Editor’s Note: This article originally appeared in Peoples Dispatch.
More than 11,000 Yemeni children have been killed or injured since the escalation of fighting in Yemen in 2015, the United Nations International Children’s Fund (UNICEF) reported on Sunday, December 11. The Saudi-led international coalition intervened in the conflict in Yemen in 2015.
Commenting on the number of children killed or maimed in the Yemen war, Catherine Russell, executive director of the UNICEF, noted that this was at best a conservative figure and that “the truce toll of this conflict is likely to be far higher.”
Russell was on a visit to the country where the Saudi-led international coalition, backed by the United States and its European allies such as the United Kingdom and France, is waging a war against the Houthi forces who control capital Sanaa since March 2015. The war has killed hundreds of thousands of people and devastated what was already the poorest country in the Arab world.
Saudi Arabia accuses the Houthis of being an Iranian proxy, responsible for displacing Yemen’s rightful government in 2014-15. The Houthis have denied the Saudi allegations and claimed that they are fighting against the corrupt ruling classes of their country, who do not serve the people but act as facilitators of international loot of Yemeni resources.
Russell called for the immediate resumption of the UN-mediated ceasefire which had ended in October this year. In April this year, for the first time in seven years of war, both the warring sides had agreed to a two-month ceasefire. The ceasefire was extended twice, and the country experienced a rare six months of relative peace. However, both parties refused to extend the ceasefire beyond October after the UN failed to devise substantial grounds for its indefinite extension.
Millions on the Verge of Death
Russell noted that in the period since the ceasefire ended, 62 Yemeni children have been killed and “hundreds of thousands more remain at risk of death from preventable diseases or starvation.”
According to the UNICEF, around 11 million Yemeni children are directly affected by the war and around 2.2 million of them are extremely malnourished. A quarter of these 2.2 million children are below the age of five and extremely susceptible to deadly diseases such as cholera and measles, among others.
UNICEF also noted that regular immunization in the country has been badly affected due to the war, with over 28 percent children missing their routine vaccinations.
The Saudi-led coalition, apart from waging its ground and air offensive in populated areas, has also imposed a crippling air, sea and land blockade of the country since 2015, preventing the supply of essentials including food, fuel, and medicine. The blockade has been identified as the main reason for the large-scale starvation in Yemen, which has pushed millions to the verge of death due to hunger and lack of medicines and healthcare equipment.
Underlining the causes of their refusal to extend the UN-mediated ceasefire, the Houthis highlighted the failure to address the central issue of the Saudi blockade which would have “alleviated the suffering of Yemeni people.” Throughout the period of the ceasefire, the Houthis had been raising the issue of insufficient easing of the blockade and had accused the Saudi-backed forces of violating the norms of the truce.
The scale of destruction caused by the war and the blockade has forced the UN to categorize Yemen as “the world’s worst humanitarian crisis.”
Prajakta Khade walked into a public health center daily for three months in early 2021, without ever receiving medical care. The healthcare worker’s 26 notebooks—containing more than 3,000 pages of community health records—point to why she couldn’t seek treatment for her ailments. She was simply too busy.
In March 2020, India’s health ministry tasked 1 million Accredited Social Health Activists (ASHAs) like Khade with COVID-19 duty in rural areas. This, in a country where 65 percent of its 1.38 billion people live outside cities. Suddenly, ASHAs’ workload increased exponentially. Yet, they remain underpaid and now suffer stress-related chronic ailments.
“If a positive case was found in the area, we had to visit the patient, contact trace, arrange medical facilities, measure their oxygen and temperature levels daily, and ensure they complete quarantine,” Khade explained about the added duties to treat the infectious respiratory disease. But all Khade was given to do her job in the assigned area in India’s Maharashtra state was a single N95 mask and 200 milliliters of sanitizer.
ASHAs, an all-women healthcare cadre, remain the foot soldiers of India’s rural healthcare. One worker is appointed for every 1,000 citizens under India’s 2005 National Rural Health Mission. ASHAs are responsible for more than 70 tasks, including providing first-contact healthcare, counsel regarding birth preparedness, and pre- and post-natal care. Plus, they help the population access public healthcare and ensure universal immunization, among other things.
The World Health Organization announced a pandemic in March 2020. But in many countries, lack of adequate healthcare and no social safety nets amid lockdowns wrecked the lives of ordinary people. In India, for example, an additional 150 million to 199 million people are expected to enter poverty in 2021 and 2022.
