are making a lot of efforts and applying precautionary and preventive measures, but we are still far from curbing the pandemic. Therefore, we recommend redoubling efforts, activating active surveillance of cases and their discovery in societies, speeding up isolation procedures, tracing contacts of confirmed cases, and providing care treatment to stop the chains of transmission of the virus. We stress the importance of involving all sectors of the government and the entire community in response efforts. This will only be achieved by spreading awareness of the seriousness of the situation, ways to prevent the virus, and the importance of adhering to the procedures announced by the health authorities.
* Has the outbreak reached its peak in the region?
not yet. The numbers are increasing and the epidemiological curve is on the rise, and we have not yet reached the peak point at which the curve begins to decline or even stabilize.
* What is your assessment of the situation of the health and medical sector in Yemen at the present time? And how prepared is it to face the Corona pandemic?
The situation in Yemen is not reassuring and raises concerns about the possibility of the spread of the emerging coronavirus disease in Yemen in a manner that could lead to catastrophic effects. Some estimates reach 16 million Yemenis (50%) with COVID-19 unless urgent and decisive action is taken
As we know, the current crisis that Yemen is experiencing due to the conflict that has been going on for more than five years is affecting the general condition of the country and the population, in addition to the fragility of the health system, which is currently operating at 50% of its actual capacity.
There are currently about 20 million people who are most vulnerable out of a population of 30 million who are in need of health care services, of whom 14 million are in dire need of these services.
* The World Health Organization confirms giving priority to Yemen and countries experiencing conflicts and crises... But the local authorities, the government and the de-facto authority in Sana'a are constantly criticizing the organization and accusing it of not providing the necessary needs. What is your response?
Indeed, the World Health Organization gives priority to countries experiencing conflict, especially Yemen, given the critical conditions it is going through. Let's take a look at the response plan developed by the World Health Organization for Yemen to confront the Corona epidemic as an example of the role that the organization, its partners and the donor community are playing in support of Yemen:
In light of the health response plan, the World Health Organization implemented the following:
- Equipping 26 emergency centers to serve as the backbone of the response to Covid-19. There are 10 centers in the southern regions, while 13 others are located in the north, in addition to two operations rooms at the central level in Sanaa and Aden, and another that will open in Taiz governorate.
§ 4 hotlines have been established in Sana'a and Aden to receive all communications related to COVID-19
§ Awareness materials are developed and distributed and circulated to facilities and entry points
§ Media attacks are also monitored and rumors are addressed
§ Equipping 333 rapid response teams (1665 individuals) in all directorates
§ The organization supports the training of these teams and equipping them with personal protective equipment
§ These teams are currently monitoring and following up all contacts of confirmed or suspected cases
§ Ensuring the readiness of entry points and obtaining the necessary resources to support the steps of quarantine, isolation and communication for risks. So far, 82% of the ports of entry have the ability to screen with the support of the organization
§ Support the identified laboratory network to ensure enhanced capacity for COVID-19 testing and provision of tests, equipment and laboratory supplies
§ The organization has strengthened the capabilities of the health authorities to equip four central laboratories for public health in the cities of Sana'a, Aden, Sayun and Taiz, and these laboratories have the full capacity to test for Covid-19 disease. Similar capabilities will be available in four other public health laboratories soon.
§ Training of 28 laboratory specialists so far
§ 6,700 PCR assays/reactions were provided for PCRs
§ 38 COVID-19 isolation units have been identified and supported by the World Health Organization to make them operational, as equipment has been provided for 32 (17 in the south and 15 in the north).
§ 520 ICU beds and 194 ventilators were provided
§ 11,717 oxygen cylinders have been provided to be refilled monthly throughout the country
§ 672 medical staff were trained in infection control, prevention, control and case management methods
§ The organization is currently working to provide 1000 beds for intensive care units, 417 respirators, 52,400 tests
§ Large numbers of personal protection units have been distributed and the organization is working to provide more.
* Recently, solutions for laboratory tests were carried out in the governorates of Taiz and Aden, and they were not sent from the global health stores in Sana’a. Does the organization have immediate plans to get rid of bureaucracy and restrictions that may hinder its rapid response to the needs of the health sector?
Unfortunately, the absence of security and stability leads to problems that are difficult to deal with and require cooperation from all parties to facilitate the arrival of supplies from their warehouses to their beneficiaries. We are facing a global epidemic that does not recognize borders and does not differentiate between groups, individuals, races or races. With regard to efforts to deal with this epidemic, we are facing real problems on the ground, and therefore we need the cooperation of local parties. We work hard and our efforts are based on seeing health as a bridge to peace. We hope that the initiative of the Secretary-General of the United Nations, in which he calls for an end to conflicts, will succeed to enable countries, organizations and local authorities to play their role in providing medical supplies and health care to those who need them.
