Five years into a crushing civil war and Saudi-led military intervention, Yemen has been devastated by what is considered the world’s largest humanitarian crisis. 24.1 million people, eighty percent of the population, are in need of humanitarian aid and protection according to the United Nations (UN). The World Food Programme reports that twenty million people are food insecure, with ten million people acutely food insecure and at risk of famine. Yemenis have been contending with bombardment, displacement, a dysfunctional healthcare system, water scarcity, widespread hunger, a cholera outbreak, and now the COVID-19 pandemic.
Carly A. Krakow, Co-Editor of Jadaliyya's Environment Page, recently spoke by phone to Helen Lackner, an analyst and researcher who spent fifteen years of her career based in Yemen. Lackner is the author and editor of numerous articles and books on the country, including Yemen in Crisis: The Road to War and Why Yemen Matters: A Society in Transition. In this interview, Lackner offers insight into the impacts of environmental crises and health concerns in Yemen in the context of pressures from water scarcity, climate change, and the COVID-19 pandemic.
Carly A. Krakow (CAK): In your writing, you have identified water as a fundamental issue affecting the future of Yemen and you have pointed out that many Yemenis are dependent on private sources of water. Could you talk about the strain that this dependence places on people economically and in terms of the fundamental necessity of accessing safe, reliable, and sustainable water?
Helen Lackner (HL): I think the first thing you have to realize when talking about domestic water in Yemen is we are talking about a large number of totally different types of supply. Most of them are very local. When talking about “privatization” or the “private sector,” what do you call a spring that is in a mountain? Do you call that the “private sector”? What do you call people queuing at the irrigation well to get some of the water for their domestic purposes? I am not sure that using the terminology of the private sector fully explains the circumstances in Yemen. In the West, we tend to interpret this to mean something wildly different compared to what we are talking about in Yemen.
It is only in the cities where a percentage of households have been connected to the official government water supply, which may or may not be privatized. In a city like Sana'a, only forty to sixty percent of households are actually connected to the city’s water distribution network. In Taizz, only forty percent are connected to the official water supply network. If you were in Taizz back in 1996, being connected meant that you got water, on average, once every thirty days. In the early 2010s, you got water once every forty-five or fifty days. It is a very limited amount. The rest of the household water supply in the cities comes from private tankers: micro-entrepreneurs who fill their tankers at wells outside the city and deliver it to your house. This is all on a small scale. Again, this is not tap water or water from big companies.
Remember that, in rural areas, most people collect water from irrigation pumps, from wells, springs, and occasionally from rainwater cisterns. Either you collect it yourself, and this is typically done by women and children who then carry it in twenty-liter containers on their heads, or you pay somebody to do it for you. For longer distances, many people have donkeys which can carry up to six containers each. Again, it is a private sector, but it is not the private sector as people in the West might typically recognize it.
The important thing to recognize is that the types of water supply vary from one area to another area five kilometers away. It is not like, for example, Jordan. In Jordan, you do have very serious water shortages, but you have a national grid with all villages on the piped water system and distribution is timed and organized at the national level. In Yemen, you do not have this and it would not make sense to have it when you look at the geography of the country. It would be insane to try and do that. Supply issues can be incredibly different from one place to another, with very different mechanisms of operation.
CAK: In your work, you have written about internal forced migration due to water scarcity in Yemen, to the extent that entire villages have been abandoned. How would you say that this is impacting Yemeni civilians, and how does this affect destination cities as people move from one location to another within the country?
HL: I think the first thing to realize on this is that the collapse of water in a particular location is not something that happens overnight. It is not that you have water today and no water tomorrow, it is a gradual process. What is happening is that wells and springs dry out, but then you have good rain and they replenish. People tend to initially go away and stay somewhere else, usually with their relatives, and then when the water comes back, they come back. They also at first purchase water which is brought to them from distant wells. It is over a period of years that they eventually give up and stay elsewhere.
Most of these movements are taking place towards the bigger cities or the towns and that also depends on existing family migration. For example, people from Al Bayda for a long, long time had many family members in Hudaydah. People from other places would go somewhere else. What it does mean is increased pressure on the same water resources and all the other resources in the destination locations which tend to be the bigger cities. That means Hudaydah, Sana'a, Taizz, Aden, and places like Mukalla.
Up to now the movements due to water shortages have not reached a scale that would have a major impact on life in the cities, but in the long run, obviously, it affects the availability of water there, as well as increasing pressure on other services and demand for employment.
CAK: How do you think climate change will impact forced migration both within Yemen, and from Yemen to neighboring countries?
HL: There are many issues. You have the issue of shortages of water in certain inland locations, but it is not the same everywhere. You have different sources and quantities of groundwater and replenishment potential as well as fossil aquifers in different areas. It is not a one size fits all system. It is very different according to different areas.