Chronic Illnesses Spike
One day about a year ago, while surveying people in her village of Vhannur in India’s Maharashtra state, 40-year-old Khade felt dizzy. But she couldn’t take a break. “At one point, my face was swollen, and I could barely see anything.” It turned out her blood pressure level had surged to 252/180 mmHg (millimeter of Mercury), much higher than the standard limit of 120/80. That is how she got diagnosed with hypertension.
However, a month’s worth of medications didn’t help because she continued to experience stress as her workload increased. Senior officials at the health center had early on issued an order to submit patient records daily by noon.
ASHAs, who aren’t considered full-time workers, receive performance-based incentives paid on the number of tasks completed. “For COVID duty, the government decided our worth as merely 33 Indian Rupees per day (43 U.S. cents),” she said. “We received this amount only for three months in the past two years.”
Moreover, during the peak of COVID-19 cases in 2021, salaries for Maharashtra’s ASHAs were delayed by five months, according to Khade. Netradipa Patil, an ASHA from Maharashtra’s Kolhapur district and leader of a union that represents more than 3,000 ASHAs, confirmed this.
One day last year, Khade’s supervisor asked for a list of hypertension and diabetes patients from her village of about 1,200 people—at 10 o’clock at night.
“How could I survey the entire community in the night?” she asked.
Often, such orders meant skipping lunch and staying hungry for 11 hours at a stretch. ASHAs worked four hours prior to the pandemic. Now, 12-hour days are normal.
When medications didn’t help, Khade consulted two private doctors. “After six months of hassle, the doctor doubled my dose to 50 milligrams.” Khade lost over 10 kilograms (22 pounds) of weight and was placed on medications to address anxiety. Even today, she suffers from fatigue.
“I was never this weak,” she asserted.
Chronic diseases among ASHAs are rising rapidly because of the workload, says Patil. “We protect the entire community, but there’s no one to look after our health.” ASHAs in Maharashtra, she says, average a monthly income of Rs 3,500 to 5,000 ($45 to $66 USD).
This reporter spoke to ASHAs’ senior officials from Maharashtra’s Kagal block. (In India, a cluster of villages form a block and several blocks form a district. Vhannur village is in the Kagal block of Maharashtra’s Kolhapur district.) Senior officials said they are not responsible for ASHAs’ deteriorating mental and physical health, and pointed to the Indian government’s order to submit data. The officials didn’t want to be named. Instead, they relayed that they also are overworked.
“ASHAs do the majority of the health department’s work, and they are massively underpaid for their duty,” said Dr. Jessica Andrews, a medical officer at Kolhapur’s Shiroli Primary Health Center. She has been handling mental health cases. “Without them, the health system will collapse.”
‘Not Treated As Humans’
Several ASHAs across India have worked for over a year without a break. One of them is Pushpavati Sutar, 46, diagnosed with hypotension (low blood pressure) and diabetes within seven months of COVID-19 duty in November 2020. Like Khade, she experienced constant spells of dizziness.
“Often, there was fake news of community COVID transmission in my area,” she said.
Every day, senior officials at the health center hounded her to find more details about such instances.
An ASHA for 13 years, she’s never made an error in her surveys and was sure of no community transmission. “After investigating, I found that the accused was COVID negative. Instead, two of his relatives were positive.”
She had to clear such misconceptions almost every day, answer senior officials’ questions, collect records and perform her regular duty. “For several days, I couldn’t sleep,” she remembered.
Further, fearing COVID-19 guidelines and quarantine rules, community members began demanding ASHAs hide COVID-19 cases. “People even accused us of spreading COVID as we would survey the entire village,” Sutar recounted. Moreover, she said senior officials asked ASHAs to visit the families of COVID-19 patients—instead of allowing data collection over the phone—putting them at risk of infection.
“At several places, there have been instances of community violence, where ASHAs were beaten up,” said Patil, who has filed legal complaints on behalf of the assaulted workers and is helping them mentally recover.
Kolhapur’s ASHA union has written to several government authorities, including Maharashtra’s chief minister and Indian Prime Minister Narendra Modi, highlighting the mental toll of COVID-19 duty. Still, none of their letters have garnered a helpful response.
“Forget adequate pay,” said Khade, as she continued surveying, juggling between completing her task and trying to keep her mind at ease. “We are not even treated as humans.”
Sanket Jain is an independent journalist based in the Kolhapur district of the western Indian state of Maharashtra. He was a 2019 People’s Archive of Rural India fellow, for which he documented vanishing art forms in the Indian countryside. He has written for Baffler, Progressive Magazine, Counterpunch, Byline Times, The National, Popula, Media Co-op, Indian Express and several other publications.
Hasina Hajukhan never imagined that returning to her maternal house would turn into a near-death experience. In April, the 28-year-old was seven months pregnant, and her medical parameters were normal. “I was taking extra care to ensure no complications during childbirth,” she told Toward Freedom.
