Since 2014, the Civil War in Yemen has resulted in an estimated 10,000 civilian deaths. As airstrikes continue, the involvement of the United States, Canada and the U.K. has become more controversial than ever before. In December 2018, U.S. Senators passed a motion to end military support for Saudi Arabia’s involvement in Yemen, putting international pressure on the U.K. and Canada to do the same. This pressure comes in response to the number of civilian deaths, and the increasingly reported on famine conditions in Yemen, but it glosses over a bigger issue with long term repercussions beyond the duration of this conflict: the destruction of the Yemeni health infrastructure.

In violation of rule 35 of the First and Fourth Geneva Conventions, airstrikes by the Saudi-led coalition have destroyed 318 hospitals and health centers in Yemen between 2015 and January 2019, leaving entire regions of Yemen without access to basic or emergency health care. Health care in Yemen is now in disarray, as those who suffer from non-conflict related, treatable illnesses succumb to their conditions in the absence of medical care.

Yemen is facing the fastest growing cholera epidemic in the world and does not have the facilities or resources to combat it. In 2018, the World Health Organization estimates that over 180,000 cases of cholera occurred in the country, leading to 196 deaths. It is likely that these numbers are even higher in reality, since Saudi Arabian airstrikes made conditions impossible for international organizations responsible for monitoring the conditions to remain in Yemen. Medication, vaccines, and water purifying supplies cannot be brought into the country as Saudi Arabia continues to block Yemeni ports. The sanitation and water supply plants in Hodeidah, a major port city and stronghold for the Houthi rebels, were destroyed in the Saudi coalition airstrikes in July 2018. Potable water across Yemen is becoming harder and harder to find, making an increase in cholera cases likely.

Furthermore, as a result of the Saudi blockade, the estimated 9,900 Yemeni people living with HIV are not receiving the life-saving medication that prevents the virus from developing into AIDS and must therefore ration their ‘red pills.’ Taha al-Mutawakei, the Yemeni Minister of Health in the Houthi-run administration, has said that the government has ‘zero funds’ allocated to HIV and AIDS. Due to the lack of funding, medication and doctors are not accessible and cannot provide HIV treatment or education at clinics, which means more Yemeni people are at risk of HIV/AIDS transmission. As of October 2018, an estimated 250,000 Yemenis with diabetes are also facing a crisis due to low insulin supplies in the remaining hospitals. Many patients have had to stop taking insulin all together due to the lack of availability.

Yemen is now facing a new threat; the H1N1 virus, or ‘swine flu’, which is treatable with the right medication. However, H1N1 has become a major concern as the malnourished population becomes increasingly susceptible to communicable diseases. The Ministry of Health and Population’s spokesman, Yousef al-Hathari, reported that there have been 418 suspected cases of H1N1 infection in Northern Yemen in the past two months, and 86 people have died thus far. As a result of the decimated health infrastructure, 80 per cent of those with H1N1 are at risk of death. However, due to the Saudi blockade, the medicine needed to prevent and treat H1N1 is not available. This is likely the first of many outbreaks in Yemen that could have been prevented with greater access to medical care. The damage to Yemen’s health infrastructure is substantial to the extent that it will not be operational for many years after a ceasefire occurs.

As a result of the Civil War, 1.2 million Yemeni civil servants, including doctors, have not been paid since late 2017. With an agreement signed in December of 2017 for a ceasefire in the port of Hodeidah, including resolutions to stabilize the central bank, it is hoped that some salaries will be paid, making it possible for doctors to return to work. However, this ceasefire is already in danger. This is despite the £2.5 million pledge by the British Foreign Secretary Jeremy Hunt, which seeks to direct resources towards civilian needs and aid in the re-establishment of stability for the Yemeni people. This ceasefire is crucial for the Yemeni population’s access to health care, as Hodeidah is the main port through which humanitarian aid enters the country. The aid will provide short-term relief to those with life-threatening medical conditions, however, the damage done to Yemen’s health infrastructure and to the health of the population will require years of peace and extensive aid to fully recover.

Unfortunately, the ceasefire is in jeopardy because both the Houthis and the Saudi-backed Yemeni government have accused each other of hundreds of ceasefire violations. These include Saudi airstrikes over the weekend of January 19-20, 2019, during which at least two civilians were killed, and a Houthi drone attack in the south of Yemen, which killed a senior intelligence officer.

It is important to remember that direct violence within conflict accounts for only a portion of those who are killed or affected by war. The people in Yemen, while living under the constant threat of airstrikes and famine, are also at the risk of dying from preventable and treatable illnesses. When the conflict in Yemen ends, the damage to the health infrastructure and the civilian population will have an impact that extends far beyond 2019.