Background War in Yemen started three years ago, and continues unabated with a steadily rising number of direct and indirect victims thus leaving the majority of Yemen’s population in dire need of humanitarian assistance. The conflict adversely affects basic socioeconomic and health conditions across the country. Methods This study analyzed the recent ongoing diphtheria outbreak in Yemen and in particular, the health system’s failure to ensure immunization coverage and respond to this outbreak. Data from the weekly bulletins of the national electronic Disease Early Warning System’s (eDEWS) daily diphtheria reports and district immunization coverage were analyzed. The number of diphtheria cases and deaths, and immunization coverage (DPT) were reviewed by district including the degree to which a district was affected by conflict using a simple scoring system. A logistic regression and bivariate correlation were applied using the annual immunization coverage per district to determine if there was an association between diphtheria, immunization coverage and conflict. Results The study results confirm the association between the increasing cases of diphtheria, immunization coverage and ongoing conflict. A total of 1294 probable cases of diphtheria were reported from 177 districts with an overall case fatality rate of 5.6%. Approximately 65% of the patients were children under 15 years, and 46% of the cases had never been vaccinated against diphtheria. The risk of an outbreak increased by 11-fold if the district was experiencing ongoing conflict p < 0.05. In the presence of conflict (whether past or ongoing), the risk of an outbreak decreased by 0.98 if immunization coverage was high p > 0.05. Conclusion The conflict is continuously devastating the health system in Yemen with serious consequences on morbidity and mortality. Therefore, the humanitarian response should focus on strengthening health services including routine immunization procedures to avoid further outbreaks of life-threatening infectious diseases, such as diphtheria.

Background: This study aims to describe malnutrition among children under five and to describe the food insecurity status during the current conflict in Yemen. Methods: Data were obtained from a Yemeni nutrition surveillance program (pilot phase) targeting 4142 households with 5276 children under five from two governorates (Ibb and Sana’a). Results: Global acute malnutrition was found in 13.3% of overall screened children, while 4.9% had severe acute malnutrition (SAM) and 8.4% had moderate acute malnutrition. One-fifth of the children under six months of age were acutely malnourished, followed by children under two years at 18.5% based on weight-for-height z scores. Significant associations between malnutrition and other diseases included suspected measles at three times higher rates (4.5%, p < 0.00) among SAM cases than other children. Diarrhea, fever, and cough were significantly higher among the SAM group (p < 0.05). Most households depended on market food purchases in the month preceding this survey (84.7%). Household coping mechanisms to secure daily meals included borrowing food to survive, changing types and quality of food, and decreasing the number of meals per day; some families sent their children to live with relatives. Conclusion: Malnutrition is a serious public health problem. The humanitarian community needs to adopt alternative strategies to improve food security and the nutrition status in Yemen.

Introduction: In Yemen, the largest cholera epidemic of modern times started in late 2016. By March 2018, more than one million cases had been reported. A national electronic Disease Early Warning System (eDEWS) for infectious disease surveillance was established in 2013. Aim: This study assessed the eDEWS’s timelines for reported cholera cases. Methods: Quantitative data published in eDEWS and the Weekly Epidemiological Bulletin of the Yemen Ministry of Health from March 2013 until March 2018 were analyzed. For assessing the early detection of cholera cases, 262 weekly bulletins were reviewed. The raw data of the immediately generated eDEWS alerts during the first outbreak wave were used to assess response timeliness. Results: Reported cholera incidence peaked at 1,698 cases (first wave) in 2016 week 49, and then reached 46,667 cases (second wave) in 2017 week 26. The mean time period between reporting and the first response was 2.85 days. Only 31% of the eDEWS alerts were verified within the first 24 hours, and the majority (83%) were verified within one week. There were major differences in the timeliness between the governorates, ranging from 8%-62% for reporting within the first 24 hours. Conclusion: The eDEWS is able to detect and alert health authorities about cholera cases even under conditions of ongoing war and civil war, however, the timeliness of the response needs improvement.