Tag Archives: cholera

‘The situation is critical’: cholera fears on Manus as water and medicine run out | Ben Doherty

The piercing pain in Joinul Islam’s right arm keeps him from sleeping. He can’t bend it to eat properly (to eat with one’s left is considered unclean), and there are precious few painkillers to allow him to rest.

Four months ago, he was attacked by a gang in Lorengau, his elbow was sliced open with a machete and the surgery to repair it did not work. He was promised follow-up surgery, but it never happened. Now, he waits for more medical treatment that might never come.

In the meantime, he bears the pain – his right arm fused at an awkward angle – without assistance. He has been told by Papaua New Guinea authorities he can get more painkillers, but only in Lorengau, the place where he was attacked.

“I cannot go back there, I cannot go back. How can I go to Lorengau? I need a safe place,” he says.

Seated in a quiet corner of the darkened Manus Island detention centre, he speaks barely above a whisper. The pain, at one point, kept him awake for two weeks, he says. “I am so tired,” he tells the Guardian, as tears well in his eyes.

Islam has been formally recognised as a refugee, having fled persecution in his homeland Bangladesh. “My country, political is problem, is not safe. For safe place, I come to Australia.”

Islam says he feels under intense pressure to quit the Manus Island detention centre, even to abandon his claim for protection altogether, and risk returning to Bangladesh. “All the time is pressure. My life is very difficult. I have been running five years. Too long,” he says.

Islam’s case is barely remarkable inside the condemned the Manus Island detention centre – officially shuttered on 31 October, with all essential services withdrawn.


Hygiene conditions are worsening day by day. We are thirsty and have been waiting for rain

Behrouz Boochani

There are few uninjured or healthy people among the 400 who remain in the camp, surviving on rainwater and makeshift wells, smuggled food, and solar panels powering phones that give them a link to the outside world.

Inside the camp, the Guardian saw men who, while walking through the wreckage of the site, had stepped on nails that had pierced their feet. Their infected wounds wept pus as they walked. Others revealed open and infected sores on their legs – cognisant that Iranian asylum seeker Hamid Kehazaei died after a small infection that, even with medical intervention, spiralled rapidly out of control in the detention centre and ultimately killed him.

Refugees at condemned Manus Island detention centre where authorities have destroyed shelters and makeshift water-collecting bins.


Refugees at the condemned Manus Island detention centre. Authorities have destroyed shelters and makeshift water-collecting bins. Photograph: AFP/Getty Images

Nearly three weeks after the camp was formally closed, the medical situation in the condemned Manus Island detention centre has reached a new, even more dangerous stage. Even men who appear healthy are battling diarrhoea and vomiting brought on by drinking salty, contaminated water pulled from makeshift wells.

On Saturday Australian Medical Association members voted unanimously to call on the Australian government to grant access for doctors to be allowed into the detention centre to intervene in what the association describes as “a worsening and dangerous situation emerging on Manus”.

“It is our responsibility as a nation with a strong human rights record to ensure that we look after the health and wellbeing of these men, and provide them with safe and hygienic living conditions,” the AMA president, Michael Gannon, said.

Periodically, Papua New Guinean police and immigration officials – on Australian orders, the Guardian was told – enter and poison the wells, befouling them with dirt and rubbish and making the water undrinkable.

The men have some purification tablets and boil what they can, but their situation is unsustainable. “We have a new hard problem these days,” Iranian refugee Behrouz Boochani says. “The toilets are full and there’s a bad smell spreading in the prison camp. Hygiene conditions are worsening day by day. Hope we have some rain today to wash away the bad smell.

“The situation in Manus is critical. We are thirsty and have been waiting for rain in the past few days. We have some water we’re rationing but it’s not enough in tropical heat. Immigration destroyed the water we’d collected from tropical rain.”

A refugee pulls water from a makeshift well inside the Manus Island detention centre.


A refugee pulls water from a makeshift well inside the Manus Island detention centre. Photograph: Ben Doherty for the Guardian

David Yapu, the police commander on Manus, has said fear of a widespread outbreak of potentially fatal illness was very real. “The centre is unhygienic, it is subject to illness such as typhoid, cholera and dysentery,” he says.

Cholera, most often spread by unsafe water, is easily treatable with the correct medication, but without it, the infection can kill in hours.

There is a meagre and dwindling cache of medical supplies inside the camp – and a fraught supply chain bringing more in – but refugees fear what will happen when these run out. Several refugees have become the unofficial medical officers of the camp, dispensing what medications they have.

“Even when IHMS [International Health and Medical Services] were here,” one refugee says, “this all we got. Panadol and water. Whatever was wrong with you: panadol and water.”

Refugees in the detention centre boil water.


Refugees boil water in the detention centre

Many of the men, after four years in indefinite detention, have been on antidepressant medication or reliant on an ever-increasing regimen of sleeping pills. These are almost extinguished now.

The Australian immigration minister, Peter Dutton, said in a television interview last week the refugees still inside the Manus Island detention centre should leave it immediately, spruiking the alternative healthcare available.

“People are squatting illegally on this maritime base and we want them to move peacefully. There are buses available; people can move to a new $ 10m facility where they have accommodation, they’ve got kitchens, they have running water, all of the services that you could imagine, including health services, security, etc; but people are trying to make a political statement by staying at the regional processing centre.”

While there is greater access to healthcare for the refugees and asylum seekers who have moved to the alternative accommodation elsewhere in Lorengau province, this remains limited. The proposed accommodation centres are still being built, with limited running water and unreliable electricity. Refugees confirmed on Monday there is still no running water in the new West Lorengau centre. Seriously ill refugees are moved to Lorengau hospital, but that is in a state of disrepair and decay. The hospital is already far beyond its capacity, it has few working diagnostic machines, and regularly runs out of medicine itself.

The alternative accommodation is still being built, despite assurances from the Australian government that the camp is complete and habitable.


Alternative accommodation in Lorengau is still being built, despite assurances from the Australian government that the camp is habitable. Photograph: Refugee Action Coalition/EPA

When a refugee was transported to Lorengau hospital from the detention centre two weeks ago suffering from what was believed to be a heart attack, the hospital’s only ECG machine was broken.

Nurses were able only to take the man’s blood pressure before discharging him and sending him to alternative accommodation in Lorengau. The Guardian met the man in Lorengau; he has not had any follow-up treatment.

Those refugees and asylum seekers who are sicker still are sent to Pacific International hospital in Port Moresby for treatment, but even here, there is often little treatment offered.

There are more than 120 refugees and asylum seekers housed – at Australian expense – in hotels around Port Moresby. One hotel has been booked in its entirety for several months with refugees and asylum seekers from Manus. Australian Border Force officials are housed nearby.

In the capital, the Guardian met more than a dozen refugees and asylum seekers awaiting treatment.

Some have been in Moresby two months and have had a single appointment, with no follow-up scheduled. There are also several women who have been sent from Nauru with serious illnesses and injuries, but they have not yet been treated.

