Despite the significant progress Yemen has made to expand and improve its health care system over the past decade, the system remains severely underdeveloped. Total expenditures on health care in 2002 constituted 3.7 percent of gross domestic product. [1]
In that same year, the per capita expenditure for health care was very low, as compared with other Middle Eastern countries—US$58 according to United Nations statistics and US$23 according to the World Health Organization. According to the World Bank, the number of doctors in Yemen rose by an average of more than 7 percent between 1995 and 2000, but as of 2004 there were still only three doctors per 10,000 persons. In 2003 Yemen had only 0.6 hospital beds available per 1,000 persons. [1]
Health care services are particularly scarce in rural areas. Only 25 percent of rural areas are covered by health services, as compared with 80 percent of urban areas. Emergency services, such as ambulance service and blood banks, are non-existent. [1]
The life expectancy in Yemen in 2019 is 66.1 years. [2] Despite the significant progress Yemen has made to expand and improve its health care system over the past decade, the system remains severely underdeveloped. Total expenditures on health care in 2014 constituted 5.64% of gross domestic product. [3] In the same year, the per capita expenditure for health care was US$202 per capita. [4]
The number of doctors in Yemen rose by an average of more than 7% between 1995 and 2000. as of 2014 [update] there were 5.25 doctors per 10,000 people. [5] In 2014 Yemen had 7 hospital beds available per 10,000 persons. [6] Health care services are particularly scarce in rural areas. 25% of rural areas are covered by health services, compared with 80% of urban areas. Most childhood deaths are caused by illnesses for which vaccines exist or that are otherwise preventable. [7]
In c. 2009, Sana'a may be the first capital city in the world to run out of drinking water. [8]
Prior to the current conflict, Yemen's health care system was weak due to its lack of spending in public healthcare. During the mid-2000s Yemen decided to take a market-based approach to their healthcare system due to increased liberalization within the country. [9] However, this market based approach directly affected the poor and those living in rural areas, because of a decrease in Yemen's budget in public healthcare and use of user fees. [9] Access to healthcare services is highly determined by geographic location. Although Yemen's constitution promises healthcare for all, only 25% of those living in rural areas have access to healthcare services compared to the 80% that have access to healthcare services in urban areas. [9] In addition, most hospitals are in urban areas which makes accessibility difficult for those living in rural areas.
Yemen's public healthcare system is composed of four levels:
However, many of these facilities lack resources and employees due to the small budget spent on public healthcare in Yemen. [9] However, in 2002 Yemen created the District Healthcare System (DHS) in order to deliver primary health care through community-based services, which in the end failed due to poor management. On the other hand, Yemen's private sector has succeeded: there were 167 private hospitals in 2002 and by 2012 there were 746 private hospitals. [9] Yemen's healthcare system prior to the current conflict was weak, however, is still better than now.
Currently, only 45% of healthcare facilities in Yemen are functioning and accessible to the public, while 247 healthcare facilities have been destroyed and damaged by the ongoing conflict. [10] In addition, healthcare facilities that are still functioning lack the resources and employees to provide the appropriate healthcare service because humanitarian aide is restricted by the constant fighting, airstrikes, bombardments, and lack of ceasefire. It is dangerous for humanitarian workers to set foot on the ground because they could be easily killed due to the constant fighting by both parties. [11] Many hospitals and clinics have had shortages in vaccines, medical equipment, and basic drugs due to the ongoing conflict. [12] Therefore, while healthcare facilities are working they lack the equipment and employees to provide all of those in need with help. In 2017, the UN reported that healthcare facilities had not been given sufficient funds and that healthcare workers were working without salaries since September 2016. [10] As a result, healthcare workers are quitting and facilities are losing staff in a time of need. At the same time, many patients are not able to afford the hospital service fees, even though they are cheap. Due to the high demand of healthcare services, local volunteers and medical students have been trained to respond to basic needs during emergencies. [13] It is estimated that 14.8 million people in Yemen currently lack healthcare and that 22 million people are in need of humanitarian assistance. [10]
Since the beginning of the conflict, the people of Yemen have become more susceptible to diseases and long-lasting health problems. More and more people are dying from treatable diseases because of the weakened healthcare system. According to the UN, since the escalation of the conflict in March 2015, more than 7,600 people have died and about 42,000 people have been injured. [10]
Children are highly suffering from acute malnutrition. According to the World Health Organization, more than 1.8 million children under the age of five are suffering from acute malnutrition and 500,000 children under five years old are suffering from severe acute malnutrition. [14] A study shows that global acute malnutrition (GAM) 12.5% from 2013 to 2016 in children under five years old. [15] In addition, the study shows that the national average of women between the ages of 15 and 49 suffering from severe malnutrition was 11.4%. However, from 2013 to 2016 it decreased by 1.6%. [15] According to the UN, in total 4.5 million people in Yemen are suffering from malnutrition.