* According to reports and field sources for "Al-Masdar Online", hundreds of confirmed cases and dozens of deaths were recorded in the areas of the Houthi authority, and other reports confirmed this.
The World Health Organization does not announce injuries and deaths, but this is the role of the concerned authorities in the country. However, the organization followed up on the health authorities in Yemen’s announcement of confirmed cases and issued a statement on its website that you can view.
The organization works closely with health authorities throughout Yemen, and the organization relies on the statistics issued by these authorities regarding the number of cases and deaths.
WHO provides evidence-based technical guidance and advice to countries that support it, and the same is true for Yemen. It also helps governments to strengthen their health systems to help them confront this pandemic.
* In the city of Aden in the south of the country, dozens of deaths are recorded daily and an accelerating escalation, the authorities say that it is due to epidemics, and the authorities have announced only a few deaths due to Corona... Do you have fears that the authorities there are covering up the outbreak?
It is not in the interest of the authorities in any country to cover up the true numbers of cases or deaths, and we do not think that the authorities in Yemen are hiding anything. However, a very influential factor is the weak surveillance system, the inability to detect cases and also the lack of a robust vital statistics system that has the ability to accurately record the causes of death.
* The government’s Supreme Committee says that the statistics it announces do not reflect the true number of existing injuries.. The committee’s spokeswoman confirms that all deaths recorded in Aden (about 1,500 since the beginning of May) are considered deaths due to Corona unless proven otherwise, justifying this by the inability to Examining all the deaths they receive... Is this justification logical?
It is necessary to follow a scientific-statistical approach in recording deaths and determining their causes and other important vital statistics. However, as I mentioned, the difficult conditions that Yemen has experienced throughout the past years of conflict and is still going through have had a devastating impact on many of the health sector's capabilities and its various systems, including surveillance systems and vital statistics networks.
* The World Health Organization says that it believes that the Corona virus is actively spreading throughout Yemen.. Has the organization reached facts and evidence that go beyond hypotheses? And statistics that go beyond what is announced by the authorities? Do your experts really expect an injury like that large number you mentioned?
The fears and expectations they refer to are more than just assumptions. These estimates are based on facts we are witnessing in the Yemeni reality. Relief operations in Yemen are the largest humanitarian operation in the world, reaching more than 13 million people every month. In Yemen, nearly 80 percent of the population needs some form of humanitarian assistance and protection. Ten million people are one step away from starvation and 7 million are malnourished.
The health needs in Yemen are already enormous; Thousands of children suffer from medical complications due to severe malnutrition, and thousands of people suffer from cancer, diabetes and other chronic conditions with a lack of medicines and treatments for these diseases. There are currently outbreaks of cholera, dengue fever and malaria with the emergence of polio in the northern governorates. Now, Yemenis face the threat of the COVID-19 pandemic, and accordingly, in these critical circumstances, in addition to political fragmentation, ongoing conflict, a weak health system, and the weak health and immune status of many groups in society - which greatly exacerbate the risks posed by the Corona virus - we face a real threat of... A health disaster unless urgent measures are taken and sufficient financial resources are provided.
* The government announced a few days ago that the city of Aden was infected, but the organization's response is not at the level of the disaster, as an official in the Emergency Committee stated. What is your response?
The situation in Aden and in other governorates is very alarming. WHO and health partners are doing their best to support and save lives.
For more than five years, the World Health Organization and our partners have played a major role in maintaining the health system in Yemen. We have conducted a cholera vaccination campaign for millions of people across the country and continue to support cholera treatment centers. We support life-saving treatment centers for severely malnourished children. We provide hundreds of sanitation facilities with fuel, clean water, oxygen, medicine and medical supplies. We reach millions of people even in the most remote parts of the country with basic health services. But we are facing a financial cliff at this critical time with COVID-19: For the WHO, we will have to cut 80% of health service delivery if we don't get funding - that money is the only lifeline that the Yemeni people have. To cut a lifeline now, at this time it would be a death sentence for the millions of men, women and children who depend on our humanitarian aid to survive.
* In light of the existing division and the lack of a single management of the health file, the weak crisis management and the fragile medical infrastructure, do you see the idea that the Health Organization or any other organization should take over the management of the Corona file from the hands of the authorities so that there is confidence in the international supporters to support the Yemenis in facing this disaster?