“Everybody here is sick, they say we are sent here for treatment but nothing happens, we just get worse,” one refugee from Myanmar tells the Guardian. “We just wait, for what, we don’t know. Who knows what our future will be.”

‘The situation is critical’: cholera fears on Manus as water and medicine run out | Ben Doherty

The piercing pain in Joinul Islam’s right arm keeps him from sleeping. He can’t bend it to eat properly (to eat with one’s left is considered unclean), and there are precious few painkillers to allow him to rest.

Four months ago, he was attacked by a gang in Lorengau, his elbow was sliced open with a machete and the surgery to repair it did not work. He was promised follow-up surgery, but it never happened. Now, he waits for more medical treatment that might never come.

In the meantime, he bears the pain – his right arm fused at an awkward angle – without assistance. He has been told by Papaua New Guinea authorities he can get more painkillers, but only in Lorengau, the place where he was attacked.

“I cannot go back there, I cannot go back. How can I go to Lorengau? I need a safe place,” he says.

Seated in a quiet corner of the darkened Manus Island detention centre, he speaks barely above a whisper. The pain, at one point, kept him awake for two weeks, he says. “I am so tired,” he tells the Guardian, as tears well in his eyes.

Islam has been formally recognised as a refugee, having fled persecution in his homeland Bangladesh. “My country, political is problem, is not safe. For safe place, I come to Australia.”

Islam says he feels under intense pressure to quit the Manus Island detention centre, even to abandon his claim for protection altogether, and risk returning to Bangladesh. “All the time is pressure. My life is very difficult. I have been running five years. Too long,” he says.

Islam’s case is barely remarkable inside the condemned the Manus Island detention centre – officially shuttered on 31 October, with all essential services withdrawn.


Hygiene conditions are worsening day by day. We are thirsty and have been waiting for rain

Behrouz Boochani

There are few uninjured or healthy people among the 400 who remain in the camp, surviving on rainwater and makeshift wells, smuggled food, and solar panels powering phones that give them a link to the outside world.

Inside the camp, the Guardian saw men who, while walking through the wreckage of the site, had stepped on nails that had pierced their feet. Their infected wounds wept pus as they walked. Others revealed open and infected sores on their legs – cognisant that Iranian asylum seeker Hamid Kehazaei died after a small infection that, even with medical intervention, spiralled rapidly out of control in the detention centre and ultimately killed him.

Refugees at condemned Manus Island detention centre where authorities have destroyed shelters and makeshift water-collecting bins.


Refugees at the condemned Manus Island detention centre. Authorities have destroyed shelters and makeshift water-collecting bins. Photograph: AFP/Getty Images

Nearly three weeks after the camp was formally closed, the medical situation in the condemned Manus Island detention centre has reached a new, even more dangerous stage. Even men who appear healthy are battling diarrhoea and vomiting brought on by drinking salty, contaminated water pulled from makeshift wells.

On Saturday Australian Medical Association members voted unanimously to call on the Australian government to grant access for doctors to be allowed into the detention centre to intervene in what the association describes as “a worsening and dangerous situation emerging on Manus”.

“It is our responsibility as a nation with a strong human rights record to ensure that we look after the health and wellbeing of these men, and provide them with safe and hygienic living conditions,” the AMA president, Michael Gannon, said.

Periodically, Papua New Guinean police and immigration officials – on Australian orders, the Guardian was told – enter and poison the wells, befouling them with dirt and rubbish and making the water undrinkable.

The men have some purification tablets and boil what they can, but their situation is unsustainable. “We have a new hard problem these days,” Iranian refugee Behrouz Boochani says. “The toilets are full and there’s a bad smell spreading in the prison camp. Hygiene conditions are worsening day by day. Hope we have some rain today to wash away the bad smell.

“The situation in Manus is critical. We are thirsty and have been waiting for rain in the past few days. We have some water we’re rationing but it’s not enough in tropical heat. Immigration destroyed the water we’d collected from tropical rain.”

A refugee pulls water from a makeshift well inside the Manus Island detention centre.


A refugee pulls water from a makeshift well inside the Manus Island detention centre. Photograph: Ben Doherty for the Guardian

David Yapu, the police commander on Manus, has said fear of a widespread outbreak of potentially fatal illness was very real. “The centre is unhygienic, it is subject to illness such as typhoid, cholera and dysentery,” he says.

Cholera, most often spread by unsafe water, is easily treatable with the correct medication, but without it, the infection can kill in hours.

There is a meagre and dwindling cache of medical supplies inside the camp – and a fraught supply chain bringing more in – but refugees fear what will happen when these run out. Several refugees have become the unofficial medical officers of the camp, dispensing what medications they have.

“Even when IHMS [International Health and Medical Services] were here,” one refugee says, “this all we got. Panadol and water. Whatever was wrong with you: panadol and water.”

Refugees in the detention centre boil water.


Refugees boil water in the detention centre

Many of the men, after four years in indefinite detention, have been on antidepressant medication or reliant on an ever-increasing regimen of sleeping pills. These are almost extinguished now.

The Australian immigration minister, Peter Dutton, said in a television interview last week the refugees still inside the Manus Island detention centre should leave it immediately, spruiking the alternative healthcare available.

“People are squatting illegally on this maritime base and we want them to move peacefully. There are buses available; people can move to a new $ 10m facility where they have accommodation, they’ve got kitchens, they have running water, all of the services that you could imagine, including health services, security, etc; but people are trying to make a political statement by staying at the regional processing centre.”

While there is greater access to healthcare for the refugees and asylum seekers who have moved to the alternative accommodation elsewhere in Lorengau province, this remains limited. The proposed accommodation centres are still being built, with limited running water and unreliable electricity. Refugees confirmed on Monday there is still no running water in the new West Lorengau centre. Seriously ill refugees are moved to Lorengau hospital, but that is in a state of disrepair and decay. The hospital is already far beyond its capacity, it has few working diagnostic machines, and regularly runs out of medicine itself.

The alternative accommodation is still being built, despite assurances from the Australian government that the camp is complete and habitable.


Alternative accommodation in Lorengau is still being built, despite assurances from the Australian government that the camp is habitable. Photograph: Refugee Action Coalition/EPA

When a refugee was transported to Lorengau hospital from the detention centre two weeks ago suffering from what was believed to be a heart attack, the hospital’s only ECG machine was broken.

Nurses were able only to take the man’s blood pressure before discharging him and sending him to alternative accommodation in Lorengau. The Guardian met the man in Lorengau; he has not had any follow-up treatment.

Those refugees and asylum seekers who are sicker still are sent to Pacific International hospital in Port Moresby for treatment, but even here, there is often little treatment offered.

There are more than 120 refugees and asylum seekers housed – at Australian expense – in hotels around Port Moresby. One hotel has been booked in its entirety for several months with refugees and asylum seekers from Manus. Australian Border Force officials are housed nearby.

