A decline in cholera cases in Yemen has prompted aid agency Médecins Sans Frontières to scale down or completely shut down their facilities aimed at treating the waterborne disease.
The weekly number of admissions in the 37 MSF cholera treatment centres in Yemen shrank from 11,139 at the peak of the outbreak in June to 567 in the second week of October.
Only nine out of every hundred patients treated by MSF needed to be hospitalised with the remaining cases believed to be due to other pathogens unrelated to cholera.
“In some locations, such as Khamir, where cultures were performed in a laboratory, no positive cases have been confirmed since the beginning of September,” said Ghassan Abou Chaar, MSF head of mission in Yemen.
The head of the Yemen mission said, however, that the decline "should not eclipse the dire health situation of millions of Yemenis who are unable to access basic primary health care”.
Since the beginning of the outbreak, MSF has admitted more than 103,000 patients to 37 cholera treatment centres and oral dehydration points.
The decline in the waterborne disease could be a result of the rainy season coming to an end. The season typically begins in June and ends in September in Yemen
Dr Caroline Seguin, MSF's deputy programme manager for the Middle East, said that although cholera now seems contained, this doesn't mean it can’t make a resurgence again.
"There is less and less hospitals running because salaries aren’t being paid and that is very, very expensive for people who cannot afford it," she said.
In the Yemeni capital, Sanaa, only one hospital provides free health care, with the majority of people having to resort to travelling long distances to get treatment.
At the peak of the cholera outbreak, MSF was employing or distributing financial compensation to 685 additional health workers to treat cholera patients.
“It is now essential to implement a proper monitoring system with an acute surveillance of the trend of cholera cases and an increased capacity for confirming them. Without appropriate and timely efforts from humanitarian actors, a resurgence of the cholera outbreak could occur,” said Mr Chaar.
But three years of war, high prices of consumer goods and unemployment have had dramatic consequences for Yemen's civilian population.
Many patients only reach medical facilities when their health conditions are critical because they can’t afford to pay for transport.
Women often deliver babies at home, particularly in remote areas, and only seek support in case of complications.
Meanwhile, the number of severely malnourished children is high.
But what may be just as damaging for Yemen's civilian population, Dr Seguin said, is the impact on their mental health of a war that seems to have no end in sight.
“There are too many people who feel as though there is no hope, the mental health of the population in Yemen, we see people really traumatised,” she said.
Although MSF has facilities around the country, addressing the impact of the war on mental health is often overlooked as international aid organisations only have so many resources to dedicate to the country.
The non-payment of public health workers’ salaries over the past 13 months — the result of a stand-off between the internationally-recognised government of president Abdrabu Mansur Hadi and the Houthi rebels who still control large areas of territory — has deeply affected the health system in Yemen, forcing many doctors, nurses and other health professionals to seek alternative sources of income. Preventable illnesses and deaths are increasing in Yemen, and this can be partly attributed to the salary crisis.
Yemen is one of MSF’s largest country programmes worldwide. The organisation employs almost 1,600 Yemeni staff and gives financial support to 1,160 ministry of health staff, as well as casual daily workers.