Death threatens the lives of hundreds of kidney failure patients in Yemen in general, and in the city of Aden in particular, where the gap is widened with the increasing number of patients as many of them endure the hardship of traveling and transportation costs to reach the interim capital of the internationally recognized government, in which four kidney centers operate, in spite of its very miserable conditions. These medical centers specialized in dialysis are: Al-Jumhuriya, Al-Sadaqa, Bin Mahfouz Al-Khairy, and Abbood, face accumulated challenges due to the economic crisis and the ongoing conflict in Yemen since 2014.
In addition, these centers suffer from a heavy turnout of patients, which exceeds its capacities and accommodation capabilities. "Khuyut" monitored the severe suffering of patients assembled in front of the gate of the dialysis center located within Al-Jumhuriya Governmental Hospital in Aden. This leads to the failure of some patients to stand the crowds and long hours queuing, as happened in early April 2023, when a twelve-year-old girl died due to the overcrowding of the center, and about two weeks before, a girl passed away in the Al-Sadaqa Center, due to the absence of specialized dialysis centers for children.
Meanwhile, Ibrahim Nasir and eight other dialysis patients who suffer from kidney failure had to endure the hardships of traveling and stopping several times for inspection at the security points spread all over the road from Radfan district of Lahj to Aden, every Saturday and Wednesday per week. "All over the way to Aden, we badly suffer the tiring trip and worry that the dialysis center may be closed one day due to the lack of resources and support" Nasser told "Khuyut."
The man, in his thirties, travels a long distance while he is full of concern that the center will be closed for the fourth year in a row, as thousands of patients suffer from the hardship of traveling to Aden from other governorates. Moreover, the average cost of dialysis sessions ranges from 30,000 riyals to 100,000 Yemeni riyals per month, in addition to living costs, residence, and other needs during the treatment period. According to Moath Thabet, one of the patients, he confirmed in his interview with "Khuyut", that the interruption of salaries, the exacerbation of the economic crisis, and the monetary division in the value of the national currency between Sana'a and Aden, patients suffer from the lack of renal centers, while the life of a kidney failure patient is linked to a specific device which the patient has to access it at a specific time.
About 5,200 Kidney failure patients in Yemen, have been facing a constant risk of death due to the severe shortage of dialysis supplies, which are not sufficient to cover the need for 700,000 dialysis sessions annually. While the conflict exacerbated the health situation, as 4 out of 32 centers in the country were closed, leaving the rest of the centers suffering from an acute shortage of equipment and supplies.
Dr. Nabila Bamajid, director of the dialysis center at Al-Jumhuriya Governmental Teaching Hospital in Aden, said in a statement to "Khuyut": "We provide daily services to patients from several Yemeni governorates including Aden, Lahj and Abyan, in addition to displaced patients from Hodeida Governorate and from areas close to Aden, such as Taiz." and Makha.”
• Director of the Kidney Center at Al-Sadaqa Hospital: "We continue to provide dialysis sessions for about 26 patients a day, in addition to emergency cases from various governorates. A large percentage of them are displaced from the governorates of Hodeida and Al-Baidha, in addition to patients from the districts of Lahj and Taiz." She wonders when to get rid of this endless suffering, which is entering its ninth year, and calls on the government to find sound solutions for it.
In the post-war years in Aden, Al-Jumhuriya Center had received five young men from the same family living in Sheikh Othman (north of Aden), who had kidney failure. Four of them passed away, while the fifth is still receiving dialysis sessions up to date.
Bamajed added that the Kidney Center in Al- Jumhuriya Hospital suffers from a shortage in the provision of essential materials for dialysis in view of the limited operating budget of the hospital, which does not cover the needs of the center. She noted that thanks for the support of the International Red Cross since 2018, without which there would have been a real humanitarian catastrophe with the increase in the number of patients and their need for dialysis sessions and medical care.
Countless challenges and limited capabilities
The increase in the number of dialysis patients is one of the most prominent difficulties and challenges facing dialysis centers in Aden, such as the center located in Al-Jumhuriya Hospital, which accommodates about 233 patients with weekly dialysis appointments, in addition to emergency patients whose numbers range from 7 to 10 cases per day, while the lobbies of the center are crowded with dozens of patients waiting for their turns.