In the capital, the Guardian met more than a dozen refugees and asylum seekers awaiting treatment.

Some have been in Moresby two months and have had a single appointment, with no follow-up scheduled. There are also several women who have been sent from Nauru with serious illnesses and injuries, but they have not yet been treated.

“Everybody here is sick, they say we are sent here for treatment but nothing happens, we just get worse,” one refugee from Myanmar tells the Guardian. “We just wait, for what, we don’t know. Who knows what our future will be.”

‘The situation is critical’: cholera fears on Manus as water and medicine run out | Ben Doherty

The piercing pain in Joinul Islam’s right arm keeps him from sleeping. He can’t bend it to eat properly (to eat with one’s left is considered unclean), and there are precious few painkillers to allow him to rest.

Four months ago, he was attacked by a gang in Lorengau, his elbow was sliced open with a machete and the surgery to repair it did not work. He was promised follow-up surgery, but it never happened. Now, he waits for more medical treatment that might never come.

In the meantime, he bears the pain – his right arm fused at an awkward angle – without assistance. He has been told by Papaua New Guinea authorities he can get more painkillers, but only in Lorengau, the place where he was attacked.

“I cannot go back there, I cannot go back. How can I go to Lorengau? I need a safe place,” he says.

Seated in a quiet corner of the darkened Manus Island detention centre, he speaks barely above a whisper. The pain, at one point, kept him awake for two weeks, he says. “I am so tired,” he tells the Guardian, as tears well in his eyes.

Islam has been formally recognised as a refugee, having fled persecution in his homeland Bangladesh. “My country, political is problem, is not safe. For safe place, I come to Australia.”

Islam says he feels under intense pressure to quit the Manus Island detention centre, even to abandon his claim for protection altogether, and risk returning to Bangladesh. “All the time is pressure. My life is very difficult. I have been running five years. Too long,” he says.

Islam’s case is barely remarkable inside the condemned the Manus Island detention centre – officially shuttered on 31 October, with all essential services withdrawn.


Hygiene conditions are worsening day by day. We are thirsty and have been waiting for rain

Behrouz Boochani

There are few uninjured or healthy people among the 400 who remain in the camp, surviving on rainwater and makeshift wells, smuggled food, and solar panels powering phones that give them a link to the outside world.

Inside the camp, the Guardian saw men who, while walking through the wreckage of the site, had stepped on nails that had pierced their feet. Their infected wounds wept pus as they walked. Others revealed open and infected sores on their legs – cognisant that Iranian asylum seeker Hamid Kehazaei died after a small infection that, even with medical intervention, spiralled rapidly out of control in the detention centre and ultimately killed him.

Refugees at condemned Manus Island detention centre where authorities have destroyed shelters and makeshift water-collecting bins.


Refugees at the condemned Manus Island detention centre. Authorities have destroyed shelters and makeshift water-collecting bins. Photograph: AFP/Getty Images

Nearly three weeks after the camp was formally closed, the medical situation in the condemned Manus Island detention centre has reached a new, even more dangerous stage. Even men who appear healthy are battling diarrhoea and vomiting brought on by drinking salty, contaminated water pulled from makeshift wells.

On Saturday Australian Medical Association members voted unanimously to call on the Australian government to grant access for doctors to be allowed into the detention centre to intervene in what the association describes as “a worsening and dangerous situation emerging on Manus”.

“It is our responsibility as a nation with a strong human rights record to ensure that we look after the health and wellbeing of these men, and provide them with safe and hygienic living conditions,” the AMA president, Michael Gannon, said.

Periodically, Papua New Guinean police and immigration officials – on Australian orders, the Guardian was told – enter and poison the wells, befouling them with dirt and rubbish and making the water undrinkable.

The men have some purification tablets and boil what they can, but their situation is unsustainable. “We have a new hard problem these days,” Iranian refugee Behrouz Boochani says. “The toilets are full and there’s a bad smell spreading in the prison camp. Hygiene conditions are worsening day by day. Hope we have some rain today to wash away the bad smell.

“The situation in Manus is critical. We are thirsty and have been waiting for rain in the past few days. We have some water we’re rationing but it’s not enough in tropical heat. Immigration destroyed the water we’d collected from tropical rain.”

A refugee pulls water from a makeshift well inside the Manus Island detention centre.


A refugee pulls water from a makeshift well inside the Manus Island detention centre. Photograph: Ben Doherty for the Guardian

David Yapu, the police commander on Manus, has said fear of a widespread outbreak of potentially fatal illness was very real. “The centre is unhygienic, it is subject to illness such as typhoid, cholera and dysentery,” he says.

Cholera, most often spread by unsafe water, is easily treatable with the correct medication, but without it, the infection can kill in hours.

There is a meagre and dwindling cache of medical supplies inside the camp – and a fraught supply chain bringing more in – but refugees fear what will happen when these run out. Several refugees have become the unofficial medical officers of the camp, dispensing what medications they have.

“Even when IHMS [International Health and Medical Services] were here,” one refugee says, “this all we got. Panadol and water. Whatever was wrong with you: panadol and water.”

Refugees in the detention centre boil water.


Refugees boil water in the detention centre

Many of the men, after four years in indefinite detention, have been on antidepressant medication or reliant on an ever-increasing regimen of sleeping pills. These are almost extinguished now.

The Australian immigration minister, Peter Dutton, said in a television interview last week the refugees still inside the Manus Island detention centre should leave it immediately, spruiking the alternative healthcare available.

“People are squatting illegally on this maritime base and we want them to move peacefully. There are buses available; people can move to a new $ 10m facility where they have accommodation, they’ve got kitchens, they have running water, all of the services that you could imagine, including health services, security, etc; but people are trying to make a political statement by staying at the regional processing centre.”

While there is greater access to healthcare for the refugees and asylum seekers who have moved to the alternative accommodation elsewhere in Lorengau province, this remains limited. The proposed accommodation centres are still being built, with limited running water and unreliable electricity. Refugees confirmed on Monday there is still no running water in the new West Lorengau centre. Seriously ill refugees are moved to Lorengau hospital, but that is in a state of disrepair and decay. The hospital is already far beyond its capacity, it has few working diagnostic machines, and regularly runs out of medicine itself.

The alternative accommodation is still being built, despite assurances from the Australian government that the camp is complete and habitable.


Alternative accommodation in Lorengau is still being built, despite assurances from the Australian government that the camp is habitable. Photograph: Refugee Action Coalition/EPA

When a refugee was transported to Lorengau hospital from the detention centre two weeks ago suffering from what was believed to be a heart attack, the hospital’s only ECG machine was broken.

Nurses were able only to take the man’s blood pressure before discharging him and sending him to alternative accommodation in Lorengau. The Guardian met the man in Lorengau; he has not had any follow-up treatment.