As is customary in many parts of India, pregnant women return to their parents’ homes to give birth. When Hajukhan first reached her mother’s house in Ganeshwadi village of the western Indian state of Maharashtra, she felt nauseated. “It was April’s final week, and I couldn’t even breathe properly,” she recounted. A heat wave had taken hold. “The climate was the stark opposite of what it was in my husband’s village.” In Ganeshwadi, things kept getting complicated with the rising heat. “Every day, I was breathless and would feel dizzy.”
Using a desk fan at the highest speed didn’t help, as it just circulated more hot air. An air conditioning system was something her family could not afford. The tin sheet roof would get extremely hot. During this crucial time, Hajukhan needed rest. However, she spent most of her day stepping out to gasp for cold air. In May’s final week, things got worse. “I felt as if I was going to die,” she recalled, teary-eyed.
Immediately, her mother dialed Ranjana Gavade, an accredited social health activist (ASHA worker), part of a community of 1 million women healthcare workers appointed for every 1,000 people in India’s villages. ASHAs are responsible for more than 70 healthcare tasks, with a particular focus on maternal and child health.
“I was worried looking at her rapidly deteriorating health and informed my colleagues.” Upon their instructions, Gavade called a government ambulance and swiftly took her to the district hospital, 33 kilometers (20.5 miles) away. Hajukhan gave birth to underweight twins. Her troubles still hadn’t ended when she was discharged after three days. For a month since then, Hajukhan has been trying to ensure her twins gain weight, but all efforts have failed. As a result, they weren’t administered the necessary Bacillus Calmette–Guérin (BCG vaccine used against tuberculosis), Hepatitis B, and Polio vaccines.
The Kolhapur district, where Hajukhan lives, has been reporting recurring floods, heat waves, incessant rainfall, and hailstorms triggered by climate change. She said everything would have been normal had she not returned to her parents’ home to give birth in the heat waves. “My children wouldn’t have had to live such a dangerous life,” she said.
Like in the village of Ganeshwadi, climate change impacts have been delaying children’s immunization schedules throughout India, making them vulnerable to diseases. Research has found that if a child belonged to a district highly vulnerable to climate change, the odds of stunting rose by 32 percent, low weight by 45 percent, anemia by 63 percent and acute malnutrition by 42 percent. An analysis by global nonprofit Save the Children found that, globally, 774 million children are living in poverty and at a high risk of climate-related disasters. Weather disasters ranging from floods to droughts prevent children from obtaining nourishment, causing low weight, and these disasters put a break on children receiving vaccinations on time. Their weakened immune systems, as a result of a lack of proper nourishment in crisis times, make them vulnerable to other diseases. Being sick can halt the necessary immunizations, and these delays have led to a rise in epidemics and diseases.
How Floods Impact Universal Immunization
Snehal Kamble, 24, a resident of Maharashtra’s flood-prone Arjunwad village, remembers the year 2019 in meticulous detail. “A day before the floods, I was preparing to go to my parent’s house.” Five months pregnant, she was looking for iron folic acid tablets. “Instead, all of us went to a flood relief camp,” she recounted. From there, she moved to another relief camp within a few days, as the water rose further. “During this time, I was worried about my house and belongings,” she said. She fell sick and was away from home for 15 days. “Those were the most difficult days of my life,” she shared. Then in January 2020, she gave birth to a boy named Sangarsh, who has often fallen sick. “When I went to my maternal house, he just couldn’t bear the heat there,” she said. The dehydration and spells of fever he experienced affected his immunization schedule. “His Pentavalent vaccine was delayed by several months because of health ailments,” said ASHA worker Shubhangi Kamble (no relation to Snehal), who has been monitoring this child since birth.
Further, his Measles-Rubella vaccine and Vitamin A dose were also delayed, making him vulnerable to diseases. “Vaccines need to be administered on time,” said Sachin Kamble, a nursing officer at the district women’s hospital in Maharashtra’s Osmanabad district. “Otherwise, it affects a child’s immunity, making them more vulnerable to diseases.”
He pointed out how the lack of vaccinations led to 2,692 cases in 2022 in Maharashtra, which reported the highest measles count in India. That was an eight-fold increase from the previous year. During this time, India reported 12,773 cases. India’s National Family Health Survey (NFHS) said only 31.9 percent of children ages 24 months to 35 months had received a second dose of measles-containing vaccine in 2019-21.
