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01 Feb 18 05 Apr 18

Yemen: A Canadian nurse on how MSF provides a lifeline to people trapped by conflict

Fractured by war: Mariko Miller, a Canadian nurse from Vancouver, sees first-hand how the continuing conflict in Yemen has created widespread suffering and a broken health system.

From the Spring 2018 issue of Dispatches, the MSF Canada magazine.

Mariko Miller understands the effect that repeated exposure to patient trauma can have on healthcare workers. As an experienced Vancouver nurse, she is aware of the importance of preventing emotional burn-out among medical staff.

So one of the things she found most remarkable about working at the Doctors Without Borders/Médecins Sans Frontières (MSF) hospital in the city of Taiz in Yemen — where she recently spent three months helping provide medical care to people affected by the country’s recent conflict — was the attitude of her Yemeni colleagues.

“The kindness among our staff was really incredible,” she says. “Just watching some of the doctors I worked with, and the way they treated patients, was something I found really inspiring. The levels of empathy were so high, and people were so careful to be caring. I’ve worked in ERs in Canada, and I know it can be hard for people to sustain that and to not burn out, so to see people in a place exposed to so much trauma still manage to hold on to that fundamental empathy was really remarkable.”



Displacement, malnutrition and disease

MSF has been present in Yemen since 1986, but has massively scaled up its presence since 2015, when the recent conflict broke out between the different warring parties. After more than three years, the conflict in Yemen has created one of the world’s worst humanitarian crises. According to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), close to three million people have been displaced, and 4.5 million children and pregnant or lactating women are acutely malnourished.

The health system has been severely fractured by war. Both sides of the conflict have failed to protect medical structures in accordance with international humanitarian law, and many hospitals (including some of MSF’s own facilities) have been hit by airstrikes. With nowhere to go for medical care, even those not killed or wounded by the fighting are at much greater risk of trauma or death as a result of the war.

“It seems like everyone has lost people because of this conflict, whether it has been from direct violence or the secondary impacts that conflict can have, such as barriers to accessing health care,” says Miller.

Many of the patients Miller saw in Taiz were suffering from infections such as tetanus and pertussis that can be prevented by effective vaccination programs. But the war has cut people off from some essential health services.

“One patient in particular I recall was a little boy with diphtheria,” says Miller. The deadly infectious disease was thought to have been eliminated in many parts of the world, but is now on the rise once again in some governorates in Yemen. “Diphtheria is something we should never see, because it’s so easily preventable by vaccination,” Miller says. “And yet here it is. The little boy’s grandmother sat by his side for days. He didn’t make it. His airway eventually closed in on him.”

While the security situation in Taiz means that MSF is currently unable to conduct vaccination campaigns in the community at large, we still provide immunizations as an outpatient service in the hospital itself. “Whenever I would visit our outpatient vaccination clinic, it was a great feeling to see our nurses doing immunizations and preventing future versions of the deadly cases we were treating in the hospital,” says Miller.

“The impact of our presence is really tangible,” she continues. “I don’t know how many times, just walking into the hospital, I would meet people thanking me and us for being there. Often an older lady just wanted to kiss me on my forehead to say thanks to MSF.” The lack of most available alternatives for free good quality care has made MSF’s medical programs lifelines for many people. “We were able to stabilize traumas, and admit the pediatric and neonatal emergency cases and patients who otherwise had limited access to services. The conflict has put that out of reach for so many,” Miller says. Many people cannot afford to pay for transportation to reach a hospital, so they wait until the last minute.

Part of MSF’s work in Taiz is to provide obstetric care, which is urgently needed. “We did over 1,000 deliveries in one month,” says Miller. “It was extremely busy. Just in terms of our obstetric care alone, we’re safely delivering a lot of complicated births every month for mothers who otherwise might not have had a safe pregnancy.”

Helping children survive and recover

MSF is also providing treatment to children suffering from illness. “We saw many small children who came in with a late presentation, and who were so sick that it was unclear if they would survive,” Miller says, “and some of them would transition to our wards so well. Days later, they were sitting up and feeding. The care they were receiving is fantastic. It’s quite amazing, how so many children come in seemingly so close to death, and still survive and recover in a place with limited resources”

Miller attributes the impact of MSF’s medical care in Taiz to the incredible dedication of her Yemeni colleagues, who make up most of MSF’s medical staff in the country. “A lot of patients come in such difficult circumstances, and staff see a lot of difficult things, but they are still so committed to doing everything they can for every single patient,” she says. “The attitude of care is important, and really shows people in the community that they have not been forgotten or abandoned. They know that if MSF is there, then someone in the international community is making the effort. So our presence is important.” 

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