Those refugees and asylum seekers who are sicker still are sent to Pacific International hospital in Port Moresby for treatment, but even here, there is often little treatment offered.

There are more than 120 refugees and asylum seekers housed – at Australian expense – in hotels around Port Moresby. One hotel has been booked in its entirety for several months with refugees and asylum seekers from Manus. Australian Border Force officials are housed nearby.

In the capital, the Guardian met more than a dozen refugees and asylum seekers awaiting treatment.

Some have been in Moresby two months and have had a single appointment, with no follow-up scheduled. There are also several women who have been sent from Nauru with serious illnesses and injuries, but they have not yet been treated.

“Everybody here is sick, they say we are sent here for treatment but nothing happens, we just get worse,” one refugee from Myanmar tells the Guardian. “We just wait, for what, we don’t know. Who knows what our future will be.”

‘The situation is critical’: cholera fears on Manus as water and medicine run out | Ben Doherty

The piercing pain in Joinul Islam’s right arm keeps him from sleeping. He can’t bend it to eat properly (to eat with one’s left is considered unclean), and there are precious few painkillers to allow him to rest.

Four months ago, he was attacked by a gang in Lorengau, his elbow was sliced open with a machete and the surgery to repair it did not work. He was promised follow-up surgery, but it never happened. Now, he waits for more medical treatment that might never come.

In the meantime, he bears the pain – his right arm fused at an awkward angle – without assistance. He has been told by Papaua New Guinea authorities he can get more painkillers, but only in Lorengau, the place where he was attacked.

“I cannot go back there, I cannot go back. How can I go to Lorengau? I need a safe place,” he says.

Seated in a quiet corner of the darkened Manus Island detention centre, he speaks barely above a whisper. The pain, at one point, kept him awake for two weeks, he says. “I am so tired,” he tells the Guardian, as tears well in his eyes.

Islam has been formally recognised as a refugee, having fled persecution in his homeland Bangladesh. “My country, political is problem, is not safe. For safe place, I come to Australia.”

Islam says he feels under intense pressure to quit the Manus Island detention centre, even to abandon his claim for protection altogether, and risk returning to Bangladesh. “All the time is pressure. My life is very difficult. I have been running five years. Too long,” he says.

Islam’s case is barely remarkable inside the condemned the Manus Island detention centre – officially shuttered on 31 October, with all essential services withdrawn.


Hygiene conditions are worsening day by day. We are thirsty and have been waiting for rain

Behrouz Boochani

There are few uninjured or healthy people among the 400 who remain in the camp, surviving on rainwater and makeshift wells, smuggled food, and solar panels powering phones that give them a link to the outside world.

Inside the camp, the Guardian saw men who, while walking through the wreckage of the site, had stepped on nails that had pierced their feet. Their infected wounds wept pus as they walked. Others revealed open and infected sores on their legs – cognisant that Iranian asylum seeker Hamid Kehazaei died after a small infection that, even with medical intervention, spiralled rapidly out of control in the detention centre and ultimately killed him.

Refugees at condemned Manus Island detention centre where authorities have destroyed shelters and makeshift water-collecting bins.


Refugees at the condemned Manus Island detention centre. Authorities have destroyed shelters and makeshift water-collecting bins. Photograph: AFP/Getty Images

Nearly three weeks after the camp was formally closed, the medical situation in the condemned Manus Island detention centre has reached a new, even more dangerous stage. Even men who appear healthy are battling diarrhoea and vomiting brought on by drinking salty, contaminated water pulled from makeshift wells.

On Saturday Australian Medical Association members voted unanimously to call on the Australian government to grant access for doctors to be allowed into the detention centre to intervene in what the association describes as “a worsening and dangerous situation emerging on Manus”.

“It is our responsibility as a nation with a strong human rights record to ensure that we look after the health and wellbeing of these men, and provide them with safe and hygienic living conditions,” the AMA president, Michael Gannon, said.

Periodically, Papua New Guinean police and immigration officials – on Australian orders, the Guardian was told – enter and poison the wells, befouling them with dirt and rubbish and making the water undrinkable.

The men have some purification tablets and boil what they can, but their situation is unsustainable. “We have a new hard problem these days,” Iranian refugee Behrouz Boochani says. “The toilets are full and there’s a bad smell spreading in the prison camp. Hygiene conditions are worsening day by day. Hope we have some rain today to wash away the bad smell.

“The situation in Manus is critical. We are thirsty and have been waiting for rain in the past few days. We have some water we’re rationing but it’s not enough in tropical heat. Immigration destroyed the water we’d collected from tropical rain.”

A refugee pulls water from a makeshift well inside the Manus Island detention centre.


A refugee pulls water from a makeshift well inside the Manus Island detention centre. Photograph: Ben Doherty for the Guardian

David Yapu, the police commander on Manus, has said fear of a widespread outbreak of potentially fatal illness was very real. “The centre is unhygienic, it is subject to illness such as typhoid, cholera and dysentery,” he says.

Cholera, most often spread by unsafe water, is easily treatable with the correct medication, but without it, the infection can kill in hours.

There is a meagre and dwindling cache of medical supplies inside the camp – and a fraught supply chain bringing more in – but refugees fear what will happen when these run out. Several refugees have become the unofficial medical officers of the camp, dispensing what medications they have.

“Even when IHMS [International Health and Medical Services] were here,” one refugee says, “this all we got. Panadol and water. Whatever was wrong with you: panadol and water.”

Refugees in the detention centre boil water.


Refugees boil water in the detention centre

Many of the men, after four years in indefinite detention, have been on antidepressant medication or reliant on an ever-increasing regimen of sleeping pills. These are almost extinguished now.

The Australian immigration minister, Peter Dutton, said in a television interview last week the refugees still inside the Manus Island detention centre should leave it immediately, spruiking the alternative healthcare available.

“People are squatting illegally on this maritime base and we want them to move peacefully. There are buses available; people can move to a new $ 10m facility where they have accommodation, they’ve got kitchens, they have running water, all of the services that you could imagine, including health services, security, etc; but people are trying to make a political statement by staying at the regional processing centre.”

While there is greater access to healthcare for the refugees and asylum seekers who have moved to the alternative accommodation elsewhere in Lorengau province, this remains limited. The proposed accommodation centres are still being built, with limited running water and unreliable electricity. Refugees confirmed on Monday there is still no running water in the new West Lorengau centre. Seriously ill refugees are moved to Lorengau hospital, but that is in a state of disrepair and decay. The hospital is already far beyond its capacity, it has few working diagnostic machines, and regularly runs out of medicine itself.

The alternative accommodation is still being built, despite assurances from the Australian government that the camp is complete and habitable.


Alternative accommodation in Lorengau is still being built, despite assurances from the Australian government that the camp is habitable. Photograph: Refugee Action Coalition/EPA

When a refugee was transported to Lorengau hospital from the detention centre two weeks ago suffering from what was believed to be a heart attack, the hospital’s only ECG machine was broken.