Another healthcare worker, Kavita Magdum, from flood-affected Ganeshwadi village, said that children in her surveying area never fell ill so frequently. She started noticing such stark changes only in the past five years. Upon inspecting this, she found, “Stress caused by the changing climate is leading to this.” For instance, Magdum sees that many children aren’t drinking breast milk, which has impacted their medical parameters. These drastic changes reflect in Indian government statistics, as well. During 2015-16, 58.6 percent of children ages 6 months to 59 months (just under 5 years old) were anemic in India. By 2019-20, this number rose to 67.1 percent. In addition, 32 percent of children nationally remain underweight.
After a year-and-a-half, Snehal’s son started getting better, thanks to Shubhangi’s consistent visits, when she monitored every parameter and ensured the best possible treatment by working hours beyond her duty. “Once the vaccination schedule started falling in place, his health, too, began improving,” Shubhangi shared.
Untimely Administration of Vaccines
While climate change is making it difficult for these healthcare workers to complete universal immunization, another challenge is the untimely vaccine administration.
“There are many instances, where vaccines in several villages are just not available,” said Netradipa Patil, leader of more than 3,000 ASHA workers and co-founder of Deep-Maya Foundation, a non-profit that works for women and children. “During such times, it becomes extremely challenging for us healthcare workers to manage everyone.”
Patil has observed that the workload has increased tremendously for all the ASHA workers because of the delay in vaccination. This is because ASHA workers are responsible for immunization, and in case of any discrepancy or error, they are held accountable. Research published in 2016 concluded, “Lack of timely administration of key childhood vaccines, especially DPT3 (the three doses of the Diphtheria, Tetanus and Pertussis vaccine) and MCV (measles-containing vaccine), remains a major challenge in India and likely contributes to the significant burden of vaccine-preventable disease-related morbidity and mortality in children.” Another paper published in 2019 inferred, “The proportion of children with delayed vaccination is high in India.”
In 2021, the World Health Organization found that 25 million children around the world under the age of 1 didn’t receive vaccines, a figure not seen since 2009. “Many children never get the Vitamin A doses on time. These doses are just not available when required,” Patil said, suggesting the Indian government should consult local healthcare workers to arrange vaccination. “We need to reach more and more people, and, currently, looking at the changing climate, we aren’t prepared to do this,” she shared. Patil made simple suggestions like identifying vulnerable children and their locality and monitoring them from the earlier stages, even before the disaster strikes. “Just by proper identification, we can save so many children,” she said.
Rising Undernourishment
Fed up with feeding medications and tonics that didn’t seem to help increase his weight and prevent him from continually falling ill due to the changing weather conditions, Rashi Patil, 23, quit taking her son to the doctor every month after 18 months. “My son just wouldn’t eat anything,” Patil said.
Moreover, the changes in local climatic patterns affected her son’s health, and he often fell sick. Last year, he was hospitalized for a week as his platelets fell and a fever intensified. What followed next were recurring illnesses that delayed his immunization schedule. Because of the fever in March, he wasn’t administered the Pentavalent 1 vaccine (it protects from five life-threatening diseases: Diphtheria, Pertussis, Tetanus, Hepatitis B and Hib [Haemophilus Influenzae Type b]). Her son soon became weak and began recovering only after the vaccine’s administration. All this while, her son struggled with good eating habits. After several trials and errors, Rashi and her husband, Rajkumar, discovered the climate affected their son’s health and eating habits.
“Now, their son makes it a point to eat only outside the house, where he gets some cold air,” says Rashi. “Contrastingly, this was never the case with my elder daughter.”
Toward Freedom reached out to Ganeshwadi’s community health officer, Dr. Prajakta Gurav, regarding what steps her team was taking to deal with delayed immunization. Gurav hasn’t replied as of press time.
The impact of poor diets is more obvious at the national level. For instance, just 11.3 percent of children between the ages of 6 months and 23 months receive an adequate diet. Plus, in 2022, India ranked 107 out of 121 countries on the global hunger index. These numbers further reveal how climate change is exacerbating the existing faultlines.
The problem is not restricted to India. Of the countries at severe risk of being adversely affected by climate change, the report by Save the Children says, “Burundi has the highest rate of stunted children (54 percent), followed by Niger (47 percent), Yemen (46 percent), Papua New Guinea (43 percent), Mozambique (42 percent) and Madagascar (42 percent).”
Research published in PLOS Medicine found that in 22 sub-saharan African countries, drought led to lower chances of completion of BCG (Bacillus Calmette-Guérin), Polio and DPT (diphtheria, tetanus, and pertussis) vaccines. “We took vaccines to the last mile. Now, climate change is eroding progress.”
For Komal Kamble, 30, vaccinating her 2-year-old daughter remains challenging. Her remote mountainous village of Kerle, in Maharashtra’s Kolhapur district, remains inaccessible most of the year.