Bamajed says in this regard: " In the whole world, the number of dialysis sessions are three days a week, at an average of four hours per session. But in Yemen, only two sessions are performed per week and each session lasts for three hours only. Thus, because of the lack of capabilities, half of the patient's life is wasted." The Al-Jumhuriya Center finds itself powerless in front of the increasing patients; as a result, the center is forced to carry out dialysis sessions for about 28 patients on an almost daily basis, outside of official working hours. "We are forced to do so because of the increasing number of patients and overcrowding. If we demand that dialysis be according to the international standard, half of the 233 patients will remain without dialysis sessions, and some will lose their lives." She added.
Hemodialysis is used to treat patients with acute renal failure through the use of a blood purification device, and the session generally takes between (3-5) hours, and is repeated three times a week.
The lives of hundreds of kidney failure patients have depended for years on 28 devices at Al-Jumhuriya Center, and work continues from four in the morning until eleven at night, and this is double shifts and long hours due to the large number of patients and the lack of devices, according to Bamajed.
She resumed: "We have a four-hour break in which the devices are sterilized and pressure is relieved in order to maintain them at the same time, and all these sessions are free of charge."
Moreover, Bamajed demanded the re-operation of dialysis centers in Aden, and the opening of centers in Ibn Khaldoon Hospital in Lahj, and in Ghazi Hospital in Abyan, in order to reduce the pressure on Aden's center as well as decrease the financial burden of patients in these governorates, especially in light of the price hikes and exorbitant transportation costs.
Additionally, the dialysis Center in Al-Sadaqa Hospital in Aden, which was established in 2014, with funding from the Turkish government, faces similar challenges, as the center has been operating 20 hours a day since its opening due to the increasing number of patients.
The director of the center, Jabeen Abdel Shakoor Abdel Sattar, said in a statement to "Khuyut" that the war period was extremely difficult with the expansion of suffering and the accumulation of challenges, adding that since the center was established and opened, it has not provided with any annual budget from the government. Thus, it relies on organizations, merchants, international agencies and other centers to save the lives of about 90 cases of kidney failure.
She continued: "We continue to provide dialysis sessions for about 26 patients a day, in addition to emergency cases from various governorates. A large percentage of them are displaced from the governorates of Hodeida and Al-Baidha, in addition to patients from the districts of Lahj and Taiz." She wonders when to get rid of this endless suffering, which is entering its ninth year, and calls on the government to find sound solutions for it.
Debts and shortage of resources and supplies
Within three years, the center's indebtedness to the provider of dialysis supplies - which has not been paid to date - has accumulated, causing additional burdens and obstacles to the supplement of the center's needs.
The obligation of the center amounts to about one billion Yemeni riyals, while its annual budget does not exceed 52 million riyals, which is spent in US dollars in order to purchase patients’ needs. This huge debt makes the center threatened with closure, as Bamajed confirmed with the increasing challenges and the insufficiency of the supplies in the center's stores, which may not be adequate to cover the needs of the next month if additional quantities are not supplied.
Further, Bamajed indicated that the center submitted many official memos and requests during the years 2020, 2021, and 2022 to the Minister of Health, and appeals to the Minister of Finance given that these two ministries are the entities authorized to raise the center’s budget or its equivalent in dollar value, especially since materials are purchased in dollars, not in Yemeni riyals, but all urges and appeals have gone unheard, and they did not receive any response.
The Al-Jumhuriya Dialysis Center in Aden also appeals to the concerned authorities in the government to reopen more dialysis centers, especially in the nearby governorates in order to ease the burden on the hospital's dialysis facility.
Dr. Bamajed confirmed that the patients' needs of complementary medicines, blood pressure medicines, and others such as vitamins, are provided from time to time by charitable men, and these medicines cost 50,000 Yemeni riyals per month for each patient.
For many years, dozens of patients have come to the dialysis center in Al-Jumhuriya Hospital, located in Khor maksar (east of Aden), to conduct dialysis sessions twice a week, and in this context, Bamajed confirmed that the patients have become the second family for her, and for the staff at the center.