Nurses were able only to take the man’s blood pressure before discharging him and sending him to alternative accommodation in Lorengau. The Guardian met the man in Lorengau; he has not had any follow-up treatment.

Those refugees and asylum seekers who are sicker still are sent to Pacific International hospital in Port Moresby for treatment, but even here, there is often little treatment offered.

There are more than 120 refugees and asylum seekers housed – at Australian expense – in hotels around Port Moresby. One hotel has been booked in its entirety for several months with refugees and asylum seekers from Manus. Australian Border Force officials are housed nearby.

In the capital, the Guardian met more than a dozen refugees and asylum seekers awaiting treatment.

Some have been in Moresby two months and have had a single appointment, with no follow-up scheduled. There are also several women who have been sent from Nauru with serious illnesses and injuries, but they have not yet been treated.

“Everybody here is sick, they say we are sent here for treatment but nothing happens, we just get worse,” one refugee from Myanmar tells the Guardian. “We just wait, for what, we don’t know. Who knows what our future will be.”

‘The situation is critical’: cholera fears on Manus as water and medicine run out | Ben Doherty

The piercing pain in Joinul Islam’s right arm keeps him from sleeping. He can’t bend it to eat properly (to eat with one’s left is considered unclean), and there are precious few painkillers to allow him to rest.

Four months ago, he was attacked by a gang in Lorengau, his elbow was sliced open with a machete and the surgery to repair it did not work. He was promised follow-up surgery, but it never happened. Now, he waits for more medical treatment that might never come.

In the meantime, he bears the pain – his right arm fused at an awkward angle – without assistance. He has been told by Papaua New Guinea authorities he can get more painkillers, but only in Lorengau, the place where he was attacked.

“I cannot go back there, I cannot go back. How can I go to Lorengau? I need a safe place,” he says.

Seated in a quiet corner of the darkened Manus Island detention centre, he speaks barely above a whisper. The pain, at one point, kept him awake for two weeks, he says. “I am so tired,” he tells the Guardian, as tears well in his eyes.

Islam has been formally recognised as a refugee, having fled persecution in his homeland Bangladesh. “My country, political is problem, is not safe. For safe place, I come to Australia.”

Islam says he feels under intense pressure to quit the Manus Island detention centre, even to abandon his claim for protection altogether, and risk returning to Bangladesh. “All the time is pressure. My life is very difficult. I have been running five years. Too long,” he says.

Islam’s case is barely remarkable inside the condemned the Manus Island detention centre – officially shuttered on 31 October, with all essential services withdrawn.


Hygiene conditions are worsening day by day. We are thirsty and have been waiting for rain

Behrouz Boochani

There are few uninjured or healthy people among the 400 who remain in the camp, surviving on rainwater and makeshift wells, smuggled food, and solar panels powering phones that give them a link to the outside world.

Inside the camp, the Guardian saw men who, while walking through the wreckage of the site, had stepped on nails that had pierced their feet. Their infected wounds wept pus as they walked. Others revealed open and infected sores on their legs – cognisant that Iranian asylum seeker Hamid Kehazaei died after a small infection that, even with medical intervention, spiralled rapidly out of control in the detention centre and ultimately killed him.

Refugees at condemned Manus Island detention centre where authorities have destroyed shelters and makeshift water-collecting bins.


Refugees at the condemned Manus Island detention centre. Authorities have destroyed shelters and makeshift water-collecting bins. Photograph: AFP/Getty Images

Nearly three weeks after the camp was formally closed, the medical situation in the condemned Manus Island detention centre has reached a new, even more dangerous stage. Even men who appear healthy are battling diarrhoea and vomiting brought on by drinking salty, contaminated water pulled from makeshift wells.

On Saturday Australian Medical Association members voted unanimously to call on the Australian government to grant access for doctors to be allowed into the detention centre to intervene in what the association describes as “a worsening and dangerous situation emerging on Manus”.

“It is our responsibility as a nation with a strong human rights record to ensure that we look after the health and wellbeing of these men, and provide them with safe and hygienic living conditions,” the AMA president, Michael Gannon, said.

Periodically, Papua New Guinean police and immigration officials – on Australian orders, the Guardian was told – enter and poison the wells, befouling them with dirt and rubbish and making the water undrinkable.

The men have some purification tablets and boil what they can, but their situation is unsustainable. “We have a new hard problem these days,” Iranian refugee Behrouz Boochani says. “The toilets are full and there’s a bad smell spreading in the prison camp. Hygiene conditions are worsening day by day. Hope we have some rain today to wash away the bad smell.

“The situation in Manus is critical. We are thirsty and have been waiting for rain in the past few days. We have some water we’re rationing but it’s not enough in tropical heat. Immigration destroyed the water we’d collected from tropical rain.”

A refugee pulls water from a makeshift well inside the Manus Island detention centre.


A refugee pulls water from a makeshift well inside the Manus Island detention centre. Photograph: Ben Doherty for the Guardian

David Yapu, the police commander on Manus, has said fear of a widespread outbreak of potentially fatal illness was very real. “The centre is unhygienic, it is subject to illness such as typhoid, cholera and dysentery,” he says.

Cholera, most often spread by unsafe water, is easily treatable with the correct medication, but without it, the infection can kill in hours.

There is a meagre and dwindling cache of medical supplies inside the camp – and a fraught supply chain bringing more in – but refugees fear what will happen when these run out. Several refugees have become the unofficial medical officers of the camp, dispensing what medications they have.

“Even when IHMS [International Health and Medical Services] were here,” one refugee says, “this all we got. Panadol and water. Whatever was wrong with you: panadol and water.”

Refugees in the detention centre boil water.


Refugees boil water in the detention centre

Many of the men, after four years in indefinite detention, have been on antidepressant medication or reliant on an ever-increasing regimen of sleeping pills. These are almost extinguished now.

The Australian immigration minister, Peter Dutton, said in a television interview last week the refugees still inside the Manus Island detention centre should leave it immediately, spruiking the alternative healthcare available.

“People are squatting illegally on this maritime base and we want them to move peacefully. There are buses available; people can move to a new $ 10m facility where they have accommodation, they’ve got kitchens, they have running water, all of the services that you could imagine, including health services, security, etc; but people are trying to make a political statement by staying at the regional processing centre.”

While there is greater access to healthcare for the refugees and asylum seekers who have moved to the alternative accommodation elsewhere in Lorengau province, this remains limited. The proposed accommodation centres are still being built, with limited running water and unreliable electricity. Refugees confirmed on Monday there is still no running water in the new West Lorengau centre. Seriously ill refugees are moved to Lorengau hospital, but that is in a state of disrepair and decay. The hospital is already far beyond its capacity, it has few working diagnostic machines, and regularly runs out of medicine itself.

The alternative accommodation is still being built, despite assurances from the Australian government that the camp is complete and habitable.


