BEIRUT, Lebanon — In northern Yemen, more and more people are falling ill and dying after having trouble breathing, yet the Iran-backed group that controls the region, the Houthis, has acknowledged only a few coronavirus deaths.
In southern Yemen, where two groups that previously fought the Houthis together have turned on each other, mortality rates have more than tripled compared with last year.
The coronavirus appears to have slammed into Yemen, a country already staggering from five years of war, competing power centers, a health care system in ruins, widespread hunger and outbreaks of cholera and other infectious diseases.
But the denial of the outbreak in the Houthi-controlled north, the absence of clear authority in the divided south and the drying-up of aid everywhere have hobbled any hope of limiting the virus’s spread, leaving health care workers and hospitals ill-equipped to cope with it and the public confused and suspicious of efforts to combat it.
Yemen was already facing what has been called the world’s worst humanitarian crisis before the virus hit. The war, in which a Saudi-led military coalition is battling the Houthis, has taken 100,000 lives. Saudi-led airstrikes have killed thousands of civilians and destroyed hospitals and schools, while United Nations officials have accused the Houthis of diverting humanitarian aid.
The pandemic has generated rumors that patients were being euthanized at hospitals, causing many Yemenis to shy away from treatment. Yet when they can no longer avoid the hospital, they are regularly turned away for lack of beds, protective equipment and medical supplies.
The authorities in many places are too weak to prevent large crowds from gathering at prayers, funerals and marketplaces, or residents from traveling within the country.
The confusion and doubt are compounded by the secrecy surrounding the outbreak — officially, the country has only 282 confirmed cases and 61 deaths.
“In Yemen, we think there’s no coronavirus because we don’t trust our own health system,” said Salah Mohammed, a school security guard in the southern port city of Aden. “They talk about a curfew to prevent the spread of the disease. Great. But why do they allow people to move freely around the country if there’s a curfew?”
With little testing available and the government and hospitals in disarray, it is difficult to measure the virus’s true spread in Yemen. What numbers are known, however, are grim.
As of last week, tests had confirmed more than 500 coronavirus cases just in Sana, the Houthi-controlled capital, said a doctor who advises the Health Ministry there. The deputy health minister is among those infected, and a former president of Sana’s flagship university is among the nearly 80 dead.
Yet the Houthi authorities have acknowledged only four cases in their territory, leaving public health officials, health care workers and aid groups to sound the alarm about an outbreak whose severity the authorities are playing down.
Some Health Ministry employees have been pleading with senior officials to make the true numbers public so that emergency medical workers and residents understand the gravity of the threat, said the doctor, who asked to remain anonymous because the authorities had threatened colleagues who had tried to go public.
On Thursday, the Health Ministry in Sana asserted in a statement that other countries’ decisions to publicize their coronavirus case counts had “created a state of fear and anxiety that was more deadly than the disease itself.” The ministry offered no numbers of its own.
“We don’t have to adhere to what the world wants us to,” Yousif al-Hadhiri, a ministry spokesman, said in an interview on Friday. He blamed the World Health Organization and international aid groups for being “lazy” and failing to deal with the outbreak.
The reason for the secrecy is unclear. But one result is that the virus is likely to spread further, analysts said.
“The Houthis aren’t just shooting themselves in the foot,” said Osamah al-Rawhani, the executive director of the Sana’a Center for Strategic Studies, a Beirut-based think tank focused on Yemen. “They’re shooting people. The people who are in power haven’t recognized or revealed the right information to the public. And secrecy makes people do the wrong things because they’ve gotten the wrong message.”
The coronavirus is ravaging the other side of the front lines as well, where forces opposed to the Houthis are also reporting dubiously low numbers. There, however, the main problem is not denial, but lack of governance and a health care system in meltdown.
In Aden, which served as the interim seat of Yemen’s internationally recognized government until a separatist group seized it last month, burial data showed that 950 people had died in the city in the first 17 days of this month, more than triple the 306 recorded for all of May 2019, according to an analysis by Abdullah Bin Ghouth, an epidemiology professor at Hadramout Universitywho advises the minister of health in Aden.
The spike in deaths suggests that the official virus death toll is a vast undercount.
At a hospital for coronavirus cases that Doctors Without Borders has set up in Aden, the only dedicated Covid-19 facility in southern Yemen, 173 patients have been admitted, more than 68 of whom have died, the group said.
In other countries, 80 percent of patients did not need hospitalization, suggesting that many more people may be infected than those who went to the hospital.
Yemen’s health care system, already overrun with outbreaks of cholera and other serious diseases, is gasping. Most doctors and nurses have not been paid in years, leading many to leave the public health system. Those who stayed are now being asked to treat coronavirus patients without protective gear.
Azzubair, an emergency room doctor at a hospital in Dhamar Province, south of Sana, said he and his colleagues had been given only cheap, flimsy masks and gowns despite treating an average of six suspected Covid patients a day.
“We can’t help but deal with possible Covid-19 cases on a daily basis,” said Azzubair, who asked to be identified only by his first name to avoid reprisals. “It’s like being in the monster’s jaws. By the time you realize you’re dealing with a suspected coronavirus case, it’s too late. You don’t really understand why they’re handling this issue in such secrecy.”
In the south, only a few hospitals are accepting coronavirus cases, with other facilities refusing patients or closing down altogether because they lack protective equipment or staff are abandoning their posts. Doctors Without Borders, which operates Covid-19 centers with a total of 25 intensive-care beds across the country, does not have enough masks, gowns or medical staff to open more, said Claire Ha-Duong, the head of the group’s mission in Yemen, and turns away patients every day.
Funding has fallen far short of the need. International donors suspended or cut much of their funding before the pandemic over concerns that the Houthis were keeping aid from going where it was needed. Lise Grande, the top United Nations official in the country, said the Houthis had since agreed to concessions that she hoped would reopen the spigot.
For any public health response to stick, however, Yemenis need to accept the need for it at a time when trust in the powers that be is at a low ebb.
One persistent rumor darting around Yemen is that people who go to the hospital receive lethal injections to put them out of their misery. In Houthi territory, armed personnel have fired into the air to keep people away as medical teams take people suspected of being infected into quarantine, residents said.
In Aden, a city of half a million, the recent power transfer has left no authority capable of mounting an organized public-health campaign. There are no quarantine centers and no restrictions on movement or gathering, and residents have protested against attempts to impose them.
Yahya, 36, a Sana resident who asked to be identified only by his first name to avoid running afoul of the Houthis, buried three relatives who died with coronavirus-like symptoms. He partly blamed those in charge: If officials had been transparent about the size of the outbreak, he said, people would have taken the virus more seriously.
He, too, had begun to show symptoms, but said he had refused to go to a hospital or a quarantine center.
“I wouldn’t go anywhere, even if it’s a Movenpick,” he said, referring to the five-star Sana hotel that shut down during the war and has now been converted into a quarantine facility. “There’s no trust anymore.”
Saeed al-Batati contributed reporting from Al Mukalla, Yemen, and Shuaib Almosawa from Sana.