According to a study, in the journal Globalization and Health, child mortality rates for those under five years old have increased nationally. In 2013 there were 53 deaths per 1,000 live births and in 2016 it was 56.8 deaths per 1,000 live births. [15] In 2016, national average maternal mortality was 213.4 deaths per 100,000 live births, which was a 1.3% increase from 2013. [15]
Currently, according to WHO, Yemen is suffering the worst cholera outbreak in history with an estimated more than 10,000 cases a week in 2018. [16] Cholera is caused by lack of clean water, according to WHO 19.3 million Yemenis lack access to clean water and sanitation. [14]
In 1950, the child mortality rate in Yemen was 370 children per 1000 births. [17] Yemen then made significant progress, with the rate falling to 58.6 children per 1000 births in 2015. [17] Subsequently, the ongoing cholera outbreak caused the death toll of children to rise. As of 2018, more than 20 million Yemeni people are in need of humanitarian assistance, including 9 million children.
Malnutrition is one of the leading causes of child mortality. By 2018, about two million Yemeni children suffered from acute malnutrition, as a result of the civil war consuming their nation's economy. Geographically, Yemen also has the world's most depleted water sources. According to UNICEF, nearly 462,000 children are suffering from severe acute malnutrition. By November 2018, an estimated 85,000 children under the age of five had died due to acute malnutrition over the three years of the war. [18] This number does not include children missing, displaced, or currently medically unstable.
Abuse and the exploitation of children in Yemen has become common practice with the continuation of the civil war between the Houthi rebels and Yemeni government forces. A reported 6,500 children have been killed or injured from violence as the country's infrastructure collapses. It is reported that upwards of 800 children being recruited to participate in the civil war.
Cholera has broken out within Yemen because of its poor infrastructure that deteriorated due widespread war in the country. Yemen faces issues in control and provisions of fresh, clean water as Yemen does not have the capacity to create the infrastructure needed to provide it; thus, people are forced to obtain unsanitary water from rivers, lakes, and wells. Cholera is prominently found in contaminated drinking water, making the Yemeni people, especially children, the most prone to such a disease. There have been more than 815,000 suspected cases of cholera in Yemen over the past three years, 60% percent of them being children. [19] Cholera can be found throughout a majority of Yemen, mostly concentrated in the cities closest to water. Cholera currently kills an estimated 95,000 people per year and infects upwards of 2.9 million people. [20]
Diphtheria has spread throughout Yemen. Upwards of 1,300 people have been infected as of March 2018, 80% of cases being children. As of February 21, 2018, there have been 66 reported deaths from Diphtheria.
UNICEF has made a huge effort in fighting the war against the cholera epidemic with major efforts of providing vaccines help immunize the Yemeni people. There have been 900,000 suspected cholera cases and can be treated. They've launched various campaigns to help combat diseases such as whooping cough, pneumonia, tetanus, tuberculosis, diphtheria, and meningitis, and they continue to send vaccines to the Yemeni people [21] As of December 4, 2018, the United States has funded approximately US$696 million in humanitarian funding for Yemen. Humanitarian organizations have created huge impacts in Yemen by providing health, nutrition, and food provisions for the impacted. The KSA and United Arab Emirates have also supported food and nutritional support by pledging US$500 million to help provide for 12 million Yemeni people.