Alternative accommodation in Lorengau is still being built, despite assurances from the Australian government that the camp is habitable. Photograph: Refugee Action Coalition/EPA

When a refugee was transported to Lorengau hospital from the detention centre two weeks ago suffering from what was believed to be a heart attack, the hospital’s only ECG machine was broken.

Nurses were able only to take the man’s blood pressure before discharging him and sending him to alternative accommodation in Lorengau. The Guardian met the man in Lorengau; he has not had any follow-up treatment.

Those refugees and asylum seekers who are sicker still are sent to Pacific International hospital in Port Moresby for treatment, but even here, there is often little treatment offered.

There are more than 120 refugees and asylum seekers housed – at Australian expense – in hotels around Port Moresby. One hotel has been booked in its entirety for several months with refugees and asylum seekers from Manus. Australian Border Force officials are housed nearby.

In the capital, the Guardian met more than a dozen refugees and asylum seekers awaiting treatment.

Some have been in Moresby two months and have had a single appointment, with no follow-up scheduled. There are also several women who have been sent from Nauru with serious illnesses and injuries, but they have not yet been treated.

“Everybody here is sick, they say we are sent here for treatment but nothing happens, we just get worse,” one refugee from Myanmar tells the Guardian. “We just wait, for what, we don’t know. Who knows what our future will be.”

‘The situation is critical’: cholera fears on Manus as water and medicine run out | Ben Doherty

The piercing pain in Joinul Islam’s right arm keeps him from sleeping. He can’t bend it to eat properly (to eat with one’s left is considered unclean), and there are precious few painkillers to allow him to rest.

Four months ago, he was attacked by a gang in Lorengau, his elbow was sliced open with a machete and the surgery to repair it did not work. He was promised follow-up surgery, but it never happened. Now, he waits for more medical treatment that might never come.

In the meantime, he bears the pain – his right arm fused at an awkward angle – without assistance. He has been told by Papaua New Guinea authorities he can get more painkillers, but only in Lorengau, the place where he was attacked.

“I cannot go back there, I cannot go back. How can I go to Lorengau? I need a safe place,” he says.

Seated in a quiet corner of the darkened Manus Island detention centre, he speaks barely above a whisper. The pain, at one point, kept him awake for two weeks, he says. “I am so tired,” he tells the Guardian, as tears well in his eyes.

Islam has been formally recognised as a refugee, having fled persecution in his homeland Bangladesh. “My country, political is problem, is not safe. For safe place, I come to Australia.”

Islam says he feels under intense pressure to quit the Manus Island detention centre, even to abandon his claim for protection altogether, and risk returning to Bangladesh. “All the time is pressure. My life is very difficult. I have been running five years. Too long,” he says.

Islam’s case is barely remarkable inside the condemned the Manus Island detention centre – officially shuttered on 31 October, with all essential services withdrawn.


Hygiene conditions are worsening day by day. We are thirsty and have been waiting for rain

Behrouz Boochani

There are few uninjured or healthy people among the 400 who remain in the camp, surviving on rainwater and makeshift wells, smuggled food, and solar panels powering phones that give them a link to the outside world.

Inside the camp, the Guardian saw men who, while walking through the wreckage of the site, had stepped on nails that had pierced their feet. Their infected wounds wept pus as they walked. Others revealed open and infected sores on their legs – cognisant that Iranian asylum seeker Hamid Kehazaei died after a small infection that, even with medical intervention, spiralled rapidly out of control in the detention centre and ultimately killed him.

Refugees at condemned Manus Island detention centre where authorities have destroyed shelters and makeshift water-collecting bins.


Refugees at the condemned Manus Island detention centre. Authorities have destroyed shelters and makeshift water-collecting bins. Photograph: AFP/Getty Images

Nearly three weeks after the camp was formally closed, the medical situation in the condemned Manus Island detention centre has reached a new, even more dangerous stage. Even men who appear healthy are battling diarrhoea and vomiting brought on by drinking salty, contaminated water pulled from makeshift wells.

On Saturday Australian Medical Association members voted unanimously to call on the Australian government to grant access for doctors to be allowed into the detention centre to intervene in what the association describes as “a worsening and dangerous situation emerging on Manus”.

“It is our responsibility as a nation with a strong human rights record to ensure that we look after the health and wellbeing of these men, and provide them with safe and hygienic living conditions,” the AMA president, Michael Gannon, said.

Periodically, Papua New Guinean police and immigration officials – on Australian orders, the Guardian was told – enter and poison the wells, befouling them with dirt and rubbish and making the water undrinkable.

The men have some purification tablets and boil what they can, but their situation is unsustainable. “We have a new hard problem these days,” Iranian refugee Behrouz Boochani says. “The toilets are full and there’s a bad smell spreading in the prison camp. Hygiene conditions are worsening day by day. Hope we have some rain today to wash away the bad smell.

“The situation in Manus is critical. We are thirsty and have been waiting for rain in the past few days. We have some water we’re rationing but it’s not enough in tropical heat. Immigration destroyed the water we’d collected from tropical rain.”

A refugee pulls water from a makeshift well inside the Manus Island detention centre.


A refugee pulls water from a makeshift well inside the Manus Island detention centre. Photograph: Ben Doherty for the Guardian

David Yapu, the police commander on Manus, has said fear of a widespread outbreak of potentially fatal illness was very real. “The centre is unhygienic, it is subject to illness such as typhoid, cholera and dysentery,” he says.

Cholera, most often spread by unsafe water, is easily treatable with the correct medication, but without it, the infection can kill in hours.

There is a meagre and dwindling cache of medical supplies inside the camp – and a fraught supply chain bringing more in – but refugees fear what will happen when these run out. Several refugees have become the unofficial medical officers of the camp, dispensing what medications they have.

“Even when IHMS [International Health and Medical Services] were here,” one refugee says, “this all we got. Panadol and water. Whatever was wrong with you: panadol and water.”

Many of the men, after four years in indefinite detention, have been on antidepressant medication or reliant on an ever-increasing regimen of sleeping pills. These are almost extinguished now.

The Australian immigration minister, Peter Dutton, said in a television interview last week the refugees still inside the Manus Island detention centre should leave it immediately, spruiking the alternative healthcare available.

“People are squatting illegally on this maritime base and we want them to move peacefully. There are buses available; people can move to a new $ 10m facility where they have accommodation, they’ve got kitchens, they have running water, all of the services that you could imagine, including health services, security, etc; but people are trying to make a political statement by staying at the regional processing centre.”

While there is greater access to healthcare for the refugees and asylum seekers who have moved to the alternative accommodation elsewhere in Lorengau province, this remains limited. The proposed accommodation centres are still being built, with limited running water and unreliable electricity. Refugees confirmed on Monday there is still no running water in the new West Lorengau centre. Seriously ill refugees are moved to Lorengau hospital, but that is in a state of disrepair and decay. The hospital is already far beyond its capacity, it has few working diagnostic machines, and regularly runs out of medicine itself.

