With seven previous Medecins Sans Frontieres’ missions under his belt, Australian Nurse and Epidemiologist Jeff Stewart, is no stranger to working in conflict and post conflict zones. Here he shares his most recent experience as a Field Coordinator in Khamir, Yemen.
I trained as a nurse and more recently as epidemiologist, but have spent a significant portion of my career working as a field nurse in North and South Sudan, Liberia and the Philippines. During my most recent mission to Khamir, Yemen, I filled a six-week gap until the next Medecins Sans Frontieres Field Coordinator took up their position. It was my first visit to Yemen and in fact my first time to the Arabian Peninsula, so I wasn’t sure what to expect. I think the context surprised me a lot. The quantity and level of airstrikes that are actually happening in the north of the country was a bit more that I was expecting. Thankfully it didn’t affect us too much. We had some airstrikes nearby while I was in Huth but nothing I felt too intimidated by, but we did see the indirect impact of conflict particularly from the North.
"There were many internally displaced persons (IDPs) as a result of the fighting"
There were many internally displaced persons (IDPs) as a result of the fighting. Khamir had a population of roughly 30,000 people while I was there, and of this number I’d say a third are IDPS, in Huth, about 40 minutes to the north of Khamir by car, there are another 2000 IDP’s. Most displaced people, probably half, are living inside the community with families or host families and the other half are either living in public buildings like schools, government buildings or living in camps. Daily life and normal activities like attending school and medical facilities has definitely been disrupted in many parts of Yemen, especially in the northern regions.
I worked mainly in Khamir Hospital, a 93 bed hospital supported by Medecins Sans Frontieres for almost all of the hospital activities, including: the emergency room, maternity, paediatrics, the operating theatre, in-patients beds as well as some neo-natal patients and a therapeutic feeding ward as well. Sometimes I travelled to Huth a forty minute drive north of Khamir, where we have a 20 bed hospital. This was more focused on paediatrics and maternity, but also had an In-patient Therapeutic Feeding program, and the emergency room which is a big focus for us as well.
Day-to-day I was more about team management and the global picture for the project, so I wasn’t involved with patients on a daily basis. I was mostly conducting meetings with the local security and health staff from Khamir hospital, and the directors from district health department. I attended a lot of meetings regarding staff security, and was responsible for verifying check points and making sure our movement plan was complete and functioning. I was the liaison point for coordinating the movement of the team and dealing with and any security issues that may arise.
There is a bit of a push to get some of the IDPs out of government buildings and schools, as the government look to get facilities back up and running and restart education again. This creates obvious tensions as there are not a lot of places for them to go. So some of my time was spent speaking with the District Manager to work out what we could do about that. Oxfam was the only other international NGO working in the area, so we had a number of cluster meetings with them to establish ways to organise and coordinate our activities supporting IDPs. We continue to provide support with our mobile clinics. We were originally doing water trucking for the IDPs but now Oxfam are doing the water trucking, although they are stopping in March due to the transportation costs. Having access to water in a big problem, there is no actual potable water and many of the wells are undrinkable due to high nitrate levels.
"Having access to water in a big problem, there is no actual potable water and many of the wells are undrinkable due to high nitrate levels"
There are general hygiene challenges for people living in the camps, this was especially evident in January during the coldest month when people were cold and had no wood or fuel for cooking. Without fuel people resorted to burning plastic bottles to cook their food and this contributed to a lot of respiratory infections. People living in tents are probably the most vulnerable and there are a proportion of IDPS who are just living under a plastic sheet and probably suffering the most.
In the hospital we are seeing referrals for complex obstetrics cases and road accident trauma patients, along with routine diseases like respiratory tract infections, diarrhoea, abdominal surgery, appendectomy and we are doing about 40-50 C-sections a month. A little bit of malnutrition but mostly respiratory tract infections for younger ones causing admissions with pneumonia this time of year. The hospital has been going for five years and the context at the moment is relatively stable so we are actually pushing to have more six month missions so staff can stay on a little bit longer. We really need to fill positions but it has been hard to recruit people because of the general image of Yemen within a security context.