The World Health Organization has provided substantial aid to Yemen and continues its efforts in creating a sustainable health system. In 2016, the World Health Organization created functional health facilities including 414 operating sites within 145 districts including of over 400 mobile health and nutrition teams in another 266 districts throughout Yemen. They've also provided extensive child health nutrition interventions in over 300 districts and have established 26 cholera treatment centers. They are the leading effort in polio immunization treating over 4.5 million children under the age of 5. They've supplied 565 tons of essential vaccines and medical supplies expected to help upwards of 3 million people in conflict impacted areas.
The World Health Organization has provided huge efforts by creating its humanitarian response plan in 2017. Their plan consisted of a US$219.2 million WHO budget and a US$430.4 million Health Sector budget that targeted support for 2.6 million women and 5.8 million children in Yemen. [22] They created four specific objectives in providing aid:
They have allocated budgets primarily towards Severe Acute Malnutrition (SAM) and Cholera projects.
Médecins Sans Frontières, also known as Doctors Without Borders, is a charity that provides humanitarian medical care. It is a non-governmental organisation (NGO) of French origin known for its projects in conflict zones and in countries affected by endemic diseases. The organisation provides care for diabetes, drug-resistant infections, HIV/AIDS, hepatitis C, tropical and neglected diseases, tuberculosis, vaccines and COVID-19. In 2019, the charity was active in 70 countries with over 35,000 personnel; mostly local doctors, nurses and other medical professionals, logistical experts, water and sanitation engineers, and administrators. Private donors provide about 90% of the organisation's funding, while corporate donations provide the rest, giving MSF an annual budget of approximately US$1.63 billion.
Health in China is a complex and multifaceted issue that encompasses a wide range of factors, including public health policy, healthcare infrastructure, environmental factors, lifestyle choices, and socioeconomic conditions.Although China has made significant progress in improving public health and life expectancy, many challenges remain, including air pollution, food safety concerns, a growing burden of non-communicable diseases such as diabetes and cardiovascular disease, and an aging population. In order to improve the situation, the Chinese Government has adopted a series of health policies and initiatives, such as the Healthy China 2030 program, investment in the development of primary health-care facilities and the implementation of public health campaigns.
After the Bolivarian Revolution, extensive inoculation programs and the availability of low- or no-cost health care provided by the Venezuelan Institute of Social Security made Venezuela's health care infrastructure one of the more advanced in Latin America.
The healthcare delivery system of Pakistan is complex because it includes healthcare subsystems by federal governments and provincial governments competing with formal and informal private sector healthcare systems. Healthcare is delivered mainly through vertically managed disease-specific mechanisms. The different institutions that are responsible for this include: provincial and district health departments, parastatal organizations, social security institutions, non-governmental organizations (NGOs) and private sector. The country's health sector is also marked by urban-rural disparities in healthcare delivery and an imbalance in the health workforce, with insufficient health managers, nurses, paramedics and skilled birth attendants in the peripheral areas. Pakistan's gross national income per capita in 2021 was $4,990 and the total expenditure on health per capita in 2021 was Rs 657.2 Billion, constituting 1.4% of the country's GDP. The health care delivery system in Pakistan consists of public and private sectors. Under the constitution, health is primarily responsibility of the provincial government, except in the federally administered areas. Health care delivery has traditionally been jointly administered by the federal and provincial governments with districts mainly responsible for implementation. Service delivery is being organized through preventive, promotive, curative and rehabilitative services. The curative and rehabilitative services are being provided mainly at the secondary and tertiary care facilities. Preventive and promotive services, on the other hand, are mainly provided through various national programs; and community health workers’ interfacing with the communities through primary healthcare facilities and outreach activities. The state provides healthcare through a three-tiered healthcare delivery system and a range of public health interventions. Some government/ semi government organizations like the armed forces, Sui Gas, WAPDA, Railways, Fauji Foundation, Employees Social Security Institution and NUST provide health service to their employees and their dependants through their own system, however, these collectively cover about 10% of the population. The private health sector constitutes a diverse group of doctors, nurses, pharmacists, traditional healers, drug vendors, as well as laboratory technicians, shopkeepers and unqualified practitioners.
