By Alex Whiting
LONDON (Thomson Reuters Foundation) - Yemen's entire health system is crumbling after months of war, with people dying from lack of medical care even in areas where there is no fighting, said medical charity Medecins Sans Frontieres (MSF).
Before the conflict erupted in March last year, Yemen, one of the world's poorest countries, relied heavily on foreign doctors and imported the bulk of its medical supplies, as well as food and fuel.
Foreign medical staff have since fled, and imports have fallen and become a lot more expensive.
"Even where there is no fighting, people are dying for lack of supplies, because the whole system itself is crumbling after a year of war," Karline Kleijer, MSF's emergency coordinator for Yemen, said in a telephone interview.
Houthi rebels pushed the government into exile in March 2015, triggering an intervention by a Saudi-led military coalition against the Houthi militia with a campaign of air strikes and a ground offensive.
Resulting turmoil has seen militant group al Qaeda in the Arabian Peninsula sweep across the eastern side of Yemen.
A shaky ceasefire, which came into effect in April, has brought some respite from the conflict. But clashes regularly flare up on battlefronts throughout Yemen.
The city of Taiz in the country's west has experienced some of the fiercest fighting.
"The ceasefire does not make any difference (in Taiz)," said Kleijer, speaking from Amsterdam having recently returned from the city.
Although there are fewer air strikes, fighting on the ground continues daily in the city centre, she said.
MSF treated some 1,700 people in Taiz for war wounds between March and May, many of them civilians.
The war has killed more than 6,400 people and triggered a severe humanitarian crisis.
Out of Yemen's 28 million people, 21 million need some form of humanitarian aid and more than half the population suffer from malnutrition, according to U.N. figures.
Many have lost their jobs and the cost of food has soared leaving many unable to pay for healthcare.
The United Nations has said parts of Yemen are now close to famine.
HOSPITALS FULL OF GUNS
Most of the hospitals in Taiz have closed and only about five are still functioning, Kleijer said. They mainly treat war wounds, and can offer very little other care.
Wounded fighters arrive for treatment wearing grenade belts and carrying guns, along with their comrades.
"When there are 20 armed guys who are just coming from the battlefield and are ... scared and angry, and full of adrenaline, that doesn't make you as a doctor or medical professional feel very safe," Kleijer said.
It is not uncommon for them to blame the doctors if a patient dies, she added.
MSF-run health centres impose a ban on all weapons, which is respected. Even so, the threat of weapons remains.
Recently, one heavily wounded man came in for treatment, who suddenly remembered he still had a grenade in his pocket. Someone took it out and accidentally pulled out the pin.
"That was an interesting one," Kleijer said. "We got the Houthis - they managed to sort it out."
MANY WILL DIE OF PREVENTABLE DISEASES
Even away from the fighting, people across the country with chronic conditions like diabetes, asthma and hypertension, may die for lack of care, Kleijer said.
The ministry of health pays medical staff salaries in government health facilities but, if its funds are cut, many existing health centres may have to close, she said.
"The health system in Yemen is ... going down faster and faster. And that is of concern because the coping mechanisms which were there are reaching the end of the line," she said.
MSF has been funding several dialysis units which help keep 650 patients alive. But the medical agency says it cannot afford to keep supplying the centres, and unless they can find another funding donor, the patients will die.
"There are a lot diseases ... which in a functioning health system people can (live) with quite easily.
"The minute that stops these people will very quickly need a level of healthcare which is definitely not available, and then they will die."