There are three aspects of climate change that must be taken into consideration. First, the areas with the higher population density are also, as it happens, the areas where water tables and aquifers are minimal for various geological reasons. That is one aspect resulting in movement from certain highland locations to the cities and to lowland locations.
Second is the rise in sea levels, which is extremely important because you have at least two major Yemeni cities that are on the coast (three major cities depending on whether you call Mukalla a major city). These cities are going to be primarily affected by any rising sea levels. All the fishing communities along the coast will also be affected by rising sea levels.
The third element is the whole issue of soil degradation and desertification, reducing the amount of land that is available for agriculture, which is already very small in Yemen to begin with. This is also directly related to the changing rainfall patterns, with longer droughts and more violent downpours and major storms. That is a further pressure particularly since we are talking about a country where seventy percent of the population lives in rural areas, largely dependent on agriculture and livestock. All these aspects combine to create more problems.
CAK: You have spent a great deal of time living in Yemen over the course of your career. How would you say that the provision of healthcare services has changed over the past decades? Obviously, the provision of these services has been extremely negatively affected during the recent periods of bombardment and war. How has the infrastructure of medical services and care evolved and been affected?
HL: Sticking to the last ten to fifteen years, looking at the current system, basically what has happened is the way the health system has been operating has been fundamentally affected by the World Bank cost recovery approach. Following the state’s acceptance of structural adjustment since the 1990s, government policies have included "cost recovery" for many social services, meaning that users must pay for the services provided.
The undermining and reduction of state supply and state coverage of social services has been transformed by the new system of cost recovery. In other words, people are charged for medical treatment and medical care. Theoretically, you still have free care in hospitals, but now hospitals only exist in larger towns and cities. Government hospitals are also supplemented by private hospitals.
Encouragement of the private sector since unification (of North Yemen and South Yemen) in 1990 has included medical services, both through hospital staff operating their own personal private clinics as well as opening private hospitals. Basically, anybody can open a hospital in Yemen; there are no regulations that prevent it. I have seen buildings originally built as blocks of flats, which then became hotels. Then, a couple of years later they were turned into hospitals. It is basically a highly profit-oriented structure.
In the medical field, the last decades have been marked by a very considerable influx of both small scale, profit-based private enterprises and NGOs, particularly internationally-financed NGOs, the latter operating in public sector establishments. Altogether, Yemen currently has about five thousand medical facilities in the country, of which only about half are operational or partly operational. The other half are either closed or minimally operational.
With the war, health and medical crises have arisen in the last three years, starting with the cholera epidemic. Then malaria. When I first went to Yemen decades ago, there was hardly any malaria there at all. As water supply schemes were built in larger villages and small towns without drainage and without sanitation, stagnant water ponds multiplied and the mosquitoes love it. There has been a rise in malaria and a very considerable rise in dengue fever and all other mosquito-borne diseases. We are talking about a medical system that was pretty inadequate to start with, and increased incidence of water-borne and other diseases has brought it to collapse, as well as the lack of salaries for staff and the military destruction of facilities. The COVID-19 crisis has just made it much worse.
CAK: Can you say more about how the COVID-19 pandemic is affecting the country?
HL: A major issue is the lack of funding for COVID-19 response and indeed for water and sanitation as well. The funding for COVID-19 was twenty-seven percent of requirement at the end of June, and the requirement is not that high. It is 180 million US dollars, which I do not think is adequate. All the UN branches and big NGOs involved with water and sanitation have written yet another desperate appeal to the funding agencies, pointing out that (as of June) they only had four percent of the funding they need for water and sanitation and reminding everybody that people cannot wash their hands if they do not have water and soap. They said the water sector (which in their terms primarily refers to the urban water sector) is in pretty desperate straits. I do not think they would have written such a desperate letter if things were not really pretty bad.
The next element of this is, of course, COVID-19. There are twenty-five operational isolation units and six labs in the country with COVID-19 testing facilities. There has been no significant progress over the past months. There have been practically no testing facilities. What has happened is that doctors and others have just stopped operating and stopped working. They have closed hospitals in Aden.
The COVID-19 situation is extremely serious, but no reliable figures are available for Yemen as a whole. The figures that come up in international statistics are laughable. I saw one today about something like six hundred cases or something. That is just ridiculous—it is much higher.
CAK: 2.41 billion US dollars in aid for Yemen is still needed to continue essential assistance through the end of the year. If these funds are not raised, the UN expects this will be devastating for people dependent upon this aid for essential services in the coming period. There is of course a long history to account for, but can you share your perspective on the broader context of this issue? In your view, what has led to this shortfall?