Pakistan is the fifth most populous country in the world with population approaching 225 million. It is a developing country struggling in many domains due to which the health system has suffered a lot. As a result of that, Pakistan is ranked 122nd out of 190 countries in the World Health Organization performance report.
Health in Iraq refers to the country's public healthcare system and the overall health of the country's population. Iraq belongs to WHO health region Eastern Mediterranean and classified as upper middle according to World Bank income classification 2013. The state of health in Iraq has fluctuated during its turbulent recent history and specially during the last 4 decade. The country had one of the highest medical standards in the region during the period of 1980s and up until 1991, the annual total health budget was about $450 million in average. The 1991 Gulf War incurred Iraq's major infrastructures a huge damage. This includes health care system, sanitation, transport, water and electricity supplies. UN economic sanctions aggravated the process of deterioration. The annual total health budget for the country, a decade after the sanctions had fallen to $22 million which is barely 5% of what it was in 1980s. During its last decade, the regime of Saddam Hussein cut public health funding by 90 percent, contributing to a substantial deterioration in health care. During that period, maternal mortality increased nearly threefold, and the salaries of medical personnel decreased drastically. Medical facilities, which in 1980 were among the best in the Middle East, deteriorated. Conditions were especially serious in the south, where malnutrition and water-borne diseases became common in the 1990s. Health indicators deteriorated during the 1990s. In the late 1990s, Iraq's infant mortality rates more than doubled. Because treatment and diagnosis of cancer and diabetes decreased in the 1990s, complications and deaths resulting from those diseases increased drastically in the late 1990s and early 2000s.
Mali, one of the world's poorest nations, is greatly affected by poverty, malnutrition, epidemics, and inadequate hygiene and sanitation. Mali's health and development indicators rank among the worst in the world, with little improvement over the last 20 years. Progress is impeded by Mali's poverty and by a lack of physicians. The 2012 conflict in northern Mali exacerbated difficulties in delivering health services to refugees living in the north. With a landlocked, agricultural-based economy, Mali is highly vulnerable to climate change. A catastrophic harvest in 2023 together with escalations in armed conflict have exacerbated food insecurity in Northern and Central Mali.
Health care services in Nepal are provided by both public and private sectors and are generally regarded as failing to meet international standards. Prevalence of disease is significantly higher in Nepal than in other South Asian countries, especially in rural areas. Moreover, the country's topographical and sociological diversity results in periodic epidemics of infectious diseases, epizootics and natural hazards such as floods, forest fires, landslides, and earthquakes. But, recent surge in non-communicable diseases has emerged as the main public health concern and this accounts for more than two-thirds of total mortality in country. A large section of the population, particularly those living in rural poverty, are at risk of infection and mortality by communicable diseases, malnutrition and other health-related events. Nevertheless, some improvements in health care can be witnessed; most notably, there has been significant improvement in the field of maternal health. These improvements include:
Sudan is still one of the largest countries in Africa, even after the split of the Northern and Southern parts. It is one of the most densely populated countries in the region and is home to over 37.9 million people.
As literacy and socioeconomic status improves in Ethiopia, the demand for quality service is also increasing. Besides, changes in the demographic trends, epidemiology and mushrooming urbanization require more comprehensive services covering a wide range and quality of curative, promotive and preventive services.
Bangladesh is one of the most populous countries in the world, as well as having one of the fastest growing economies in the world. Consequently, Bangladesh faces challenges and opportunities in regards to public health. A remarkable metamorphosis has unfolded in Bangladesh, encompassing the demographic, health, and nutritional dimensions of its populace.
A landlocked sub-Saharan country, Burkina Faso is among the poorest countries in the world—44 percent of its population lives below the international poverty line of US$1.90 per day —and it ranks 185th out of 188 countries on UNDP's 2016 Human Development Index. Rapid population growth, gender inequality, and low levels of educational attainment contribute to food insecurity and poverty in Burkina Faso. The total population is just over 20 million with the estimated population growth rate is 3.1 percent per year and seven out of 10 Burkinabe are younger than 30. Total health care expenditures were an estimated 5% of GDP. Total expenditure on health per capita is 82 in 2014.
