Analysis by researchers at Johns Hopkins Center for Humanitarian Health identifies 20 top recommendations to mitigate future cholera outbreaks in Yemen and other humanitarian emergencies, including call for end of attacks on health, water and sanitation infrastructure.
Between April 27, 2017 and July 1, 2018, more than one million suspected cases of cholera in two waves were reported in Yemen, which had been declared a high-level emergency by the United Nations in 2015. Humanitarian organizations implemented a robust response to cholera despite numerous challenges including famine-like conditions, active civil conflict and destroyed health infrastructure within a shrinking humanitarian space in Yemen.
Prior to the outbreak, Yemen did not have a sufficient cholera preparedness and response plan in place despite previous cholera outbreaks, endemicity of cholera in the region and active conflict, according to a new report from the Johns Hopkins Center for Humanitarian Health, which is based in the department of international health at the Johns Hopkins Bloomberg School of Public Health. This lack of preparedness, in addition to extreme insecurity, resulted in gaps in disease surveillance, insufficient ability to reach conflict-affected populations and social mobilization interventions, and delays in evaluating the use of the oral cholera vaccine, among other obstacles, found the researchers.
The new report, “Cholera in Yemen: a case study of epidemic preparedness and response,” calls for better anticipation of and preparedness for epidemics in complex humanitarian emergencies with weakened public health systems. Recommendations include technical components, such as boosting the presence of peripheral laboratories to confirm cholera cases combined with improved surveillance in order to better monitor the outbreaks, to the humanitarian, such as improving coordination and requesting the UN to adopt a stronger stance on the protection of both health facilities as well as water and sanitation infrastructure from airstrikes.
“The cholera response in Yemen remains extremely complicated, with no easy fixes,” says Dr. Paul Spiegel, director of Johns Hopkins Center for Humanitarian Health and the report’s lead author. “Humanitarian access in Yemen is extremely limited, and the humanitarian community did well in a very difficult and insecure environment. Our goal was to produce meaningful recommendations for how to better prepare for future cholera outbreaks in Yemen and other emergency-prone countries, taking into account the extreme limitations of working in Yemen during an active conflict.”