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The suffering and death in war-ravaged Yemen — the Arab world’s poorest country— has reached new heights with the spreading of the coronavirus among its very vulnerable and fragile population. The death toll from the COVID-19 pandemic could even be greater than the combined number of those who have died from war, disease and hunger over the last six years, according to Lise Grande, the U.N.’s head of humanitarian operations in the country.

Yemen’s civilians have been the unwilling participants in a proxy war that has cost hundreds of thousands of lives and has left the public health system in shambles. Last December, the United Nations Office for the Coordination of Humanitarian Affairs noted that the conflict in the country has claimed some 233,000 lives over the six year period, either directly due to the conflict or from causes related to it, calling the number “unfortunate and unacceptable.”

The conflict started in 2014 when Iranian-backed Houthi fighters seized Sana’a, Yemen’s capital, and much of the country’s north. The Houthis were confronted by a U.S.-backed Arab coalition led by Saudi Arabia and the United Arab Emirates (UAE) in a bid to bring back Yemeni President Abed Rabu Mansour Hadi (who had been forced to resign) to power, without success. Since 2017, Hadi has reportedly been living in Saudi Arabia.

The effects of the war on the civilian population have been deepened by floods that have ravaged huge areas across the country, facilitating the spread of cholera and other waterborne diseases. Since January 2019, over 2,500,000 cholera cases have been recorded, 12 to15 percent of them severe. As the medical situation further deteriorates, it is becoming more difficult to implement an effective humanitarian response.

Children have been severely affected by the conflict. For the past three years, 25% of civilian casualties have been children, according to data reported by the charity Save the Children. What makes this situation even more concerning is that many of the children are dying either directly as a result of the conflict or from entirely preventable causes.

The Saudi- and Emirati-led coalition has implemented measures making it difficult to import needed medical supplies, depriving the Houthi-run public health system of critical medicines. This has proven deadly for patients receiving emergency care who rely on life-saving medical supplies. Houthi forces have also been accused of stopping humanitarian cargo trucks, and holding them for days before allowing them to continue.

Public health personnel and hospital facilities have been attacked, leading to the closure of health facilities. This has further hindered the proper delivery of health care. Physicians for Human Rights, an NGO, has consistently denounced those abuses. To make matters worse, 92% to 95% of medical equipment in Yemeni hospitals and health facilities no longer functions, according to that organization.

The situation is particularly dire in rural areas, which already lack the essential resources that are only minimally available in the cities. According to UNICEF, 20 million out of the country’s 30 million people currently rely on food assistance. However, the coronavirus pandemic has made the delivery of food even more problematic.

Countries on both sides of the conflict (Iran, on one side and the United States, the United Kingdom, France, Saudi Arabia and the UAE on the other) have the humanitarian responsibility to redress this situation. In 2018, U.N. Secretary General Antonio Guterres called it “the worst humanitarian crisis in the world.”

There is something wrong when the richest Arab countries team up with leading democracies to bomb thousands of civilians and ravage the poorest country in the Middle East.

Horrified by the loss of 323 young Argentinean lives during the sinking of the Belgrano cruiser by the British during the Malvinas/Falklands war, Bruce Chatwin wrote, “I cling to the archaic idea that unjustifiable killing in peace or war eventually rebounds on the killer. The dead do haunt the living. There is such a thing as blood guilt.” The same words could be applied to those responsible for the war in Yemen today.

Cesar Chelala is an international public health consultant.

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