Dialysis patients at Dhamar General Hospital. Credit: UNOCHA Yemen
Some information is difficult to share, such as advising your dialysis patient that you must stop their life-sustaining treatment because you no longer have sufficient resources or medical supplies. This is the daily predicament of Dr. Jamal Al-Shami, Head of Dhamar’s general hospital in Yemen. The hospital currently treats about 200 patients suffering from kidney failure, all of whom require dialysis treatment. They include 46 people who were displaced from their homes by the conflict in Yemen. Dhamar is a relatively stable governorate that is not on the front lines of conflict. It hosts almost 150,000 people, mostly from neighbouring governorates.
“As a health facility, we provide treatment to internally displaced people [IDPs] and to the war-wounded, whether from Aden or Sa’ada, without any discrimination,” said Dr. Al- Shami.
Dialysis services cut
The conflict in Yemen has killed over 7,400 people and injured almost 40,000 since March 2015. More than half of all health facilities have been damaged or destroyed since the conflict began. Last year, humanitarian agencies aimed to reach 10.7 million people who were not able to access basic healthcare. Dhamar’s general hospital lacks fuel and essential medical supplies, and most of the employees have not received a salary in months as Yemen is experiencing a liquidity crisis.
The hospital’s dialysis centre is particularly affected by the shortages and has been forced to make tough decisions. To meet the minimum needs of its patients from across Yemen, the centre had to reduce dialysis sessions from every two weeks to every three weeks, and it reduced the length of dialysis treatment time for each patient from five to three hours.
“We are just unable to provide the patients with the full treatment they need according to medical standards,’’ said Dr. Al- Shami. The lack of treatment increases patients’ suffering. Reduced dialysis causes liquids and toxic materials to build up in the patients’ body, which can lead to a coma, respiratory and cardiac complications, and even death.
“Reduced dialysis causes liquids and toxic materials to build up in the patients’ body, which can lead to a coma, respiratory and cardiac complications, and even death.”
Now the hospital cannot even sustain these reduced dialysis services.
The entrance to the emergency ward at Dhamar General Hospital. Credit: UNOCHA Yemen
Inside the hospital, dozens of patients, mostly female, are gathered in a 30m2 room, lying on beds side by side. Most of them have been staying there for months. They come from distant regions across the country, and cannot afford the transportation costs or to rent accommodation in the city.
Maymouna, 25, has suffered from kidney failure for over nine years. She has been at the hospital for eight months and requires three dialysis sessions a week. On the day of her scheduled dialysis the doctor was unsure if she could be treated. As Maymouna waited, she was clearly in discomfort and pain, her agony compounded by the fact that she also suffers from hepatitis and high blood pressure.
Iman is in her early twenties. She contracted kidney disease five years ago while giving birth to one of her three children. Iman lives at the hospital, as she cannot afford regular transportation from Taizz, one of the governorates that has seen intense fighting, where she previously lived with her relatives. She has no option but to hope for adequate treatment at the hospital. The alternative is private health care in Sana’a, which is way beyond her and most patients’ means.
In the hospital’s corridor, Iyad, 12, sits next to his grey-bearded grandfather. Iyad has suffered from kidney failure for one year and needs two dialysis sessions a week. “My gandson also suffers from anaemia,” said Iyad’s grandfather. “Every day he’s getting skinnier, and he’s not growing properly.”
Counting down the clock
To cope with its devastating situation, the hospital sought urgent support from other dialysis centres, including those in Ibb and Al-Hudaydah governorates. However, these centres face a similar fate. In the centre in Ibb, six dialysis patients recently died in one week. The hospital launched an appeal, asking national and international donors for financial support. Without that assistance, the hospital is counting down the clock, knowing its patients will succumb to a slow, bitter and painful death.
The lack of resources to maintain the Dhamar dialysis centre is just one of many problems for Dr. Al-Shami. The main oxygen supply room is closed after sustaining damages from a nearby air strike. Basic supplies have become a luxury at the hospital, as it seeks to function with approximately 30 per cent of its pre-crisis budget and significantly less staff. All 53 foreign nurses who worked there have left the country, and only five of the 12 foreign medical physicians are still working.
“Many war-wounded people had to have amputations because we lack specialized surgeons and equipment to treat their injuries,” explained Dr. Al-Shami. His helplessness and unease are clear, as tomorrow he will have to tell more patients they can no longer be treated. “I feel ashamed,” he said.
This story was previously posted on Medium