The alternative accommodation is still being built, despite assurances from the Australian government that the camp is complete and habitable.


Alternative accommodation in Lorengau is still being built, despite assurances from the Australian government that the camp is habitable. Photograph: Refugee Action Coalition/EPA

When a refugee was transported to Lorengau hospital from the detention centre two weeks ago suffering from what was believed to be a heart attack, the hospital’s only ECG machine was broken.

Nurses were able only to take the man’s blood pressure before discharging him and sending him to alternative accommodation in Lorengau. The Guardian met the man in Lorengau; he has not had any follow-up treatment.

Those refugees and asylum seekers who are sicker still are sent to Pacific International hospital in Port Moresby for treatment, but even here, there is often little treatment offered.

There are more than 120 refugees and asylum seekers housed – at Australian expense – in hotels around Port Moresby. One hotel has been booked in its entirety for several months with refugees and asylum seekers from Manus. Australian Border Force officials are housed nearby.

In the capital, the Guardian met more than a dozen refugees and asylum seekers awaiting treatment.

Some have been in Moresby two months and have had a single appointment, with no follow-up scheduled. There are also several women who have been sent from Nauru with serious illnesses and injuries, but they have not yet been treated.

“Everybody here is sick, they say we are sent here for treatment but nothing happens, we just get worse,” one refugee from Myanmar tells the Guardian. “We just wait, for what, we don’t know. Who knows what our future will be.”

Yemen’s cholera outbreak now the worst in history as millionth case looms

The cholera epidemic in Yemen has become the largest and fastest-spreading outbreak of the disease in modern history, with a million cases expected by the end of the year and at least 600,000 children likely to be affected.

The World Health Organization has reported more than 815,000 suspected cases of the disease in Yemen and 2,156 deaths. About 4,000 suspected cases are being reported daily, more than half of which are among children under five, who account for a quarter of all cases.

The spread of the outbreak, which has quickly surpassed Haiti as the biggest since modern records began in 1949, has been exacerbated by hunger and malnutrition. While there were 815,000 cases of cholera in Haiti between 2010 and 2017, Yemen has exceeded that number in just six months.

Save the Children has warned that, at the current rate of infection, the number of cases will reach seven figures before the turn of the year, 60% of which will be among children. In July, the International Committee of the Red Cross predicted there would be 600,000 suspected cholera cases in the country by the end of the year.

Tamer Kirolos, Save the Children’s country director for Yemen, said an outbreak of this scale and speed is “what you get when a country is brought to its knees by conflict, when a healthcare system is on the brink of collapse, when its children are starving, and when its people are blocked from getting the medical treatment they need”.

Kirolos said: “There’s no doubt this is a man-made crisis. Cholera only rears its head when there’s a complete and total breakdown in sanitation. All parties to the conflict must take responsibility for the health emergency we find ourselves in.”

More than two years of fighting between the Saudi-led coalition and Houthi rebels has crippled the country, causing widespread internal displacement, the collapse of the public health system, and leaving millions on the brink of famine.


When I see a mother lose her baby because of cholera, it makes me so angry

Dr Mariam Aldogani, Save the Children

The crisis was exacerbated when sanitation workers whose salaries had gone unpaid went on strike. This meant garbage was left on the streets, which was then washed into the water supply. It is estimated that 19.3 million Yemenis – more than two-thirds of the population – do not have access to clean water and sanitation.

The government stopped funding the public health department in 2016, meaning many doctors and hospital staff have not received salaries for more than a year. Healthcare has since been provided mainly by international organisations, the efforts of whom have been hampered by the conflict.

The spread of the disease has nonetheless slowed. At the beginning of the most recent outbreak, in May this year, between 5,000 and 6,000 new cases were detected daily. That rate has since dropped to just under 4,000 a day. The mortality rate has also declined, from 1% at the beginning of the outbreak to 0.26% now.

“Whatever decline we’re seeing now is due to the heroic efforts of workers at the scene,” said Sherin Varkey, the officiating representative of Unicef Yemen.

Varkey said the situation would not be solved until there was peace in the country.

“There are no signals that give us any reason for optimism. We know that both parties to the conflict are continuing with their blatant disregard of the rights of children,” he said. “We’re at a cliff and we’re staring down and it is bottomless. There seems to be no hope.”

A worker is pictured in a government hospital’s drug store in Sana’a, Yemen


A worker is seen at a government hospital’s drug store in Sana’a, Yemen. Photograph: Khaled Abdullah/Reuters

Cholera should be easily treatable with oral rehydration salts and access to clean water. But Mariam Aldogani, Save the Children’s health adviser for the city of Hodeidah, said conditions in the country had made this very difficult.

Aldogani said: “All the NGOs are trying to increase the knowledge of how to prevent the disease, because it’s preventable, you have to boil the water. But if you don’t have money to buy gas, and you have to walk a long way to get the wood, how can you boil the water?”

Aldogani, who has been a doctor since 2010, said witnessing the suffering of her patients was deeply painful. “I saw one young man, he had cholera and severe dehydration. He was in a coma and he died in front of his mother. We tried our best, but he came too late and she was crying, and I cried. It makes me angry. When I see a mother lose her baby, especially a stillbirth, she waits for this baby for a long time and then she loses it because of cholera, it makes me so angry.

“The war is a big problem for us, it’s a wound. But with the cholera, you have the wound and you put salt in the wound. It hurts. I hope this war can be stopped. We need peace for the children of Yemen. Our situation before the war was not good, but it was not like this.”

Blame the Saudis for Yemen’s cholera outbreak – they are targeting the people | Jonathan Kennedy

Over the past four months, Yemen has been ravaged by a cholera outbreak that the UN has branded the worst in the world. About 7,000 new cases are reported daily – 436,625 have been recorded since the end of April – and already there have been more than 1,915 deaths.

The epidemic is one aspect of a broader humanitarian emergency in Yemen. Two-thirds of the population – 18.8 million people – require some form of emergency aid. Food production has collapsed and 4.5 million children and pregnant and lactating women are acutely malnourished. Only 45% of health facilities are functioning, and 14.8 million people lack access to basic healthcare. About the same number require assistance to access safe drinking water and sanitation.

Cholera, a bacterial infection, is spread by water containing contaminated faeces. It can be easily prevented and easily treated. Cholera first spread from the Ganges delta in 1817, and the resulting pandemics killed tens of millions of people across the world over the 150 years. Modern improvements in water and sanitation infrastructure, and better access to medicines and healthcare, have brought a marked fall in the number of cases. Today, outbreaks occur chiefly in areas where water, sanitation and health systems are inadequate, or where they have been destroyed by natural or manmade disasters.

UN agencies, respected media outlets – including the BBC and New York Times – and influential medical journals such as the Lancet all argue that two years of conflict have created conditions conducive to a cholera outbreak. This narrative, while true, tells only part of the story. It fails to account for the possibility that one party might be more culpable for the outbreak and the other more affected by it.