Examples of health care systems of the world, sorted by continent, are as follows.
Relief International is an international non-governmental organization (NGO) that partners with communities impacted by conflict, climate change, and disaster to save lives, build greater resilience, and promote long-term health and wellbeing. Relief International is a global alliance of four organizations: Relief International Inc, Relief International UK, Relief International France and Relief International Europe.
Liberia is one of the poorest countries in the world. Civil wars have killed around 250,000 people and displaced many more. The wars ended in 2003 but destroyed most of the country's healthcare facilities. Recovery precedes proceeds, but the majority of the population still lives below the international poverty line. Life expectancy in Liberia is much lower than the world average. Communicable diseases are widespread, including tuberculosis, diarrhea, malaria, HIV, and Dengue. Female genital mutilation is widely practiced. Nearly a quarter of children under the age of five are malnourished and few people have access to adequate sanitation facilities. In 2009, government expenditure on health care per-capita was US$22, accounting for 10.6% of totaled GDP. In 2008, Liberia had only one doctor and 27 nurses per 100,000 people. It was ill-equipped to handle the outbreak of Ebola in 2014 and 2015.
The fertility rate was approximately 3.7 per woman in Honduras in 2009. The under-five mortality rate is at 40 per 1,000 live births. The health expenditure was US$197 per person in 2004. There are about 57 physicians per 100,000 people.
India has a multi-payer universal health care model that is paid for by a combination of public and government regulated private health insurances along with the element of almost entirely tax-funded public hospitals. The public hospital system is essentially free for all Indian residents except for small, often symbolic co-payments in some services. Economic Survey 2022-23 highlighted that the Central and State Governments’ budgeted expenditure on the health sector reached 2.1% of GDP in FY23 and 2.2% in FY22, against 1.6% in FY21. India ranks 78th and has one of the lowest healthcare spending as a percent of GDP. It also ranks 77th on the list of countries by total health expenditure per capita.
Since 2016, a food insecurity crisis has been ongoing in Yemen which began during the Yemeni civil war. The UN estimates that the war has caused an estimated 130,000 deaths from indirect causes which include lack of food, health services, and infrastructure as of December 2020. In 2018, Save the Children estimated that 85,000 children have died due to starvation in the three years prior. In May 2020, UNICEF described Yemen as "the largest humanitarian crisis in the world", and estimated that 80% of the population, over 24 million people, were in need of humanitarian assistance. In September 2022, the World Food Programme estimated that 17.4 million Yemenis struggled with food insecurity, and projected that number would increase to 19 million by the end of the year, describing this level of hunger as "unprecedented." The crisis is being compounded by an outbreak of cholera, which resulted in over 3000 deaths between 2015 and mid 2017. While the country is in crisis and multiple regions have been classified as being in IPC Phase 4, an actual classification of famine conditions was averted in 2018 and again in early 2019 due to international relief efforts. In January 2021, two out of 33 regions were classified as IPC 4 while 26 were classified as IPC 3.
An outbreak of cholera began in Yemen in October 2016. The outbreak peaked in 2017 with over 2,000 reported deaths in that year alone. In 2017 and 2019, war-torn Yemen accounted for 84% and 93% of all cholera cases in the world, with children constituting the majority of reported cases. As of November 2021, there have been more than 2.5 million cases reported, and more than 4,000 people have died in the Yemen cholera outbreak, which the United Nations deemed the worst humanitarian crisis in the world at that time. However, the outbreak has substantially decreased by 2021, with a successful vaccination program implemented and only 5,676 suspected cases with two deaths reported between January 1 and March 6 of 2021.
The first confirmed case relating to the COVID-19 pandemic in Yemen was announced on 10 April 2020 with an occurrence in Hadhramaut. Organizations called the news a "devastating blow" and a "nightmare scenario" given the country's already dire humanitarian situation.
{{cite web}}
: Missing or empty |url=
(help){{cite web}}
: Missing or empty |url=
(help)