A Victory in Yemen

Jonathan Gornall

AFP photo: John MacDougall

Last month, victory was declared in a war that Yemen has been fighting against a brutal enemy for the past two decades. But in the wider world, the triumph passed almost unnoticed.

Since 2011, the attention of the world’s media has been focused exclusively on the struggle between Yemen’s government and the Houthi rebel insurgency. One of the many tragedies spawned by that catastrophic conflict, which continues unabated, is that it has come utterly to define Yemen and its people, dominating the national narrative in the eyes of the world and reducing an entire nation and its population to a one-dimensional stereotype. In Yemen, you are either a soldier at arms, pursuing a deadly game of tit-for-tat strikes and counter strikes, or you are a helpless civilian, at the mercy of fate and driven to the brink of starvation.

Yet against the background of Yemen’s apparently all-consuming conflict of arms, and to the credit of the government and a small army of volunteers and healthcare professionals, this war-weary nation has somehow found the time and force of will to wage and win a war of attrition against one of the world’s most devastating diseases. That it has done so is not only a credit to those involved, and to the international organizations that have supported them through thick and thin. It also serves as a reminder – and, perhaps, as an inspiration – to other nations burdened by apparently all-consuming civil strife.

Yemen’s victory over lymphatic filariasis, perhaps better known as elephantiasis, is proof that real life can, and does, continue to thrive in the cracks between the slabs. Filariasis is one of 20 conditions categorized by the World Health Organization as a Neglected Tropical Disease. It is among the most disturbing.

The cause is a tiny parasite, the thread-like filarial worm, which is transmitted to human being by mosquitoes, often in childhood. The worms nest in the lymphatic system, a body-wide network of vessels whose primary purpose is to transport fluid away from tissues, filter it and return it to the circulatory system where it joins the bloodstream.

Each worm can live for up to eight years, often unnoticed by its host but nevertheless quietly producing millions of larvae that circulate throughout the body. For the majority of people, infection goes unnoticed, although they contribute to the spread of the disease by passing on the worms to others via mosquito bites. For some, however, the effect is devastating, not only damaging the kidneys and the body’s immune system, leaving the host prey to all manner of diseases, but also causing tissues and skin to swell and thicken alarmingly.

This is elephantiasis, in which a person’s skin comes to resemble that of an elephant, leaving victims with grotesquely disfigured body parts, usually arms and legs but also breasts and genital organs. For some, the effect is permanent. These patients, as the WHO notes, “are not only physically disabled, but suffer mental, social and financial losses contributing to stigma and poverty.” In 2000, a global survey estimated that around the world over 120 million people were infected, of whom 40 million had been left disfigured and incapacitated.

Filariasis was first recognized as a problem in Yemen in 2000. The government immediately adopted a WHO protocol for the elimination of the disease – the Program for the Elimination of Lymphatic Filariasis – and embarked on an extraordinary public health campaign. The initiative immediately earned the support of international organizations, including The Task Force for Global Health, an independent, US-based nongovernmental organization that, through its Mectizan Donation Program, donated hundreds of thousands of doses of drugs supplied free of charge by the pharmaceutical companies Merck and GlaxoSmithKline.

Within a year, surveys had been carried out in all of Yemen’s 22 governates and 100,000 Yemenis were found to be at risk from the disease. Everyone considered vulnerable was effectively immunized against it by annual doses of a combination of drugs, homes were sprayed with larvicide and mosquito breeding grounds were methodically identified and neutralized with chemicals.

It is unclear how many Yemenis have been left with the physical consequences of the disease. For those unfortunate enough to have fallen victim to the later stages of filariasis, intensive medical help was on hand, but only so much can be done to relieve the suffering of a condition that, once it reaches the stage of elephantiasis, is a burden for life.

Regardless, they are not to be neglected. Even in Yemen’s “non-permissive environment,” says Dr. Altaf Musani, the WHO’s representative in the country, local health teams “will continue to improve approaches to morbidity management, focusing on the treatment of patients with clinical symptoms.” In order to ensure filariasis remains consigned to history in Yemen, the national disease surveillance system will also be maintained for years to come.

Last month, in announcing that Yemen had defeated filariasis – an achievement matched in the WHO’s eastern Mediterranean region so far only by Egypt – the WHO paid tribute to “the years of hard work by hundreds of thousands of health workers and volunteers who have braved extremely difficult field conditions to deliver treatment of this disease to the Yemeni people.”

Those “difficult field conditions” persist. Barely days after Yemen’s victory over filariasis was announced, an air raid by the pro-government coalition on what Houthi rebels claim to have been a prison in western Yemen reportedly left at least 60 dead and dozens more wounded. The Saudi-led coalition say it was a storage site for drones and was not on a list of “non-targeting sites.”

Against this background, the achievement of those Yemenis who have chosen to bring succor rather than suffering to their fellow citizens is nothing less than astonishing, and a rare flicker of light in this beleaguered country’s ongoing darkness. But more broadly, it is also a tribute to the better side of human nature, a testimony to the determination of individuals to do the right thing on behalf of their fellow human beings in the face of great odds. As such, it serves as an inspiration to us all.

Jonathan Gornall is a British journalist, formerly with The Times, who has lived and worked in the Middle East and is now based in the UK.