HL: In 2019, the UN Humanitarian Response Plan (HRP) requirement was nearly 4.2 billion US dollars, which is the highest I think of anywhere in the world. It was funded at eighty-six percent, an incredibly good record for UN funding. In a number of countries with major humanitarian problems, the UN issues annually a Humanitarian Response Plan based on its assessment of needs, and this is used to appeal for funds from the international community. The appeal is presented to the UN-sponsored donor conference, usually held in Geneva, where the different states make their pledges of contributions, which are later disbursed to the different UN agencies and other agencies involved with the Plan. These are usually, on average, funded at about sixty percent.
We may have all kinds of debates about how the UN works with the distribution of money, in the sense that the contracting system for humanitarian aid has so many subcontracts that the percentage of money and support that actually gets to Yemen is very, very much smaller than it should be. The UN system will contract to UNICEF, which will contract to their international NGO, which will contract to their next international NGOs, which will then contract at the national level, which will then contract the local NGOs. All these are taking their overhead. (In the UK system, for example, standard overheads for consultancy firms for an organization are well over thirty percent.)
You have a situation in 2020 where the amount pledged (and that means pledged but not even received), is substantially less than what has been requested. The appeal was twenty-five percent lower than last year and by the time the conference was held in June, the UN was asking for 2.4 billion US dollars. Pledges received at the conference were 1.35 billion US dollars, vastly less than required, at a time when the appeal itself was insufficient, given the worsening of the humanitarian crisis overall and the arrival of COVID-19. Though there certainly are grounds to question the accuracy of assessments in previous years, this does not detract from the current disastrous situation.
The WHO, UNICEF, and others have been saying for the last two months that unless they received more money by the end of June, they were going to start closing down operations. They have started closing down operations, and about thirty out of forty-one are expected to close.
The first thing they have had to do has been to stop paying the staff. Now the staff of most of these organizations were officially government health staff. Since 2016, they have not been paid their salaries due to the economic effects of the war. Many medical staff members were paid "incentives" thanks to international funding, and this is what has now been stopped. Doctors, nurses, and medical staff on the front line do not have any proper equipment. The COVID-19 “Preparedness and Response Snapshot” from 4 July 2020 tells you that there are 227,500 personal protective equipment "items." (In Britain, they count the individual items, like one glove counts as an item, or one swab, even though you need two to do the testing. So when you see 227,000 items, I put the word items in quotation marks.)
What does that mean in terms of actual protection? People are expected to work without pay, without protection, without equipment, without medication. I cannot say that I blame people for just staying at home and not going out and not trying to do it. But there are still a lot of medical staff who are taking these risks and working. I think if you are looking at the COVID-19 situation, they are risking their lives, they are dying, and they are not even being paid. I think these things really do need to be addressed. We are talking about an extremely high death rate. By the time people come to hospitals, it is too late.
CAK: Yemen imports over ninety percent of basic food staples, and food security is a dire issue. There are so many harrowing stories about families being forced to choose which of their children to feed based on who is most likely to survive. There is simply not enough to go around. Do you see a path forward either in the short or long term for increased food independence and sustainability? Obviously, things are getting much worse rather than better in the immediate term, but how do you think the next period will look from a food perspective?
HL: As you pointed out, about ninety percent of staples are imported. The basic staples, which are wheat and rice, are either totally or almost totally imported. This has been the case for decades This is not a war-related issue, this was like that before, though the war has worsened things considerably. There are many factors involved: one is the very rapid population increase; two, the extreme additional pressure of climate change; three, the deterioration of terraces and various other areas where crops were cultivated.
Basically, I think Yemen cannot become food self-sufficient in the future. However, things can improve. Totally different agricultural policies would make a difference, in particular a serious focus on the development of high-value rain-fed crops, as well as drought-resistant varieties for locally grown staple crops.
The war has made things much worse for two reasons: one is, as would be expected, people cannot afford to buy available food because of the collapse of the economy, the non-payment of government salaries for now more than three years, the closure of most small enterprises, the skyrocketing cost of fuel (for the transport of food, as well as water), and the increased cost of what food is available. The second is the war blockade on the Red Sea ports, which has restricted the import of basic commodities, including both commercial and humanitarian supplies.
People are always going on about humanitarian aid, but the majority of basic food imports are done by the private sector and they are done on a commercial basis. Again, financial issues are extremely important and the blockade is extremely important in determining what does and what does not arrive in Yemen. If you are looking at the impact of reduced aid, the other thing you need to look at this year as the result of COVID-19 and other factors is a significant reduction in remittances. Remittances might drop by about seventy percent. Remittances have previously been at least as high as all other aid sources.
In terms of long term perspectives, one of the things that has happened—and again we are back into water—is that the irrigated area has grown, meaning that there has been much more pressure on water, which does eventually mean that many parts of Yemen will no longer be fit for human habitation. This means people would move on, most likely to Saudi Arabia, Oman, and the UAE in a clear case of forced migration. When water runs out, people have no option.