The World Health Organization sees Yemen as one country. We are working with health authorities on both sides on this to ensure Yemen is as prepared as possible. It is not possible for any organization to take over the management of the Corona file, this is the task of the local authorities and we help and support as much as possible.
Instead, we say that all Yemenis should work together in solidarity to combat this disease and engage the entire community in the response effort by understanding the severity of this disease and what they need to do to protect themselves.
Even in resource-constrained environments, collective action, including the full commitment of government, groups and the private sector, can effectively mitigate the impact of a pandemic.
* The death rate is about 17.4, according to the statements of the Secretary-General of the United Nations, and the percentage has exceeded 20 percent of the total announced injuries. Is this a normal rate given the death rate that the organization’s statistics indicate globally? And what are the reasons for that?
No, this rate is very high than the global death rate, which ranges between 5% -5.5%.
But as we said before, we must first make sure that the deaths attributable to COVID-19 are indeed caused by this disease. This requires a robust surveillance system and an effective and active vital information and statistics system.
* If we compare conflict areas such as Libya and Syria, which announced the registration of injuries before Yemen, so far there are still a limited number of cases recorded and there has not been a jump, as is the case in Yemen .. Do you think that there are other reasons and factors not related to the fragility of the health sector that contributed to the alarming rise?
The numbers registered in these two countries are limited, and the numbers registered so far in Yemen are also limited. However, this may be attributed to the weakness of the surveillance system and methods of case detection and isolation of contacts. Improved surveillance systems in countries experiencing conflict could lead to a significant increase in the numbers of confirmed cases from what we see now. At the same time, we should not overlook the differences in the effects of the conflict from one country to another. For example, while the conflict led to the outbreak of a wave of malnutrition among large numbers of the population in Yemen and subsequently affected the immunity of this population, we did not see this wave in Libya and Syria.
* There are those who talk about an American, Saudi or Gulf conspiracy behind the epidemic’s arrival in Yemen.. What is your comment?
The COVID-19 pandemic has reached the whole world, affecting both rich and poor countries, and developed and developing countries alike. What we know about the patterns of spread of the virus, whether through imported infection or the pattern of local and community transmission, makes its appearance in all countries, including Yemen, to be expected.
* How true are the recent allegations of the Sana’a authorities about the inefficiency of the smears and solutions sent by the organization, and their inaccuracy in the laboratory in detecting confirmed cases of corona, and that they show positive results for non-human samples?
• WHO provided more than 6 million PCR tests, about 2 million of which were manufactured by TIB Molbiol in Berlin, Germany
• More than 120 countries have received and used this test
• WHO standards for a test provider included at the time the decision was made to work with TIB Molbiol on the basis of the ISO: 13485 quality standard for manufacturing, the obligation to re-check the assay with any changes, and to provide testing to countries across WHO regions. The test, which was originally developed by a team led by the Charité and includes a member of TIB Molbiok, has been validated in three external laboratories and the verification has been published in a peer-reviewed journal.
• Subsequent to the publication of the protocol and performance of the assay, WHO has supervised multiple repeat validations of the assay by laboratories included in the WHO Reference Laboratories Network.
• The genetic makeup of animals and humans are not the same, so it would not be scientifically valid or accurate to measure the results of non-humans tested against human tests.
• The only complaint about the assay is that the two gene targets are tested in sequence, not together in a multiplex assay. In all PCR tests with multiple genetic targets, one target is inevitably more sensitive than the other. Thus PCR providers tend to offer language that says 'If both genetic targets are detected, the result is confirmed positive, and if one target is not detected, it is called 'inconclusive' or 'positive positive' and the test is repeated. This is a relatively common phenomenon in samples with low viral load, as the amount of viral RNA is above the 'detection limit' for one PCR target gene, but below the LOD for the other.We have recommended that laboratories rely on a single target gene in settings where it is known That COVID-19 is circulating, and certainly maintained with additional targets or sequences only when the disease first occurs in a country.
The bottom line is that all the medical materials, supplies and supplies that WHO has sent to various countries are of high quality and are subject to safety and efficacy tests. What is sent to Yemen is no different from what is sent to other countries in the region in terms of quality and effectiveness. We call upon everyone not to get carried away by rumors, attempts to cast doubt and false information, which have no aim and no point in spreading fear and frustration among people and causing them to lose confidence in the international organizations that work to support them.
In its last statement, the Ministry of Health in Sana’a acknowledged the spread of Corona in all regions, without providing a number of injuries and preferred to hide it and not publish it as numbers with the justification of maintaining community morale and not spreading terror... Is this justification logical?
