North Yemen: Living under daily coalition airstrikes

©Agnes Varraine-Leca/MSF
Since December 2017 the international coalition led by Saudi Arabia and the United Arab Emirates has intensified its airstrikes against the Houthis in northwest Yemen, leaving the inhabitants more exposed than ever.
Just a few kilometres from the frontline is Haydan village in Saada governorate, a mountainous region with almost no medical facilities. The endless barrage of airstrikes has made transport here extremely challenging.  
In March 2017, Médecins Sans Frontières teams returned to the hospital in Haydan that had been bombed and destroyed by Saudi warplanes in October 2015. MSF teams provide healthcare to isolated communities in Haydan as well as the remote surrounding area.
The testimonies and stories told by patients at the hospital provide a glimpse into the dire conditions people have endured for more than three years of conflict.
Saada government in Yemen, Haydan, March 2018. A girl waits in front of the emergency entrance at Haydan hospital. ©Agnes Varraine-Leca/MSF
Emergency room at Haydan hospital. ©Agnes Varraine-Leca/MSF
His face half-hidden by his arm, Mohammad is lying on a bed in the emergency room in the hospital in Haydan. The shrapnel wounds in his leg and abdomen are severe. He waits silently for the ambulance to take him for surgery in another hospital that’s an hour and a half away by road. Mohammad was on his way to Friday prayers at the mosque when he was hit near the Houthi stronghold of Maran, in north Yemen. 
“One minute I was walking down the road, and then I woke up here. Was it a bomb or a rocket? I have absolutely no idea,” he says. Mohammed lost consciousness with the impact but he was picked up by passers-by who brought him by car to the hospital in Haydan, where MSF stabilises the war-wounded before referring them to one of the hospitals in Saada.
Formerly a court clerk in Saada, Mohammad is not a combatant. He fled the fighting in Saada for Yemen’s capital Sana’a where he now lives with his family. He had gone to Saada governorate to try and get his salary, which, like 1.25 million other Yemeni government employees, he has not received since September 2016.
Three-year old Ayman (right), with his father Hamoud (left), and his mother Karima (centre). Ayman fell from the first floor of his home. He now suffers from dizzy spells and no longer speaks. His family is waiting at the Haydan hospital. ©Agnes Varraine-Leca/MSF
The children of the Ghani family pose in front of the entrance of their house, bombed during the war of Saada, between 2004 and 2010. Saada governorate in Yemen, Haydan, March 2018. ©Agnes Varraine-Leca/MSF
Two women walking close to the Haydan cementery. Saada governorate in Yemen, Haydan, March 2018. ©Agnes Varraine-Leca/MSF
A baby girl, only a few weeks old, was taken to the emergency department of Haydan hospital, suffering from respiratory difficulties. She will stay in observation in the emergency department. Yemen, Saada's governroate, Haydan, in March 2018. ©Agnes Varraine-Leca/MSF
A group of women on their way to the Haydan Hospital, Yemen, Saada's governorate. Haydan, in March, 2018. ©Agnes Varraine-Leca/MSF
16,749 air raids in three years 
Because of the difficulty with transport close to the frontlines, the war-wounded arrive late at the hospital in Haydan and consequently are often in critical condition. Médecins Sans Frontières’ teams refer these patients to hospitals in Saada. “What we see most are bullet wounds and injuries like shrapnel wounds sustained during bombing raids,” explains Frédéric Bonnot, MSF’s project coordinator in Haydan.
In March 2018, ground conflict between the Houthis and coalition-supported forces loyal to President Hadi was a daily occurrence on almost all of Saada Governorate’s borders. Particularly badly affected were Kitaf in the east, Baqim in the north and Razeh in the west. 
A truck full of food was bombed during the evening of 22 February by the international coalition led by Saudi Arabia. The coalition said that they had targeted a Houthi checkpoint. Saada governorate in Yemen, March 2018. ©Agnes Varraine-Leca/MSF
Even before the most recent conflict broke out in March 2015, Saada’s inhabitants were among the most vulnerable in the country. The governorate was already the scene of intense fighting during a succession of wars between the Houthis and the then President Ali Abdallah Saleh’s armed forces between 2004 and 2010. President Saleh was assassinated in December 2017. Before 2015, extremely high levels of stunting had already been observed among children under the age of five in Saada governorate1.
1Epicentre, Nutritional situation analysis for MSF in Yemen, January 2018, Severine Frison

Top-left: Four-year-old Abeer wears the carrier which holds his little sister Yasmine, three month, who suffers from acute watery diarrhoea. His family lives in Haydan.

Top-right: Saada governorate in Yémen, Haydan, March 2018. Radyah (left) has three children, a fourth died when he was five. She came to Haydan hospital because her son Mohammad (right) has been anaemic for several weeks. He has a fever and refuses to eat.

Bottom-left:  Aref Moqbel is 20 years old, and on his belt, wears the Jambiya, a traditional Yemeni knife. He married Safaone year ago, who is now two months' pregnant. For the last month, she's been suffering from migraines and nausea.

Bottom-right:  Ali, his wife and his daughter Zahra, come from Qarn Bin Zayed, an hour's drive away. One month old Zahra suffers from respiratory difficulties and was admitted to Haydan hospital.