For his part, Doctor Ali Musa confirmed to "Khuyut" that the positive thing is the continuation of the operation of the dialysis centers and their resistance to the difficulties and challenges they face in order to providing their services within the available resources provided to them despite the shortage. They continued to preserving the lives of numerous patients during these years, amid indifference of the government agencies and institutions, and their failure to carry out their duties in this respect.
Factors contributing to the spread of the kidney failure
Millions of Yemenis suffer very poor health conditions, and perhaps people with kidney failure are among the Yemenis who suffer the most as a result of the deterioration of the health sector due to the current conflict. Their survival depends on their ability to access dialysis centers, a number of which have been damaged by the ongoing conflict in Yemen since 2015. Moreover, the death rate among patients with kidney failure according to the International Red Cross, is 25% due to the lack or absence of health services.
• There are no specialized dialysis centers for children in all parts of Yemen, according to the official of the Al-Jumhuriya Center in Aden; They are treated as young men while, according to the laws of the United Nations, they are children and underage.
Furthermore, patients need two suits for washing during the two scheduled days. The cost of the suit ranges from 42 to 43 US dollars, and it is used only once. Although dialysis sessions are provided 100% free of charge to patients, there are some additional burdens on their shoulders in terms of housing and daily expenses. The dialysis center covers about 10 thousand sessions every three months, which prompts the government center in Al-Jumhuriya Hospital to bridge the gap, amid the absence of fundamental solutions.
Kidney failure results from the inability of the kidneys to perform their functions of purifying the blood and maintaining the level of minerals in it. This leads to the accumulation of body waste in the blood, and this appears in the form of elevated kidney function when measured.
In this regard, doctors who spoke to "Khuyut" reported that there are no much variation of patients with renal failure in the countryside and cities. However, the percentage of men is higher than that of women, due to the absence of health awareness, water pollution, genetic diseases, exacerbation of chronic diseases, Overuse of medications, staying up late and the increase in the population. Dr. Bamajed confirmed that the majority of patients who visit the center are young people, between the ages of 18 and 25.
Pediatric dialysis sessions are different from the rest of the other ages, as pediatric patients need doctors specializing in dialysis and special devices appropriate to their age and weight. Thus, admitting children with adult patients poses great risks to the lives, especially in light of the absence of health awareness among families in the country, according to the official of the dialysis center at Al-Jumhuriya governmental Hospital in Aden.
Insufficient and declining support
The Red Cross reported the closure of three dialysis centers in Yemen, while the rest of the other centers suffer from poor operational capacity and are threatened with closure. However, the ICRC continues to support five centers in several cities and governorates in Yemen since March 2015.
The International Red Cross supports several dialysis centers in Yemen, specialized in dialysis, including the Al-Jumhuriya center in Aden, and provides them with dialysis materials, sessions, and medicines, in addition to covering a large part of the operational budget. However, Bamajed recounts to "Khuyut" a painful retreat of the support that began a year and a half ago, by saying: "There are shifts in the priorities of international donor organizations in Yemen in general, and not just the Red Cross, because they have other burdens and problems in different conflict areas in the country.
There are no specialized dialysis centers for children in all parts of Yemen, according to the official of the Al-Jumhuriya Center in Aden; They are treated as young men while, according to the laws of the United Nations, they are children and underage.
Charities and merchants seek to cover the deficit on behalf of the government. Accordingly, a specialized dialysis center has been built near Al-Jumhuriya Hospital, but it is still closed due to the failure of these entities to provide the rest of the needs, such as equipment and to provide its annual requirements.
Dozens of specialized dialysis centers are struggling to continue operating, and some of them have stopped due to a lack of medical supplies and operating expenses, which has led to the deprivation of thousands of patients from medical care in the country.
Dialysis centers also suffer from a uncertain operational budget to ensure that their doors remain open to prevent the slow death of these patients. These centers contain old devices that work around the clock, due to the increase in patients all over Yemen, as most of them moved to major cities to receive treatment.
It is worth mentioning that, during the years of the war, the regimes in Aden and Sana’a failed to mobilize public resources to provide essential services and maintain health facilities with their needs of medicines and medical supplies. Besides, the war caused the deterioration of the health sector, like other service sectors in Yemen, due to the ongoing conflict since 2015.