For the village population of less than 1,100 people, the nearest healthcare facility is 15 kilometers away. Last year, within a week of October rains, the road that connects her village to the nearest hospital was completely under floodwater.
Komal’s daughter couldn’t get proper medical care for two days, worsening her health. Her chest was full of cough, and the fever rose, making things difficult for the agrarian Kamble family. This wasn’t restricted to heavy rainfall, though. Since her birth in 2021, Komal has taken her daughter to a private doctor at least 20 times, spending over Rs 15,000 ($182). Last year, she was feverish and wasn’t given the crucial Japanese encephalitis vaccine, a Vitamin A dose and the Measles-Rubella vaccine. This made her vulnerable to more diseases, challenging the Kamble family.
Healthcare worker Shubhangi Kamble from Arjunwad says that instances of children missing their vaccination are rising rapidly. When she went to find out why this was happening in her village, Arjunwad, she saw that children fell sick during floods and heat waves. “This was the time that coincided with their vaccination schedule, and so many couldn’t get the vaccines,” she shared.
However, a delay in vaccination has caused more problems than she had anticipated.
“Almost every day, at least one parent dials me asking where they should get their children hospitalized,” she said.
Now, every rainfall brings a health issue for Komal’s daughter. “I am tired of going to the healthcare center to hear that my daughter is underweight or sick and can’t be given the vaccine,” Komal said, with frustration in her voice.
Meanwhile, with every climate disaster, it will become increasingly difficult for many families to complete the immunization in time. “I’ve been vaccinating children for over a decade, but things never got this difficult. We took vaccines to the last mile. Now, climate change is eroding progress,” said healthcare worker Kavita Magdum.
Sanket Jain is an independent journalist based in the Kolhapur district of the western Indian state of Maharashtra. He was a 2019 People’s Archive of Rural India fellow, for which he documented vanishing art forms in the Indian countryside. He has written for Baffler, Progressive Magazine, Counterpunch, Byline Times, The National, Popula, Media Co-op, Indian Express and several other publications.
Editor’s Note: This report was originally published via email by Friends of the Congo.
BUSHUSHU, South Kivu Province, Democratic Republic of Congo—On Thursday, May 4, under the effect of heavy rain, the Nyamukubi and Chishova rivers burst their banks, causing major mudslides and landslides. In the affected areas, the damage is enormous: Entire villages have been devastated by the waters and the assessments are still provisional.
#URGENT: Quand l'inondation de Kalehe est en cours. Plusieurs sources locales à Bisunzu, près de Rubaya indiquent qu'un éboulement de terre a touché cette région ce lundi 08 mai. Le bilan n'est pas encore connu mais c'est près d'une dizaine de creuseurs artisanaux. #RDCpic.twitter.com/tmhdZXQ6bc
— Akilimali Saleh Chomachoma (@akilimalisaleh) May 8, 2023
On Saturday, the territory’s administrator put the number of bodies found at 203. On Sunday, he mentioned at least 394, 120 of whom were found floating on the lake at the level of Idjwi island, the others having been found in Nyamukubi and in the neighbouring village of Bushushu. More than 200 bodies were buried on Saturday, May 6, in Bushushu and Nyamukubi.
At least 400 people are reported dead, according to a local official, and many are missing. The civil society of Kalehe says that nearly 4,500 people are still missing, as the chances of finding survivors are diminishing.
“The situation is bitter! We came to bury our brothers while the state should anticipate things by creating a special commission for the prevention of natural disasters. Whether in Uvira, Kamituga or here in Kalehe, these events are repeated, so a commission is needed,” says Benjamin Kasindi, head of the political party Alliance des Nationalistes pour un Congo Émergent in South Kivu, who traveled to bring aid to the victims.
Teams are still digging for bodies with their hands and some shovels. They wrap the bodies in blankets or sheets before burying them in mass graves. On the shore of the lake float pieces of wood, metal sheets, furniture and other materials carried by the raging rivers. Young people are trying to salvage what they can from the sunken houses: Metal sheets, metal structures, boards, etc. The Red Cross and the government are continuing to register the families who have lost their loved ones, as well as other victims.
Initial assistance in the form of medicines, tarpaulins and food from the provincial government of South Kivu arrived on the spot on the same Saturday. This aid is still insufficient in view of the number of victims, according to the administrator of Kalehe territory, Archimède Karebwa. He continues to call on the central government and other humanitarians to intervene because the situation is so deplorable.
Akilimali Saleh Chomachoma is an independent journalist in eastern Democratic Republic of Congo. Follow him on Twitter for updates and reports.