Since the end of 2017, airstrikes from the coalition led by Saudi Arabia and the United Arab Emirates have escalated in Saada governorate, which was targeted by one-third of the 541 airstrikes recorded in December by the Yemen Data Project.
According to the organisation, this was the highest number of bombing raids registered in one month since January 2017 — up 67% from November.
The aerial bombardment campaign began after Houthi missiles were fired towards Saudi Arabia, and its capital Riyadh. “As soon as a missile is fired at somewhere in Saudi Arabia, the Saudis respond almost immediately by bombing Saada,” comments Frédéric Bonnot. 
The airstrikes hit public infrastructure, markets, houses and civilian vehicles, as well as military bases and Houthi-held checkpoints. On 29 March 2018, two coalition airstrikes targeted a truck barely 200 metres from MSF’s offices in Saada. 
Yemen Data Project
On 8 May 2015, the coalition declared all towns in Saada governorate military targets. According to Yemen Data Project, in the past three years, the coalition has carried out 16,749 air raids in Yemen, i.e. an average of 15 a day. Almost a third of the raids have hit non-military sites. 
Information provided by the Yemen Data Project is obtained from numerous sources and systematically crosschecked. When no independent data is available, they are crosschecked with sources from opposing sides to the conflict as to ensure the reporting is as precise and impartial as possible.
Saada governorate in Yemen, Haydan, March 2018. Haydan 
School, bombed in 2016 by theinternational coalition
led by South Arabia. ©Agnes Varraine-Leca/MSF

Roads are routinely targeted, particularly those of strategic value. “The road passing through Saaqain district we use to go from Haydan to Saada has been targeted several times since the beginning of the year. It’s the same in Yasnim where we provide support to a health centre,” continues Frédéric Bonnot. “This is impacting our ability to get around and refer patients to hospitals in Saada. There can be delays, and it’s often a question of life or death.”

 The road between Saada and Khamer, bombarded by the international coalition led by Saudi Arabia. ©Agnes Varraine-Leca/MSF

Hard choices
19-year old Qoussor waited an hour and a half on the side of the road before finding a car that would take her and her son to the hospital in Haydan. Baby Nabil is only 6-weeks old and for the past few days he’s had trouble breathing. Even though his mother lives not far away on the other side of the mountain in Maran, the airstrikes that continue day after day mean there is little available transport in the area and the options that remain are expensive, so people have to make hard choices. 
“It’s really difficult for people in Maran to get around. Either there are no vehicles available because the bombing is too heavy or we don’t have the money to pay for it,” she says.  
The journey to the hospital had to be made and due to his poor health, Nabil must spend a week in the hospital. 
 Amran governorate in Yemen, March 2018. ©Agnes Varraine-Leca/MSF
The cost of transport remains a major obstacle for Yemenis in need of healthcare. “More patients come to the hospital in Haydan on market days,” explains Frédéric Bonnot. “On Wednesdays and Saturdays there is more transport available from the more remote areas in the mountains and the valleys, and families needing medical treatment take advantage of it.” 
Emergencies and treatment
In 2017, almost 7,000 people received treatment in the hospital’s emergency room. Of this number, 44% were children under the age of five and 41% were women. Children are often hospitalised for respiratory infections, diarrhoea and anaemia. Between 50 to 60 consultations are provided every day.
“We also see patients with cancer and heart disease, but there’s no way of referring them because there aren’t any facilities able to offer long-term treatment.” 
Roxanna Stavila, MSF medical advisor in Haydan.
A mother and her two children wait in front of the emergency department of Haydan hospital.
©Agnes Varraine-Leca/MSF 

Wrapped in a blanket, baby Nabil is receiving supplemental oxygen and there’s an intravenous infusion in his left hand. His health deteriorated rapidly, leaving his family no other choice but to travel to Haydan. The journey cost them 1,000 Yemeni Rials (3.25 Euros), an amount they negotiated. The price can be as much as 15,000 Rials, according to the location, availability of transport and the cost of fuel. 

Another, somewhat less visible, consequence of the war is the prices of commodities, particularly raw materials, which have risen sharply since 2015. This makes life even tougher and increasingly challenging for people in Yemen. The price of gas and petrol has doubled in the past three years and wheat flour has risen by more than 50%. 
According to the World Food Programme, imports increased in January and February 2018. But scarcity of essential imported food and fuel commodities continued in March 2018. The reasons for this are several: the imposition of taxes in Sana’a on goods from Aden and other ports in the south of the country, trading practices that include stockpiling merchandise to push prices up, travel restrictions and trafficking associated with the conflict. 
 Khamer, Amran governorate, in March 2018.  ©Agnes Varraine-Leca/MSF
This situation weighs heavily on the daily lives of people in Yemen. Like Qoussor who, at the age of 19, has known almost nothing but war. Maran, the town where she was born and grew up, suffered from intense conflict during the Saada War, which lasted from 2004 to 2010. Back then, underground shelters were constructed where people could take refuge during airstrikes. Tunnels dug in the mountain lead to caves rarely more than a metre high. Qoussor says that in these caves, “Standing up is impossible”. 
These shelters are still used by the population when the bombing is fierce and families no longer feel safe in their homes. The last time they were forced to seek refuge, Qoussor and her relatives spent two days in the caves, rationing bread they managed to bring with them.