Yemen’s Response to COVID-19: Part II

In Yemen, local actors, governance mechanisms and communities are all shaped by strong cultural roots and regionally nuanced socio-political dynamics. These systems face increasingly extreme threats and pressures, nonetheless they form part of a social fabric which gives direction to a way of life alongside a cyclical, internalised system of conflict. If a nationwide ceasefire cannot be reached, these local actors (whom have led in upholding these systems and ways of living) are likely to be as deeply embedded in an effective response or solution to COVID-19 in Yemen as the many conflict actors themselves are.

This three-part series commissioned by PSRP is co-authored by Raiman Al-Hamdani (Researcher at ARK Group and Yemen Polling Centre) and Robert Wilson (Research Analyst at PSRP). Read Part I here.

This second part of the series looks to examine the ways that communities have dealt with a number of health crises prior to the arrival of COVID-19. It considers the current condition and development of Yemen’s health system. Further, it also considers the potential role of tribes as influential local actors whom have a history of supporting communities. It considers the possibility of tribes guiding community responses to COVID-19. 

History of Community and Responses to Health Crises in Yemen 

Prior to COVID-19, Yemen’s health systems and humanitarian programmes had been overwhelmed. Throughout the current conflict, the country has endured a resurgence of epidemics, including what was described as the world’s worst cholera outbreak in recorded history, in May 2017. Then, in December 2017, a diphtheria outbreak affected 18 of the 22 governorates. More recently, in May 2020, the city of Aden experienced a combination of diseases, including pneumonic plague, dengue fever, malaria and COVID-19, killing nearly one thousand civilians. Added to this are the narratives provided by conflict actors, circulating misinformation about the arrival of disease, which include the Houthis tying COVID-19 to foreign conspiracies, claiming that a cure will come under their rule.  Despite this, it has been observed that Yemeni people remain trustful of health systems and experts [1]. 

Even around the onset of the most recent conflict in 2015, doctors in the country often lacked the resources to perform other fundamental procedures, such as caesarian sections. As the burden on infrastructure and facilities grew, the nexus between health systems and community networks seemed increasingly clear; an overall response was not dichotomous, as communities attempted to accommodate local and international efforts. 

The Yemen Community Engagement Working Group (CEWG), comprising of international and national NGOs, was conceived in late 2015 as a facilitation mechanism in engaging community networks and focusing the humanitarian response to the conflict. It was recognised by CEWG that there was a need to align the various communications and engagements with the experiences and capacities of differently affected populations in Yemen. 

The CEWG’s 2016 report set out the reality of community diversity in shaping humanitarian responses to varying cycles of crises. It highlighted a need to fully engage communities and integrate them as a tangible part of adaptive responses. It suggests that there is a clear connection between the efficacy of the wider humanitarian response and the agency of communities. Therefore, improving processes of community engagement through communication and information sharing may assist differing humanitarian responses in being more effective in adapting to a variety of challenges in Yemen. 

This historical context explains a clearly engrained tradition of power in the expression of Yemeni communities, as well as an ability to adapt and develop systems of subsistence moving forward through a series of contemporary crises. This ability has involved navigating substantial health challenges over recent years, and contributing to a response.

Since 1918, Yemen’s modern history has involved a continuous battle against water scarcity, famine, and disease. Throughout the twentieth century, it was commonplace to hear of villagers undertaking dangerous journeys into the desert in search of food, returning to find that disease or hunger had killed most of their village. This remained the norm into the 2000s. Along the barren deserts of the western Tihama, for instance, village communities lived in harsh conditions, unable to find water or access to basic services. In general, across the country,  Yemenis lacked medical facilities and were entirely dependent on foreign aid to provide these services. 

In the south, British troops had arrived as early as the 1830s, taking control of the port of Aden in 1839. There were however no hospitals for local people until around 1885. In the north, the first hospital was built in 1906 with the help of the Ottomans. Around this time, Yemeni doctors were also leaving the country for the first time to study medicine abroad. It wasn’t until 1926 that Yemen had a field hospital for its army, and Yemeni nationals continued to leave the country in pursuit of the medical qualifications necessary to run these new centres, due to lack of training opportunities at home. Russia, China, and the US then all set up developmental aid facilities gradually, and by the 1950s, southern Yemenis had built a hospital in Crater, Aden. From the 1960s until unification in the 1990s, Yemenis began to have more control over their own medical programmes, despite low resources, lack of expertise, and a general dependency on foreign practitioners to make up for the low numbers of Yemeni doctors. 

