Non-Communicable Diseases in Crisis-Stricken Yemen

Non-communicable Diseases (NCDs) in Yemen

After facing the crisis for more than two years, the situation of the healthcare and humanitarian condition in Yemen reached into a severely critical position. There are millions of the Yemen population have been facing significant risks due to the number of non-communicable and infectious diseases. The rising poverty level has been an impending primary concern in the country due to the frequent issues associated with a range of political and social conflicts. Concerning the report of WHO (2017), it has been claimed that more than seven million Yemen populations face significant scarcity of food and other nutritional elements, which has been further increasing the severe issue of malnutrition in the country.

Also, there are nearly 462,000 children who have been undergoing cruel malnutrition issues with a higher risk of life-threatening hurdles. Around 15 million people in Yemen have been facing a lack of access to sanitation, hygiene services, and clean water that have further imposed significant risks to the population to harvest various types of acute syndromes such as malaria, scabies, and most commonly diarrhoea .

Present situation of health care in Yemen

About the health cluster reaction plan, it has been identified that infectious diseases and various types of nutritional and maternal conditions are the primary concern in Yemen. In this context, the increasing issue of collapsing health and humanitarian system have been weakening capability of Yemen’s population to access standard healthcare service. The condition has been further jeopardizing the people’s ability to survive for finding an appropriate solution to the current concern of both communicable and non-communicable diseases. The situation is also considered to be severely vulnerable to children, and it further led to an increase in premature death due to NCDs. The following figure (Fig. 1) illustrates the risk of untimely death resulted from NCDs in Yemen.

According to the above illustration, the ratio of premature deaths due to NCDs in Yemen have been slightly improving in comparison to the year 2000. However, concerning the projected linear figure, the total number of deaths due to various types of NCDs have been increasing in contrast to the global character of deaths due to the same reason. The increase in the end due to NCDs has been rising for the past 10 years. According to the figure (Fig.2), a clear illustration has been shown with the mortality ratio of people who died from both NCDs and other types of infectious diseases (WHO, 2018).

The above figure shows that NCD such as cardiovascular diseases is accounted for 39% of the total mortality rate of people died from NCDs and infectious diseases. Additionally, 6% of the total number of deaths have been occurred due to cancer, 4% in chronic respiratory disorders, and only 2% of mortality is resulted due to diabetes. However, other types of NCDs accounted for 12%, and 15% have died due to various kinds of injuries. In this context, it can be said that NCDs are accounted for 57% of total mortality rates in Yemen. The figure also shows 29% mortality due to infectious diseases along with nutritional, perinatal, and maternal conditions (WHO, 2018). Therefore, it is evident that NCDs have been imposing severe threats for Yemen than the communicable diseases and other relevant life-threatening conditions.

The reason behind the increase in Non-Communicable Disease in Yemen

The war, which has started in Yemen, had begun on 25 March 2015, had led to various socio-economic effects on the people who were suffering from different non-communicable diseases along with type 2 diabetes. An international coalition was led by Saudi Arabia, launched airstrikes against Yemen’s armed grouped with led to significant conflicts. Within one year, the disputes have spread all over the country and affected human rights along with other war crimes. In such a situation, the treatment of Non-communicable diseases was also painful, wherein insecurity and damages have reduced access to aids for the conditions. Apart from the above, Maternal health, malnutrition, and non-communicable diseases are the main concerns in Yemen. It is seen that the Risk factor of the NCD is higher in Women’s rural areas of Yemen. As per WHO, the main reason for such diseases is that they do not exercise regularly. Physical inactivity is termed as the leading risk factor for various chronic diseases like diabetes and hypertension. There is a more significant number of women in rural areas of Yemen who do not know about physical education and do not allow staying engaged in physical activities. In addition to that, there is a larger population in Yemen who are continuously facing crisis or Emergency of the acute food insecurity that has increased the severe malnutrition and increased risk of excess mortality. The country is also facing increased conflicts around Al Hudaydah, which have raised the concern regarding the infrastructure which have the chances to damage the import of food and have led to scarcity. About 1.8 million children in Yemen are malnourished, which has made them more vulnerable to these diseases. Four hundred thousand lives are at risk due to acute malnutrition. The arrival of the Cholera in April 2017 has affected 1.2 million people, wherein 30% of them were children. Cholera and diphtheria are not only the main reason of health issues but the main reason the death in Yemen are maternal and poor nutrition along with poor nutritional condition.

