Nishanth Arulappan, a doctor from Vellore, Tamil Nadu, worked in Yemen from August-December 2016, and witnessed the consequences of a brutal war. In this first-person account, he tells us why he doesn’t regret the time he spent there.
Originally named “Arabia Felix”, the Latin equivalent of “Happy Arabia”, Yemen today is the site of a humanitarian crisis.
Although I’d worked in Yemen in 2014, it was not the same country I had seen before. If there is one song that was applicable in my workplace for the last several months it is ‘Civil War’ by Guns N’ Roses, as some of the lyrics bear an uncanny relevance to the situation in Yemen.
Working with Doctors Without Borders/Médecins sans Frontières (MSF), and keeping in mind the core humanitarian principles of neutrality, impartiality, and independence, I had watched the war tear this already poor and battered country further apart. The challenges were of a different kind this time, owing to the highly fragile and sensitive political situation.
A Different Yemen
Since March 2015 supplies of critically important life-saving drugs and food have been strained. The prices of most essential commodities required for survival have skyrocketed. Vital civilian infrastructure such as schools, hospitals, marketplaces, bridges, stadiums, and university buildings have been bombed and shredded to the ground. The distinction between civilian and military objectives has often not been respected in this war. Four MSF health facilities have been struck by airstrikes or projectiles in the last 15 months – one of them in Hajjah.
The MSF managed hospital in Hajjah was hit by an airstrike a few days before I left for my assignment, and it was not easy to convince the folks at home that things will be ok this time. Thanks to Google, they were updated with all security-related events on a real-time basis, and I had to constantly reassure them that things were alright in our project. And thanks to several uninformed people in my town, my folks were worried each time they heard somebody say: “Nishanth has gone to Yemen???! Of all the places in the world to work, why did he choose to go there?” My parents never relayed this to me while I was in the field, but reviews from others in the family after I returned enabled me to somewhat reconstruct the exchange that would have transpired regarding this.
But I don’t regret a single moment of my time spent in Yemen. I had the opportunity to be introduced to Yemeni people, whose resilience in the face of war is extraordinary. Markets were open, children were going to school, and students in the university were writing their exams, while fighter jets were bombing the locality. During a brief transit in the capital, there was a wedding procession full of music and dancing going on. Then…without warning, there was an airstrike nearby. Silence followed the deafening sound and the pressure wave that followed soon after, rattling the loose windows in the buildings. The buzzing of the fighter jets disappeared after five minutes. Then the blast of music hit the area again, the dancing and revelry continued late into the night! The war has raised the threshold of what is “normal” – enabling them not just to survive, but thrive regardless of the danger and economic hardship.
MSF in Yemen
MSF’s work in conflict areas is – putting it rather mildly – extensive and intense. Unlike some other INGOs we are action-based, offering medical care directly on-site. We are independent – all our activities in Yemen are funded by private and individual donors, and not by any government, which allows us to be independent of the political currents and intervene solely based on medical needs. Being impartial and neutral, we treat patients irrespective of their ethnic, tribal, religious, or political affiliations.
MSF has worked in Yemen since 1986, and continuously since 2007, when a civil war was fought between the state then and Houthis, and following the Arab Spring repercussions in the country. However, following the current war, MSF has expanded its projects to several areas where access to quality medical care still remains a challenge.
Wound Ballistics 101
In 2014 we were treating conflict-related injuries on a fairly regular basis – twice or three times a week. But this time we were quite close to an active frontline, and were receiving war-wounded on a daily basis, often not having enough space to accommodate the rapid inflow of patients.
Some of the stories behind the injuries are quite frankly unbelievable. The fact that a bullet “chose” a particular trajectory, or decided to stay where it is, made the difference between life and death for them.
For example, there was a 22-year-old woman, nine-months-pregnant with her second child, with a stray bullet in her back. She was drying the clothes on the roof, when she suddenly experienced a sharp pain and felt something enter her upper back. Thankfully, she was able to walk and there was no muscular weakness or any altered sensations in her limbs (which is an indication that her spine was not damaged). Once in the hospital, clinical examination revealed the presence of a minor entry wound in the left upper back and a palpable, firm mass on the other side of the spine. Imaging showed that the bullet chose to “ignore” the spine while traveling to the other side! The baby was unaffected, was literally alive and kicking around in her abdomen! We removed the bullet under local anesthesia, and gave it to her husband, who promised to convert it into an ornament for the baby in the future!
There was another guy with a bullet to his head, who came walking and talking to the Emergency Room, though slightly irritable. Imaging revealed that the bullet was inside the left side of the brain, without affecting the areas critical for survival, and did not cross the midline. He was operated later in the day, and discharged a week later.
While there are encouraging stories like this, we also saw several patients who were struck by stray bullets from shooting during weddings and social gatherings – so-called “happy shootings” – and unfortunately did not survive. Even if the war didn’t exist, Yemen would probably still have a fair amount of injuries due to accidental firearm discharge.
Abdulrahman (left) was walking with his eight-year-old daughter to collect wood when a stray bullet hit his chest. No one was around to hospitalise him or give him first-aid. They walked for 20 minutes until they found a pharmacy. The pharmacist gave Abdulrahman first-aid. He was hospitalised at an MSF-supported facility in Ibb governorate where he received surgical care. Even if the war didn’t exist, Yemen would probably still have a fair amount of injuries due to stray bullets. Photo: Malak Shaher/MSF
Key challenges for MSF
The main challenge for us is to ensure that all the actors in the area respect the neutrality of the medical facilities, and abstain from using the space for furthering their political objectives. It requires from us continual dialogue to explain our principles to the political actors, and it requires their understanding and co-operation to ensure the smooth and efficient conduct of humanitarian operations.
Medical facilities are protected under international humanitarian law. But in a conflict where warring parties do not always differentiate between civilian and military targets, medical facilities have been attacked. Sadly, it has become a trend in the investigative reports to blame this on faulty intelligence or targeting errors, and there is no real accountability or prosecution of these incidents, some of which amount most probably to war crimes.
As the war “goes on with brainwashed pride” (Civil War, Guns N’ Roses), the humanitarian needs in Yemen are mounting by the day. MSF’s presence and its medical work are more necessary than before – both to treat the wounded, and to witness and advocate on behalf of people whose lives and dignity may otherwise lie buried forever, beneath the rubble of this war.
This article was first published in The Hindu.