In the 1990s however, clear shifts in the management of public health emerged. Vaccination awareness campaigns became powerful instruments in improving the health and well-being of Yemenis. Despite growing conservatism in the country, Yemenis have remained largely open to vaccination and birth control and trustful of doctors. Confidence among Yemenis in medicine and the medical community indicates that people continue to be trustful of science and health-based advice. Conversely, in countries including Afghanistan and Pakistan, vaccines are invariably viewed with suspicion, often being linked to the interests of foreign powers.

Current Medical Community

The medical community in Yemen continues to experience similar pressures compared to those faced by Civil Society Organisations (CSOs), yet displays a clear capacity and resilience in navigating increasingly challenging conditions. In addition to the issues around seeking medical training abroad so far set out, in 2015 with the onset of conflict, more Yemeni doctors left the country seeking safety. Many of those remaining now fear for their safety due to the arrival of COVID-19 and a lack of resources and personal protective equipment. Throughout the conflict, others have left in search of a better life, as invariably their salaries have consistently gone unpaid at home, with doubts over whether any salaries have been paid at all.

Moreover, the lack of protective equipment has seen a sharp rise in Yemeni doctors’ deaths in both the north and the south. The medical community, which includes nurses, caretakers, and volunteers have been demonstrating resilience in making use of whatever limited resources they have. Doctors, public health officials, and nurses are all under-equipped or funded. Despite this, high levels of trust amongst the public, mean their voices can be harnessed in the battle against COVID-19, especially when it comes to personal hygiene and social behaviour. In a society where diseases have plagued the country, a complete reliance on a limited number of doctors, reflects a level of confidence in the relationship and dynamics between Yemeni doctors and their society.

By 2015, conflict in Yemen catalysed the return of famine, diseases such as cholera, and the destruction of medical facilities and other critical civic infrastructures such as water systems. In areas where water resources must be shared, community cooperation and conflict and resource management have been central in gaining local consensus among tribes and communities over processes like spate irrigation. These customary methods were once vibrant communitarian mechanisms. In some areas, conflict has impacted the gains made by these processes, creating conditions more reminiscent of the earlier decades of the twentieth century. 

As conflict has extended and national fracture has deepened, differing forms of community existence have likely developed even stronger identities and autonomous functions, and this needs further consideration. A 2019 report by the X-Border Local Research Network, a research consortium focusing on the causes of conflict in border areas, outlined coastal Yemeni communities as having evolved to become an extension of Somali communities across the Gulf of Aden. In this case, locally specific maritime ties have ultimately shaped and supported the existence of these communities throughout conflict. The dynamics involved in managing a COVID-19 response here would differ to those in a mountainous region of Yemen’s north, owing to the distinctions between communities and governing actors across regions, where local dimensions play an extremely important role. 

Further north, Marib is described as one of the more stable governorates, remaining aligned with the state and functioning through overall good governance. Even with this perceived stability, there are questions remaining over whether Marib can offer a potential model of response to COVID-19. Like any other, the function of the governorate is complex and is ultimately underpinned by unity among the local population and alignment of closely affiliated security providers. Economic resources are present, and the governance model welcomes community participation, engaging with political parties, local actors, and tribes.

While this function has partly been shored up by a low tolerance for political dissent amongst the population, Salisbury has described the diversity of community meetings in Marib. In these discussions, ‘a wide range of normally divided people’ can come together in a community space to discuss the governorate’s direction. Largely, this meeting should be viewed in connection to recent Houthi advances towards Marib. What is also important in this case, however, given the unique complexity of Yemen’s conflict and inter-group dynamics, is the possibility for dialogue within Marib between members of the General People’s Congress, secular nationalists, al-Islah affiliates (acting under the broader umbrella Muslim Brotherhood), tribes, and religious conservative Salafists. 