Morbidity and Mortality Rates of People Due to NCDs

Non-communicable diseases are the leading challenges in public health, which results in ill health, economic loss, and diminished quality of life. As per the World Health Organisation Global Status Report on the non-communicable diseases, it was stated that 38 million people die every year due to NCDs, wherein more than 40% are premature and are preventable. However, due to carelessness and lack of awareness, people die with NCDs. As per one of the reports of WHO, by the end of 2025, more than 70% of death will be caused due to non-communicable diseases, wherein 85% will be occurring in developing countries like Yemen. The evidence has shown that, if effective cures are not taken, then 41 million people will die from NCDs in low-resourced countries like Yemen with diseases such as cancers, diabetes, cardiovascular diseases and chronic respiratory diseases. It had been further stated by WHO that 9 million deaths take place because of NCD underage of 60 where most are preventable. In rural areas and low sourced countries like Yemen, the NCDs are higher in women as compared to men as women are not exposed to physical activities and other health concern activities. It had been analysed by WHO that in the past, the leading cause of the mortality and morbidity in the humanitarian setting was the infectious diseases as well as malnutrition, mainly in Children. However, as the health system is crumbling, non-communicable conditions such as highly treatable illnesses like kidney diseases, diabetes, high blood pressure, and another form of cancer are left unmanaged and undetected. The treatment for the non-communicable disorders is present with an estimation of 20% of the facilities of health. Such chronic conditions have led to 39% of the mortality before the conflicts, which in the present context have led to deadly results as the medical supply pipelines had dried because of logistical constraints, the decline in the ministry of health, and also purchasing power of the Yemeni citizens. The diabetes patients are dealing with issues without getting access to adequate health services, nutrition, and medicines because of financial hardship and a severe shortage of the required drugs. Moreover, as per one of the research, more than 80% of the NCDs can be cured by eradicating common risk factors like tobacco usage, unhealthy diets, physical inactivity, and also usage of alcohol. However, effective management and heal if NCDs risk factors need a strategic framework that could tackle the issues of health and minimize the growing burden of mortality and morbidity of these non-communicable diseases.

Health and Welfare Organisation to Tackle with Yemen’s Health Crisis

As per the Health Cluster analysis. The significant causes of death in Yemen are due to infectious diseases, perinatal and nutritious conditions, and non-communicable diseases. As the health system of Yemen is continuing to get collapse, the inability of the people to gain access to healthcare has led to catastrophic impacts. Since the country is facing a new need for health, the health cluster has planned to address long-lasting repercussions. It is providing health facilities to keep them to get rid of operational damages and support provided along with maintaining pipelines for suppliers and medicines. In 2017, health Cluster had reprioritized its responses by giving its focus on those districts and regions which have a higher need for health care and conduct activities to sustain the health system. The attention had been given on the significant vulnerable group, i.e., children below age five, pregnant and lactating women, and the one who is suffering from the chronic situation. The new approach had given the focus on mainly 3 pillars which included consolidation and expansion of the public health interventions like disease surveillance and vaccination, generation of the standards package of the health services as well as providing of the lifesaving and life-sustaining people’s services suffering from chronic diseases like diabetes and also higher blood pressure. To support the delivery, the health cluster plan has acknowledged ten specific areas of interventions like immunization, infectious disease management, trauma care, and disease surveillance. The partners have also given its effort to provide support to the health system by enhancing the health facilities, maintain the pipeline for the medicines, and to field mobile health teams. Since Yemen had issues in localized access constraints, the agency has made its mobile teams and bureaucratic impediments to make import and transport the medicines and other required supplies. The associated partners were able to give support to the patients and save their life. The cluster partners are even engaging in gender mainstream in the program cycle. The cluster partners look after the needs of men, women, girls, and boys from assessment to monitoring and evaluation, which will be considered and mitigated. The agency has targeted female-headed households, sufferers of chronic, pregnant, or lactating women to provide protection from gender-based violence.

