At the entrance to al-Sadaqa Hospital in Aden, militia members argue with the parents of patients. (Lorenzo Tugnoli/For The Washington Post)

When Kenan was born four months premature, there were no doctors at al-Sadaqa Hospital to care for him. So his grandmothers tried to save him.

They placed the infant in an incubator, but it was broken. They tried a second one. It wouldn’t heat up.

It had been 24 hours since a doctor had last visited the hospital. A day earlier, a physician was beaten up during an argument with the militiamen who were supposed to guard the hospital, and the doctors walked out in protest.

Yemen’s civil war had already crippled the hospital, the largest civilian public hospital in southern Yemen. Now it was completely paralyzed, illustrating the fragility of a health system broken by war and utterly incapable of caring for the victims of what the United Nations calls the world’s worst humanitarian crisis.

Hospitals and clinics have been bombed and mortared. Shortages of essential drugs, vaccines and medical equipment are widespread. In most government health facilities, staff haven’t been paid in a year.


A member of the militia that control al-Sadaqa Hospital walks through the intensive care unit with his rifle. (Lorenzo Tugnoli/For The Washington Post)

Nabila al-Hanani, deputy head nurse, talks to a group of nurses in the ICU at al-Sadaqa. (Lorenzo Tugnoli/For The Washington Post)

Women attend to their children in the ICU. (Lorenzo Tugnoli/For The Washington Post)

Kenan’s grandmothers scrambled to find a working incubator.

“We brought him to the third one,” said Umm Salah Hussein, one of his grandmothers, “and that’s where he died.”

“There was no oxygen and there was no help,” chimed in Umm Mohammed Zaid, his other grandmother, staring at the baby’s corpse, wrapped in a red cloth, still inside the incubator.

The baby’s twin brother had died a day earlier. Now, Kenan’s mother, who had been asleep recuperating, awoke to learn her remaining son was gone.

Care for the most desperate

The dispute at the hospital was the latest tragedy for a health-care system that has been steadily eroded by a conflict pitting northern rebels against Yemen’s internationally recognized government.

In the turmoil that followed the country’s 2011 Arab Spring uprising, Shiite rebels, known as the Houthis, forced out the government from the capital, Sanaa. A regional coalition led by Saudi Arabia and the United Arab Emirates and supported by the United States entered the war to restore the government. The aim was to prevent Iran’s Shiite theocracy, widely believed to be backing the Houthis, from expanding its influence in a sphere dominated by Sunni Muslim countries.


A ward at al-Sadaqa Hospital in Aden. (Lorenzo Tugnoli/For The Washington Post)

The war deepened a humanitarian crisis that has put more than 22 million people — 75 percent of the population — in need of assistance. More than a third of them are at risk of starvation, according to the United Nations. Thousands have died of treatable diseases such as cholera, meningitis and diphtheria, and more than 3 million have fled their homes.

One of the better-funded public hospitals, al-Sadaqa attracted the poorest and most desperate patients. On any day, the hospital received 500 to 800 patients.

But it labored under almost unimaginable difficulties. For the past three years, it was the fiefdom of the local militia that guarded it, one of the many armed groups seeking influence in Aden. The militiamen routinely harassed doctors and nurses, and allegedly looted equipment. The hospital was forced to pay salaries of $15 a month per militiaman and could never fire any of them. “We either had to pay or someone would be killed,” said Gamal Abdul Hamid, the hospital administrator.

Finally, the staff grew tired of the abuse. Now, with most of its 70-plus doctors and medical trainees on strike, the facility had stopped accepting new arrivals. That potentially jeopardized the lives of thousands of patients who could not afford a private hospital.


Nabila al-Hanani, deputy head nurse, argues with militia members. (Lorenzo Tugnoli/For The Washington Post)
Fragile lives

On a sultry day in the children’s wing of al-Sadaqa Hospital, 15 babies were suffering from severe malnutrition. But the worst case was 3-year-old Ayesha Ahmed. Her legs were thin as twigs. With each breath, her ribs protruded through her belly, stretching out her thin, dry skin.

Her parents had borrowed $40 for the car to transport them from their village, 200 miles away, and an additional $75 to buy medicines for their daughter. They arrived at the hospital the day before the dispute, and doctors helped her. Ayesha’s diarrhea ended and she stopped vomiting. She was also drinking fortified milk.

But with her life still teetering precariously, her parents were considering taking Ayesha to another hospital. That would be a financial challenge. “We only have $10 left,” explained Naziha Mah­youb, her mother. “We will try to borrow money from anywhere.”

Mundhir was born premature and was the size of a deflated football. His tiny face was attached to a tube that ran to an oxygen bottle, but his body was not moving.

“The oxygen has stopped for the past 10 minutes,” said his mother, Fikria Sa’el, 39, worry evident in her voice. “No bubbles are coming out.”

A nurse rushed to the machine that regulates the oxygen flow. His twin brother, Nadhir, had died nine days earlier.

Suddenly, bubbles emerged in the bottle. Mundhir’s bony chest moved up slightly, and his sister thanked Allah.

But three days later the staff would discover that Mundhir was bleeding in his intestines, nurses said. A doctor sneaked into the hospital, her face covered by a black veil to avoid the militiamen outside; she administered a blood transfusion and left. The nurses called her a hero.

Fresh blood flowed through an IV attached to his left arm. Mundhir’s eyes opened. He had survived for 29 days.

In the intensive care unit, 5-month-old Taif, who had a congenital heart disorder, rasped like an old woman. She desperately needed a blood transfusion and heart surgery.

Her parents had tried to transfer her to a private hospital the day before. But some were too expensive. Others refused to accept her in such serious condition. A Malaysian charity offered to perform free surgery but said Taif needed to weigh at least 15 pounds. She weighed six.

How could their daughter gain weight, her parents wondered, when there were no doctors to help her?

“They left us without medicine, and no one to follow her case,” her mother would bitterly say later.


Taif Fares gasps for air in al-Sadaqa Hospital’s ICU. She was born with a heart disorder requiring constant care. She died few days after this photo was taken. (Lorenzo Tugnoli/For The Washington Post)

A day later, Taif nearly died. She had been vomiting, badly in need of blood, and her heart had stopped, said her mother, Fatma Jalal. “When the nurse came and saw her, they tried to revive her,” she said. “The heartbeat came back slowly.”

Eight-month-old Alin was in the next bed. She had been in a coma when she arrived, but she had improved when the doctors treated her, before they left the hospital. Now, her condition was deteriorating again. Her medical report read: “In severe shock.”

She had contracted malaria and was running a high fever. She stared blankly at the ceiling.

“Before she became sick, she used to say ‘Mama’ and ‘Papa’ ” said her father, Nidhal Mohammed. “Now, she doesn’t say a word.”

Postscript

The doctors ended their walkout after an armed force linked to the Saudi- and UAE-led coalition took over the hospital’s security.

Ayesha’s parents brought her back to al-Sadaqa after the protest ended and her health started to improve.

Taif took a turn for the worse and died even as she received the blood transfusion she had so long needed.

Alin was transferred to other hospitals for treatment.

Mundhir died on the day the strike ended.


Fikria Sa'el tends to her son Mundhir, born premature. (Lorenzo Tugnoli/For The Washington Post)

Ali Al Mujahed contributed to this report.