More broadly in Yemen, stability and governorate function are important parts of early steps in a gradual shift from security-centric discourse to a more politically focused direction for all groups. The impetus in reaching some kind of middle ground among multiple, competing political narratives is now critical. In terms of a response to COVID-19, among the many other challenges Yemen faces, engaging differing forms of local function and recognising the importance of spaces which allow for groups and communities to deliberate over common ground, are of critical importance.

Tribes

Yemeni tribes have shown themselves to be rational, fluid and heterogeneous structures, and at times, fully capable of enacting the traditional functions of the state through justice and security provision. This section provides a glimpse into how their influence can be leveraged, based on political associations, geographies, and their respective credibility. These factors allow tribes to facilitate ceasefires and ask for populations to stay at home, thus securing compliance.

Throughout Yemen, local governments and tribal figures have met consistently to try and plan security responses, and more recently, COVID-19 responses. Nevertheless, tribes in Yemen face a multitude of threats from varying sides, from extremist groups to being drawn into direct conflict with other tribes. Nonetheless, disparate tribes possess differing resources and powers across the country, which can be leveraged in the fight against COVID-19. 

Tribal sheikhs in Yemen have the ability to act as mediators and arbitrators in other tribal feuds. One anecdotal example of influence shows tribes managing to end a five-year blood feud between two families in Dhammar. To provide tribal leaders the resources to focus on COVID-19 may seem notional, but prior to and throughout the conflict, the role that they have played in assisting with governance in the absence of government and providing socio-political direction for Yemen, has been clear. Tribes are embedded in local governance systems and would be well placed to provide COVID-19 advice to people, ensuring high compliance. 

Furthermore, with the lack of state presence, it is tribes who are a source of justice, security and protection; invariably providing food, water, and shelter to their members. Providing everyday services to members may seem exclusionary, but tribes often absorb people who are vulnerable or have been left with no affiliation. The government in exile performs more of a representative function for Yemen. They act on the international stage, appointing representatives to the United Nations General Assembly. But, on the ground, it is the tribes who ensure people’s immediate security. Their power in the fight against COVID-19 should not be ignored, as the pandemic could even unite tribes on the basis of mutual threat.  

Houthi authorities in northern areas lacking the resources to combat COVID-19 are aware of how powerful tribes are. The group have sought out tribal leaders to capitalise on their influence in civic engagement and spreading awareness. It seems this is an attempt by the Houthis to demonstrate to people in these areas that they are taking all of the necessary steps to counter COVID-19. Ultimately, despite the continuation of negative practices including blood feuds and more recently honour killings, there is recognition that tribal sheikhs hold local power and influence that could be harnessed effectively against COVID-19. If harnessed correctly, existential threats facing tribes such as radicalisation, modernity, urbanisation and violence, can be eradicated and their ability to reach out to locals more directly than the state is one way for traditional local structures to be successful in the fight against COVID-19. 

Historically, Yemeni tribes respond reflexively to disputes using mediation, arbitration, and negotiation rather than violence. In contrast to their reputation, and the ongoing negative practices of blood feuds and honour killings already described, Yemeni tribes strategically avoid most forms of violence, especially in inter-tribal disputes. Within tribal affairs, tribes usually only engage in violence when protecting or defending resources, or in the event that peaceful mechanisms of conflict resolution have broken down and there is no other alternative. Conversely, political actors in Yemen are also sometimes able to manipulate or persuade tribes to join their side. Sheikhs, who generally direct dispute resolution processes, have a strategic incentive to address conflict at its early stage, when it is more easily resolved, and less likely to spiral into violence. Violence, once committed, expands the conflict and makes it harder to solve, while also physically endangering other members of the tribe. Tribal members are thus united in their desire for non-violent outcomes.

 

[1] Trust in heath systems and experts also remains high in Kurdish Region Iraq. See also our PSRP/OTT report, ‘Political Trust and Social Cohesion at a Time of Crisis: The Impact of COVID-19 on Kurdistan Region-Iraq’ here.

 

Part III of this series will consider the importance of further engaging with women and CSOs as leading responders to other health crises for communities. It encourages a deeper understanding of the capacities of these actors and the need to engage with these sectors of Yemeni society in supporting the COVID-19 response. 

Read the whole series: Part I | Part II | Part III

Read all PSRP COVID-19 research and reports.

Photo: © Raiman Al-Hamdani