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SANAA, Yemen (AP) – Cholera is on the rise again in Yemen. The UN announced that the number of suspected cases had doubled in March compared with previous months and that doctors in busy health facilities feared that it could not compete with an epidemic of the world's 2017 worst outbreak.
This wave highlights the fact that Yemen, which has suffered several cholera outbreaks during four years of civil war, is still unable to stop its spread.
At al-Sabeen hospital, in the capital, Sanaa, the beds are full and patients sleep in tents in a courtyard. Some of them wait for their treatment by lying on cardboard, under trees, with intravenous hanging on the branches.
"We get cases all the time, sometimes three to four times a minute," said Dr. Ismail al-Mansouri. "The hospital is under heavy pressure because it receives patients from all over the country."
Even the doctors are not immune: Al-Mansouri and several other staff members have caught cholera. On March 28, one of their colleagues, a much appreciated pediatrician, died of the disease.
Two more outbreaks since 2016 have caused more than 1.4 million suspected cases and killed more than 3,000 people. Most of these cases are due to an epidemic that started in April 2017 and became the largest in the world.
The spread has slowed since late 2018, although it has never stopped. Now, the seasonal rains that started earlier than usual this year have caused an outbreak of the disease.
There were 76,152 new suspected cases and 195 deaths in March, compared to about 32,000 in February and 39,000 in January. The March report brings to nearly 300 the number of people who reportedly died of cholera this year.
Last month's rates are comparable to those of the first weeks of 2017, when cases rose to 10,000 and 20,000 per week. It reached 50,000 a week at its peak and then infected more than a million people before declining by mid-2018.
"This year's epidemic is much worse and the situation is very dangerous," said Adel al-Alamni, head of the cholera treatment center in al-Sabeen.
Cholera is spread mainly through water and food contaminated with faeces. It can usually be treated if it is taken early, but it can kill quickly by dehydrating its victims with severe vomiting and diarrhea.
The destruction caused by the civil war in Yemen has created essential conditions for the spread of cholera. The conflict is between Shiite rebels known as Houthis who control the northern part of the country and a Saudi-led coalition that supports the world-renowned southern-based government.
Fighting and air strikes damaged the sewage systems and water points. Most people do not have access to clean water, especially the more than 3 million people who were driven from their homes by the war. The main water treatment plant outside Sanaa is down. Sewage is often used to irrigate fields, potentially infecting food supplies, and dump into wells, the main source of water.
Health services and garbage collection have further deteriorated as about 1 million officials have been largely unpaid since the transfer of the Central Bank in 2016 from Sanaa under Houthi control to the city of Aden, in the south of the country. Nearly half of pre-war health facilities are no longer functioning, often because they have been damaged by air strikes.
Cholera adds to what is already the worst humanitarian crisis in the world. Nearly two-thirds of the 23 million residents of Yemen need some help and tens of thousands of others are probably dead from malnutrition, preventable diseases and epidemics.
The resurgence of cholera has been concentrated in the districts around Sanaa and other northern areas. Rescue agencies Doctors Without Borders and Save the Children warned last week of an "alarming spike" with 1,000 children infected every day with a suspicion of cholera.
Most of the patients at al-Sabeen hospital are children under 10, said al-Mansouri.
Among the most recent deaths, there were two pregnant women and their unborn baby. Dr. Mohammed Abdel-Moghni, a colleague from Al-Mansouri, had treated children during the recent cholera outbreaks.
His colleagues and his family think that he was infected during his morning rounds, checking out the dozens of patients he was attending before taking his breakfast at the hospital's cafe. He died of kidney failure, a common complication of cholera.
Health workers occupying cholera patients have not yet been vaccinated, said Mansouri, noting that doctors are left without protection. Infection control in health facilities is almost non-existent due to lack of resources, which makes staff vulnerable, he said.
In Yemen, virtually no one has been vaccinated against cholera. US officials said the agencies generally had not been able to introduce vaccines because of the difficulty in distributing them amid conflict. The only vaccination campaign to date has been in a few districts in 2018 and has covered 400,000 people.
Parents have trouble getting treatment for children with cholera. At al-Sabeen hospital, Mohammed Hadi announced that he had taken his 3-year-old daughter, Naama, from Radda's home in the east of the country, in hopes of receive treatment in a private facility, but that was too expensive. So they were camped at al-Sabeen, where treatment is free, they slept in a tent for two days, then found room on the floor in a room full of 19 other patients.
Naama had the symptoms of cholera. Hadi, a farmer, said that he was still trying to understand how she had been infected.
"Is it water? We know that the water is polluted. Is it food?" he said. "Look at my daughter's condition, it's very difficult."
Activists have launched social media awareness campaigns, warning against raw vegetables. Messages are being sent to WhatsApp groups to urge residents to sanitize water tanks, especially those located next to underground sewer tanks.
The United Nations has requested $ 4.2 billion for humanitarian operations in Yemen this year and said the fight against cholera was one of the main goals. He has set up hundreds of diarrhea treatment centers and oral rehydration clinics throughout the country. But in some areas, like the densely populated city of Taiz, several centers are not functioning due to delays in aid, according to a city health official. He spoke on condition of anonymity because he had not yet spoken to US agencies about the possibility of relaunching support for the centers.
Doctors say complications can always be caused by complications that US centers can not detect. The centers, for example, are not equipped to treat kidney failure, said Dr. Jamal Abdel-Moghni of al-Thawra Hospital, one of Sanaa's largest. It is one of only two facilities in Yemen to be able to treat kidney failure.
"The number of people coming to our hospital for complications of cholera is simply unimaginable," said Abdel-Moghni, a relative of the deceased doctor. "Every day, there is death and the day that pbades without death is an exceptional day."
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