Over the past three years there has been a substantial increase in the number of children admitted to Médecins Sans Frontières/Doctors Without Borders (MSF) hospitals in Yemen for measles. In the first half of 2023, the number of measles patients received in MSF-supported facilities has nearly tripled, at almost 4,000, compared to the whole of 2022. Considering the impact of almost nine years of conflict, and the economic hardship wracking the country, what we see is likely the tip of the iceberg.

In 2022, we raised the alarm on surging child malnutrition in Yemen – a condition that exacerbates other diseases. Malnutrition weakens the immune system, making children, especially those who are not vaccinated, even more susceptible to the deadly impact of measles.

Both of these conditions are preventable and highlight the lack of essential healthcare and the poor economic conditions for people in Yemen. These factors have had a substantial impact on the lives of people like Aisha, and her three-year-old son Abdullah.

“Abdullah was suffering from throat pain, high fever, and red eyes; then a red spotty rash appeared on his body,” says Aisha about her son, Abdullah, who has been admitted to Abs hospital in Hajjah governorate.

“When I took him to the clinic, the doctor said he had measles with complications, and he would need to be hospitalised. Abdallah had already received some vaccines, but some were missing; it was difficult to keep going to the clinic. Transport was either unavailable or very expensive. So, we didn't cover all his vaccines,” says Aisha.

Measles is a highly contagious viral infection that can easily spread in densely populated communities. It predominantly affects children under five and is particularly dangerous for those with underlying conditions or complications. Although a potentially deadly disease, it is preventable through vaccinations.

Economic hardship, fueled by violent conflict, makes it extremely difficult for people in remote areas to pay for fuel or transport to bring their children to the hospital. Aggravating this is the absence of vaccination campaigns, and affordable and functional general healthcare facilities in the country, forcing people to travel further afield to obtain the necessary treatment.

As a result, patients often arrive in MSF-supported hospitals with complications, including advanced-stage measles, which could be avoided with preventive care such as vaccination or with timely medical treatment.

While it’s difficult to quantify all the factors in Yemen’s growing challenges with measles and other preventable diseases, it’s clear that major gaps in routine vaccination and limited access to basic healthcare facilities play a major role. To make matters worse, we have seen a huge increase in the prevalence of the disease in our clinics this year.

“In 2020, we saw the number of measles patients in our clinics drop from 731 in 2019, to just 77. We might attribute this to the massive vaccination campaign carried out in 2019,” says Isaac Alcalde, MSF head of mission in Yemen.

“However, the limited vaccination activities in the years that followed, coupled with challenges in accessible healthcare services likely skewed these numbers, and in 2021, we received 762 measles patients,” he says.

“But the dramatic increase we’ve seen this year cannot be ignored – the caseload has nearly tripled, going up to almost 4,000, increasing the strain on medical facilities, which are already overloaded. These are not just numbers we’re talking about – they’re children’s lives,” says Alcalde.

Unfortunately, this dramatic increase in the number of measles cases is not an isolated issue. Our medical teams have witnessed the rise and devastating impact of the disease in Amran, Sa’ada, Hajjah, Ibb, Hodeida, Taiz, Marib and Shabwah governorates.

United Nations agencies have also highlighted the severe increase in vaccine-preventable diseases in Yemen, pointing out that the country recorded more than 22,000 measles cases in 2022, including 161 deaths. In April of this year, there had already been 16,114 cases. With diphtheria and pertussis – whooping cough – cases are also on the rise, as are deaths from each disease.

In some of the health centres we support, we have adapted our activities to cater to the increased needs. For instance, since we started our response to measles in Al Bayda governorate, we saw a total of 1,784 cases between mid-February and June 2023.

Nearly 52 per cent of cases were complicated, while only 12 per cent of these patients had been vaccinated prior to admission, offering a bleak illustration of the low level of immunisation.

This lack of immunisation appears to be driven by logistical barriers, including the restrictions on humanitarian imports, the number of health facilities able to provide vaccinations, as well as an absence of health education to highlight the essential role vaccines play in protecting people from diseases like measles.

Our teams have also extended the measles isolation unit in Abs Hospital to cater to the increased number of patients. In Al Qanawis Mother and Child Hospital, in Al Hudayda governorate, more than half of the patients admitted to the paediatric ward were children suffering from measles, just days after it opened in May 2023.

Similarly, a substantial increase of cases in Mocha, Taiz governorate saw the need for a new isolation ward to be opened specifically for measles in April 2023. In Khamer and Haydan, 35 per cent and 41 per cent (respectively) of patients admitted to the paediatric unit were suffering from measles. ​The common thread in these different locations is a high prevalence of cases, along with an alarmingly low level of immunization.

The fact that measles is so contagious, and poses a deadly risk to so many, means that preventive measures for those who have contracted measles, like isolation, are key. In the various governorates where MSF treats measles in Yemen, we hear from parents who recognise the symptoms of measles and work to protect both their children and their neighbours’ children.

This was the case with Layal and her brother Hussein, whose mother brought them to the Ra’ada Hospital in Al Bayda.

“At first, Layal was in contact with her relatives, and then when she started to develop symptoms like fever and rash, I isolated her brother,” says Layal and Hussein’s mother.

“Unfortunately, he had already contracted the disease, and symptoms started to appear. But thanks to God, I transferred them to the hospital early enough and they recovered. I am aware that measles can spread quickly, and it can also affect other children in the neighbourhood, that's why I was worried at the beginning.”

Addressing this grave health crisis demands a comprehensive and coordinated response. To protect Yemeni children from the risk of measles, it is imperative to bolster preventive measures, community involvement, and enhance case management. The authorities, along with humanitarian and health actors in Yemen, must ensure the availability of vaccines in health structures, increase the accessibility and capacity of general healthcare facilities, strengthen referral pathways and reinforce community health awareness.