"If I’m honest, when I first found out I was going to Yemen I had to check on a map to see exactly where it was. As is still the situation today, it's a conflict that's hugely under-reported.
My name is Elma Wong. I'm an anaesthetist from Birmingham, UK. This is my fourth assignment working with MSF in Yemen.
What I've seen on my return visits is a broken country with a broken healthcare system. The people of Yemen have had to deal with the war for four years now.
"The patients keep arriving and you don't know when they'll stop. You don't know how many more are going to come through the door."
THE SITUATION IN YEMEN
Since March 2015, forces loyal to President Hadi, backed by a Saudi and Emirati-led coalition, have been fighting anti-government Ansar Allah forces, resulting in bombing, gun battles and widespread destruction.
Many hospitals have been destroyed and those still open are in urgent need of medical supplies. Yemenis are struggling to afford food and fuel due to unemployment and rising prices.
These conditions, combined with airstrikes and ground fighting, have turned this conflict into one of the worst man-made humanitarian crises in the world.
MASS CASUALTIES IN ADEN
The first time I was in Yemen I worked in our emergency trauma hospital in Aden.
While I was there we had two mass casualty events, which is when around 10 or 15 injured patients arrive at once.
These were the result of suicide bombers detonating themselves in parts of the city where they knew there would be large gatherings of people. On both of those occasions 50 or so people were dead at the scene.
Dealing with mass casualties is awful, largely because of the chaos. The patients keep arriving and you don't know when they'll stop. You don't know how many more are going to come through the door.
Everybody does the best they can, with the limited resources available – the number of staff, the supplies, the bed space. You create space in corridors where you need it.
At the time you keep your head, you stay focused, you work as a team and you get through the incident.
It’s afterwards that it hits you. That’s when you realise what you've just witnessed: a terrifying scene of so many people injured at one time, and the knowledge that, somewhere quite close to you in the city, 50 or 60 people just lost their life for nothing.
CHOLERA AND DIPHTHERIA
When I was in Yemen in 2017, it was the middle of one of the largest cholera outbreaks in recent history.
We admitted more than 100,000 people to our cholera treatment centres across the country that year.
The war meant it was even harder for people to get clean water, get rid of waste and seek medical help. Preventable diseases are coming back in a big way because there's no healthcare system.
As the cholera epidemic subsided, cases of diphtheria broke out.
Diphtheria is a disease that’s been consigned to history in most parts of the world thanks to childhood vaccinations.
The last case in Yemen was in 1992.
ATTACKS ON HEALTHCARE
MSF has been in Yemen since before the conflict. We have several longstanding projects, which means that we've been able to react as the conflict evolves.
Already being there put us at a huge advantage and allowed us to start seeing patients straight away.
For example, our project in Aden, where I’ve worked twice, was there for several years before the fighting started. When it did start, we happened to be on the very frontline of the fighting.
On 2 April 2019, a group of armed men forced their way inside the hospital in Aden, threatened guards and medical staff, and kidnapped a patient who was due to undergo surgery. Later the same day, he was found dead on a street in the city. This forced us to stop admitting patients to our hospital in Aden.
Attacks on our patients and staff aren’t rare in Yemen. Since 2015, MSF facilities have been hit by six times, five by coalition airstrikes.
The bombing of Abs hospital alone left 19 people dead, including an MSF member of staff, and 24 injured.
Last year, a just-built cholera treatment centre, also in Abs, was destroyed.
A BROKEN HEALTH SYSTEM
From what I’ve seen on my return visits to Yemen, the trauma is consistently relentless – whether that's in the form of frontline gunfire, landmines or airstrikes.
But what has changed is that the existing health system has broken down. When a country has experienced so much conflict, there's just no money for hospitals or for supplies or even for medical staff.
"If we weren't there, I can't imagine what would happen to these people."
In 2018, we worked in 13 hospitals and health centres across the country and provided support to more than 20 health centres across 12 governorates.
The work that we're doing really does save lives. If we weren't there, I can't imagine what would happen to these people.
It really is thanks to our supporters that we can carry out our desperately needed work in Yemen today. "