We receive daily data for cases of infection from all countries of the region, including Yemen, and we publish them on our websites. In general, we always emphasize that transparency, openness and community involvement in response efforts are the key to success in the fight against COVID-19. No country has succeeded in efforts to respond to the pandemic except by adopting the principle of transparency and frankness and making efforts to enable its societies to understand what is going on, realize the reality of the situation and understand the degree of its seriousness. Therefore, we recommend all governments and authorities to announce the reality of the situation and publish accurate data and documented numbers.
* Heads and CEOs of 17 organizations, including the World Health Organization, called on donor countries to translate their pledges through strong and significant financial support at the online conference hosted by Riyadh on Tuesday, to finance the humanitarian operation and programs to confront Corona.. Was the financial deficit the only obstacle to the global health response to Yemen’s needs? In the last period? Are there other obstacles and difficulties facing your work?
The financial crisis is the biggest challenge facing us and the most severe obstacle to responding to the crisis in Yemen. فعلى مدى الأشهر الستة المقبلة، سوف تحتاج منظمة الصحة العالمية وشركاؤها إلى 203 ملايين دولار أمريكي للوصول إلى أكثر من 7 ملايين شخص. من بين 41 برنامجًا رئيسيًا للأمم المتحدة في اليمن، سيتم إغلاق أكثر من 30 برنامجًا في الأسابيع القليلة المقبلة إذا لم تتمكن الوكالات الإنسانية من تأمين أموال إضافية، مما يعرض ملايين الأرواح للخطر الذين يعتمدون على دعمنا الإنساني. فنحن وجميع المنظمات العاملة في اليمن ليس لدينا تمويل جديد ونواجه جرفًا ماليًا سنعجز معه الآن عن توفير أجر معيشي أو" حوافز "لأكثر من 10000 عامل رعاية صحية يعملون في المستشفيات اليمنية العاملة والمرافق الصحية ويمثلون العمود الفقري لأي نظام صحي.
نخشى أن يؤدي هذا الوضع ليس فقط إلى الحد من توافر الرعاية ، ولكن أيضا إمكانية الوصول إليها. فقد يضطر المرضى مرة أخرى إلى السفر أبعد من ذلك بكثير ، وأحيانًا مئات الكيلومترات ، لطلب العلاج في مستشفيات المحافظات - بسبب العدد المحدود للعاملين في مجال الرعاية الصحية في مستشفيات المقاطعات والمستشفيات.
وهناك خمسة برامج تديرها المنظمة في اليمن منها ثلاثة مهددة بالتوقف بسبب نقص التمويل في وقت توفر هذه البرامج خدمات ذات أولوية لحماية الأطفال والامهات وغيرهم من الفئات الأكثر احتياجاً للرعاية.
* كما يبدو فإن الجهود الأممية ما زالت تراوح مكانها في ظل إصرار أطراف الصراع على التصعيد العسكري والعمل الأحادي.. هل من الممكن أن تنجح الجهود الأحادية لكل طرف في احتواء الجائحة والحد من انتشار الفيروس في اليمن؟ وما هي الرسالة التي توجها للأطراف المتصارعة؟ وما هي رسالتك كمسؤول أممي أولاً وطبيب عماني ثانياً للمواطنين اليمنيين على مستوى البلاد في ظل المخاطر الحالية؟
أود أن اقول إن اليمن بلد عريق وذو تاريخ ضارب في جذور الزمن والشعب اليمني معطاء ومحب للسلام والخير للجميع ولقد علَّمتنا هذه الجائحة العديد من الدروس بشأن العمل من منطلق تقني وإنساني والحاجة إلى عمل موحد لمواجهة هذا التهديد الخطير للبشرية. ولا يمكننا أن ننجح إلا بالعمل معاً، بلدان ومنظمات إنسانية ومجتمعات وأفراد، وبضمان أن أعمالنا القائمة على التضامن والشراكة الحقيقية والثقة المتبادلة والشفافية تخدم حتى أكثر الفئات عُرضة للخطر من أجل الصالح العام.
ولا يوجد وقت أفضل من الآن للاتحاد والتعاون بين أبناء الشعب اليمني الواحد. هناك مسؤولية دينية واخلاقية واجتماعية قبل ان تكون مسؤلية مهنية لانقاذ الارواح ورفع المعاناة عن اليمينين بغض النظر عن اماكن تواجدهم داخل اليمن او اعمارهم فلنجعل هذه الجائحة غير المسبوقة فرصة للجميع لطرح الخلافات جانباً وإيجاد أرضية مشتركة والعمل معاً من أجل الإنسانية.