In addition to that, the World health organization has started the Minimum service package (MSP) to ensure if the primary health care services are attained by the people, which works as a lifeline for a rapidly collapsing system of health. WHO and its partners have scaled up its operational responses towards the infectious outbreak of disease? The WHO has supported the functional and technical work. At the time of eruption of cholera, these organizations have established Rapid response teams in around 333 districts in Yemen to detect, assess and respond to cholera and other disease outbreaks. The WHO had also provided 1.5 million bed nets to 76 districts in Yemen and 1137 of malaria kits when an outburst of malaria took place in a country that tested more than 941600 patients and treated 402110 cases. WHO has also cured more than 30-60% of the patients of Yemen who were suffering from cancer by providing cancer treatment drugs? Lastly, the Humanitarian Country Team had also launched the 2018 Yemen Humanitarian responses plan to enhance the lifesaving and have ensured delivery of services and livelihood in many of the affected parts of the country.

The present situation of diabetes in Yemen

Yemen is known to be one of the 21 countries and territory which comes across the IDF MENA region. There are 463 million people worldwide who have diabetes in the world, wherein 55 million people are present in the MENA regions. Taking Yemen into consideration, it is seen that there are approximately 14,708,000 adult population wherein the entire case of diabetes in adults are 572,700, which show that prevalence of diabetes in adults in 3.9%. There are an estimated 366,000 people who are living with type 2 diabetes and 447,000 people who are believed to suffer from undiagnosed type 2 diabetes (Al-sharafi and Al-Tahami, 2017). Type 1 Diabetes Mellitus is one of the prevalent chronic endocrine-metabolic disorders that is seen in children and adults, which is categorized by hyperglycaemia, which either would be acute or even life-threatening. This has resulted in economic development and a change in lifestyle. Individuals with diabetes are facing a vulnerable situation in the humanitarian crises due to a lack of access to food supplies and insecurity. The crisis-affected people are facing the risk of diabetes, mainly type 1 diabetes, due to the development of diabetes, such as harmful alcohol usage. Since the humanitarian crisis is prevailing in Yemen, the issues of diabetes are largely ignored. This is the reason that humanitarian agencies and government are now searching the ways and means to address diabetes along with other non-communicable diseases. The undiagnosed or inadequately treated diabetes leads to severe complications in the long term. The general population are not aware of the consequence of the disease and are thus keep it untreated.

Ways to prevent diabetes in Yemen

However, As per the United nation and following the political declaration of Non-communicable diseases being adopted by the UN General Assembly, Who had developed an NCD global monitoring framework to evaluate the progress in prevention and control of the major non-communicable diseases such as cancer, diabetes, etc. In such criteria, WHO have stated that although diabetes cannot be cured and is not inevitable, certain cures can minimize the risk of diabetes. This organization has said that people in Yemen chew khat, which has mild stimulating effects. The users are found chewing it regularity as recreational drugs, which leads to increased performance. However, if a modification in behaviour is brought by stopping tobacco use, khat chew usage, unhealthy diets, and usage of alcohol, then it will lead to a rise in the risk of Diabetes. The establishment of the healthcare facilities, which assists in providing better information, would also help the country to reduce the issues of diabetes. The proper analysis and data regarding diabetes could assist the people in minimizing the chances of amputation and blindness. It was even found that people in Yemen had stopped the usage of insulin as there is a lack of electricity during the time of war, and insulin is unfit to work if it is not preserved in the refrigerator. So, the country should improve on the electricity system and enhance awareness regarding diabetic issues. Thus, it can be analysed after reviewing the case of Diabetes in Yemen that proper medication and effective care are highly needed in these countries as lack of medication, care, and other issues have to lead the country to face the worsening impact of diabetes.

