In the Yemeni city of Aden, doctors and nurses of Al-Wali Hospital and their families have become patients. With the 75 beds in this private hospital now full, members of the public are being turned away.
"Right now, we can't accept anyone else," said Amr Al-Turkey, a critical care physician in the hospital who is recovering from COVID-19.
Across the city, medical staff and their relatives are falling ill with COVID-19, doctors and aid workers have told NPR. As the coronavirus spreads, there are soaring numbers of infected patients, while the health care facilities lack everything from protective gear for staff to beds for the ill to specialist expertise.
Turkey's account comes as the aid group Doctors Without Borders, which goes by MSF, the acronym of its name in French, warns a "catastrophe" is unfolding in the city because of the coronavirus.
MSF runs the only facility dedicated to treating COVID-19 patients. It's based in Aden but cares for the sick from all across southern Yemen. From the end of April until now, just over 200 patients have been admitted, and of those close to 100 have died.
The aid group said the number of deaths in Aden from the coronavirus is likely much higher.
Thierry Durand, MSF's coordinator of operations in southern Yemen, said the organization's staff there is sometimes left feeling "powerless." Speaking to NPR shortly after leaving Aden as part of his work rotation, he described medical teams working day and night even as patients, colleagues and loved ones died before them.
"The only way to help people pass the peak of this disease is with oxygen therapy, with or without mechanical ventilation," Durand said. But not enough is available. "So we are seeing people dying quickly – in a matter of a few hours."
The staff is also directly affected. Between the COVID-19 clinic and another hospital in the city where staff work, Durand said 40 of MSF's health care workers are sick – some from diseases such as dengue but many from the coronavirus.
Their relatives are falling sick, too. "One of our doctors brought his mother into the clinic during the night. In the morning, she was dead," Durand said. "And he is now sick."
Last week MSF called on the United Nations and donor states to do more to help. Yemen has a long list of needs: from funds to pay health care workers to supplies of protective equipment for medical staff to oxygen to help patients breathe.
But the U.N. warns that the funding for its programs in Yemen is heading toward a "fiscal cliff." The U.N. Office for the Coordination of Humanitarian Affairs said at a press conference this month that if donor countries don't step up, some of its operations "that are very much essential to fighting back against [COVID-19], will have to close."
In response to the coronavirus, the U.N. in Sanaa has allowed some staff usually based in the capital to leave the country and work outside Yemen.
A U.N. official who asked not to be named because he did not have authorization to speak on this issue told NPR that only those staff who could work remotely have left and that the change has not affected ongoing aid operations.
Yemen already suffers what the U.N. is calling the world's most extreme humanitarian crisis. Some 24 million people – close to 80% of the population – need aid. More than 20 million people across the country are food insecure, and the country has the worst cholera outbreak in modern history, with more than 110,000 suspected cases recorded in April.
Despite multiple attempts at a cease-fire, the war there continues. The country is divided between the Aden-based government, which is backed by Saudi Arabia, and Houthi militias who control the capital, Sanaa, and much of the north. The Houthis receive support from Iran, Saudi Arabia's regional rival.
Infighting between Saudi-aligned factions further complicate the picture. Last month the Southern Transitional Council separatist movement declared "self-rule" in Aden. Its militia seized some government offices and the central bank. Governors of some of the affected provinces rejected their calls, but the region is now even more unstable.
In the midst of all this, MSF's Durand said that in Aden officials had taken little action to tackle the coronavirus outbreak. "Nobody wanted to know or admit that it was circulating," he said. "There was little talk of the isolating [through lockdowns and quarantines] or testing. Until, at the end of April, they couldn't escape it anymore."
Local authorities repurposed a hospital that had been defunct for two years into a treatment center for COVID-19 patients. MSF helped with the repairs and eventually took over its management. During the holy Muslim month of Ramadan that began April 23, where families, friends and neighbors gather to break the daily fast, the number of cases "just exploded," Durand said.
The health ministry of the Aden-based government reports 212 confirmed cases and 39 deaths – far lower than even the number of fatalities seen at the COVID-19 hospital run by MSF.
Meanwhile, Houthi authorities in northern Yemen have yet to publish much data on the spread of the disease in their areas. In Sanaa, two medical centers have reportedly been turned into COVID-19 isolation units.
Doctors have petitioned authorities to provide protective gear to all hospitals in the city. Areej Haider, 31, a medical student in her final year of study, works in the emergency unit of Al-Thawra, the biggest hospital in Sanaa. She said the hospital is seeing some patients with symptoms of COVID-19 but doesn't have the equipment to test for or manage the disease.
Haider grew up in Aden and said she knew three of the doctors there who have succumbed to COVID-19. When her medical supervisor also contracted the virus, his students – some of them now emergency medical specialists – worked to keep him alive.
"He was on a ventilator for 10 days," she said. Aden doesn't have respiratory specialists. Haider said Yemeni doctors who do have that expertise, some now abroad, "gave advice remotely." Two former students stayed by her supervisor's hospital bed and helped manage his ventilation according to the "correct protocols."
"Now he is home," she said.
When not at the hospital, Haider gives medical consultations by phone from home. She has distributed her number through friends, colleagues, Facebook and WhatsApp. "Some of the people who call me have symptoms of coronavirus. Others have other diseases, like malaria," she said. She tries to help them remotely by prescribing medicine or requesting tests.
With many hospitals in Aden are unable to admit patients, especially those displaying a fever or other symptoms of COVID-19, this kind of remote visit may be some people's only chance of medical help.
Nada Homsi contributed to this story.
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