Analysis on overall situation of the Country and associated result

This study is regarding the non-communicable diseases wherein Yemen is taken into consideration. It had been analysed that non-communicable conditions are chronic diseases that tend to take place for a long duration and takes place due to genetic, physiological, physical, and environmental factors. There are different types of NCDs wherein heart attacks, stroke, cancer, diabetes, asthma, and chronic obstructive pulmonary disease are some of the significant kinds of NCDs. It is acknowledged that NCDs is the major contributor to death globally wherein 41 billion of death occurs due to NCDs, which is 71% of the total end that takes place in the world. Although NCDs are found to occur at any age group, people age 30-69 years are found affected by it in a greater manner. It had been analysed that these diseases are caused due to an increase in unplanned urbanization, population aging, and globalization of unhealthy lifestyles. Moreover, unhealthy diets and lack of physical activity have resulted in increased blood pressure, an increase in blood glucose, obesity, and elevated blood lipids. This results in metabolic risk factors, which could lead to cardiovascular diseases. There are various socio-economic factors such as poverty, vulnerable and socially disadvantaged people which is linked with these diseases. When people do not have money, and when they do not have good companions, then they are exposed to various harmful products like tobacco and unhealthy dietary practices. It had further been analysed that to control the NCD, the country should focus on reducing the risk factors that are linked with diseases. Comprehensive approaches need to be applied, such as health, transport, finance, education, planning, and others, to reduce the risks connected with Non-communicative diseases to prevent them from controlling them. Moreover, it had also been analysed that country should also keep its contact with the different welfare and non-governmental organization to manage risks.

WHO IS WHO

The war, which has started in Yemen, had begun on 25 March 2015, had led to various socio-economic effects on the people who were suffering from different non-communicable diseases along with type 2 diabetes. An international coalition was led by Saudi Arabia, launched airstrikes against Yemen’s armed grouped with led to significant conflicts. The conflict which began in 2015 was between two groups namely Houthi armed movement as well as Addrabbuh Mansur Hadi led Yemeni government. As per ACLED, more than 100,000 people got killed in Yemen which possess more than 12,000 civilians and 85,000 people died due to famine because of the war. Within one year, the disputes have spread all over the country and affected human rights along with other war crimes.

War, Conflict, and Healthcare

Healthcare options of intent to take a setback in areas list with political controversies resulting in war. Even though international law aims to protect men women and children during armed conflict, people intend to see the massive price this was written population pays. After the war continued for 4 years in Yemen, the devastation created by the in discriminated attack kills people and shatters the civilian infrastructure. The significant consequences of what is the loss of life and property in the emergency room and operator in theatres are overflowing with wounded individuals with 70 patients be admitted in a day. People with bullet wounds land by hospitals were treated, and the scene is shocking. In extreme cases, communities are deliberately kept away from medical assistance are punished as if they are perceived as an enemy group. Injuries due to trauma as a result of armed conflict open call for emergency care and requires surgery. Similarly, as a medical need tends to escalate, health care services tend to collapse. Individuals with chronic conditions ages diabetes, pregnant women, and HIV patients are highly vulnerable during such instances. As essential item tends to become scares the price of necessary relief items, and food keeps on increasing while fear of death and insecurity continuous, leading to loss of mental peace generating psychological distress.

Yemen on non-communicable disease

The outbreak of diabetes in Yemen infected several people despite being completely treatable many people died from the disease.

In addition to diabetes, people are suffering from anaemia, a severe condition among expecting mothers and children

A country where the supplies and healthcare facilities lack access to drinking water does, and adequate nutritional support does not go well with the current health crisis.

Diabetes is a significant reason for limb amputation in Yemen, Syria, and Iraq. People are not getting the needed medical treatment, and when they do, it is often too late.

The conflict is destroying the healthcare system in Yemen, leaving several people without lifesaving treatment: inclusive of those with chronic conditions.

The age-standardized prevalence rate for the age range 30–64 years in this group in Yemen was found to be 6.3% for diabetes

Emergency treatment and prevention of diabetes in Yemen

The disease is easily prevented, and treatable most cases can be treated with the use of a healthy lifestyle and food habits

However, the severity of the disease is insignificant, provided diabetes may lead to severe cases of amputation or loss of sight due to diabetic retinopathy.

The rising number of diabetes-based cases is a direct manifestation of the ongoing war and economic difficulties that have made the country's health facilities no longer functional.

Establishment of healthcare facilities that can work on ensuring better information among the citizens related to diabetes. The information about diabetes can help in educating people about diabetes and reducing the chances of blindness or amputation.