The Yemeni civil war began in September 2014 when Houthi rebels, a group of Zaydi Shia from northern Yemen, took control of the capital, Sana’a, and then, with help from forces loyal to Ali Abdullah Saleh, the former president, overthrew the government the following January. The internationally recognised regime led by President Abed Mansour Hadi set up a parallel government in the southern port of Aden.

Since March 2015, Saudi Arabia has led a coalition of Sunni Arab states that has attempted to restore the government using airstrikes, an air and naval blockade, and ground troops. The US and UK provide the coalition with logistical support and military equipment. The Saudis have accused Iran of assisting the rebels, but there is limited evidence for this claim and it is denied by the Houthis and Iran.

At least 10,000 people have been killed and 40,000 injured in the conflict. Both sides stand accused of disregarding the wellbeing of civilians and breaching international law. The rebels have indiscriminately fired artillery into residential areas in government-controlled areas and Saudi Arabia. But as the Saudi-led coalition commands far greater resources, it has been able to cause destruction of a totally different magnitude.

The Saudi air force has carried out indiscriminate attacks that have caused the majority of civilian deaths and injuries during the conflict. Airstrikes have targeted civilian infrastructure, including hospitals, farms, schools, water infrastructure, markets and the main port of Hodeida. They complement a Saudi-led naval and air blockade of rebel-controlled areas that has caused shortages of many essential items, including food, fuel and medical supplies.

It was not until four weeks after the start of the outbreak that the first plane carrying medical aid was allowed to land in Sana’a. The government no longer pays public employees working in rebel-controlled areas. About 30,000 health workers have not received a salary for almost a year. Sanitation workers and water engineers in Sana’a have been on strike for months, leaving uncollected rubbish on the streets and municipal drains clogged.

So it is not surprising that rebel-controlled areas are disproportionately affected by the cholera outbreak. About 80% of cases – and deaths – have occurred in governorates controlled by the Houthis. In rebel-controlled areas the attack rate – the number of cases among every 1,000 people – is 17, compared with 10 in government-controlled governorates. The percentage of people with cholera who die is 0.46% in rebel-controlled areas, compared with 0.3% in government-controlled governorates. Thus, a person living in areas under rebel control is 70% more likely to contract cholera and, if they do, 50% more likely to die.

These numbers indicate that the outbreak is not simply an inevitable consequence of civil war. It is rather a direct outcome of the Saudi-led coalition’s strategy of targeting civilians and infrastructure in rebel-controlled areas. Criticism of the US and UK governments’ support for the Saudi-led intervention, this has not led to a policy change. In December 2016, the Obama administration banned the sale of precision-guided bombs to Saudi Arabia due to concerns about civilian casualties in Yemen, but in May 2017 the Trump administration agreed to sell $ 500m such weapons as part of a $ 110bn deal. The following month a bipartisan effort to stop the sale failed by a few votes in the Senate. Last month in the UK, the high court rejected activists’ claims that ministers were acting illegally by continuing to sell fighter jets and precision-guided bombs to Saudi Arabia when they might be used against civilians in Yemen. In the absence of strong international condemnation of Saudi-led operations, it is hard to foresee a quick end to this public health emergency and the broader humanitarian crisis.

  • Jonathan Kennedy is a lecturer in global health at Queen Mary University of London

Yemen: more than one million children at risk of cholera – charity

More than one million malnourished children aged under five in Yemen are living in areas with high levels of cholera, the charity Save The Children warned on Wednesday as it began sending more health experts to the worst hit areas.

The scaling up in response came after latest figures show that a deadly cholera epidemic that started in April 2015 has infected more than 425,000 people and killed almost 1,900.

Save the Children said children under the age of 15 are now accounting for about 44 percent of new cases and 32 percent of fatalities in Yemen where a devastating civil war and economic collapse has left millions on the brink of starvation.

“The tragedy is both malnutrition and cholera are easily treatable if you have access to basic healthcare,” said Tamer Kirolos, Save the Children’s Country Director for Yemen.

“But hospitals and clinics have been destroyed, government health workers haven’t been paid for almost a year, and the delivery of vital aid is being obstructed.“

Cholera, which is spread by ingestion of food or water contaminated by the Vibrio cholerae bacterium, can kill within hours if untreated.

The cholera outbreak prompted the United Nations last week to revise its humanitarian assessment and it now calculates 20.7 million Yemenis are in need of assistance, up from the previous figure of 18.8 million in a population of 28 million.

Oxfam has projected the number of people infected with cholera could rise to more than 600,000 – “the largest ever recorded in any country in a single year since records began” – exceeding Haiti in 2011.

Save the Children said it currently operates 14 cholera treatment centres and more than 90 rehydration units across Yemen but was scaling up its response and sending more health experts to the worst hit areas.

The charity said new analysis of district level data revealed more than one million malnourished children aged under five – including 200,000 with severe acute malnutrition – were living in cholera hot-spots.

Millions are malnourished in Yemen where famine looms, the United Nations says. A Saudi Arabia-led coalition intervened in Yemen’s civil war in 2015, backing government forces fighting Iran-allied Houthi rebels and fighting limits access for aid workers. 

‘Cholera is everywhere’: Yemen epidemic spiralling out of control

Ali Muhammad’s entire family are sick. In the months since his home district of Abs in northern Yemen was hit by a cholera outbreak, he has lost both parents and all six of his children have fallen ill.

“Cholera is everywhere,” he said, according to a testimony provided by Médecins Sans Frontières, who are caring for his eldest daughter at a cholera treatment centre in Abs. “The water is contaminated and I don’t drink it. We have tanks, but we don’t get water regularly. The situation cannot be worse.”

As the area grapples with both the cholera epidemic, which began to spread in April, and the impact of the country’s civil war, the life of the qat harvester has become harder and harder. “Everybody is sick and in rough shape, and their poor financial condition does not enable them to move from one health centre to another.

“My father got sick and although we hospitalised him, he passed away. My mother died as well. And I am just like many others.”

The Abs district was the scene of a deadly airstrike by the Saudi-led coalition last August that demolished a hospital supported by MSF, killing 19 people, including one of the aid agency’s staff members, and injuring 24.

Less than a year later, as the ongoing conflict hits an stalemate, creating the largest humanitarian crisis in the world, the MSF cholera treatment centre in Abs town alone is receiving more than 460 patients daily, which is more than anywhere else in the country.

A girl drinks water from a well that is allegedly contaminated with cholera.


A girl drinks water from a well that is allegedly contaminated with cholera. Photograph: Hani Mohammed/AP

The International Committee of the Red Cross warned on Monday that the cholera epidemic in Yemen was spiralling out of control, reaching a milestone of over 300,000 suspected cases. More than 1,600 people have died. Children account for nearly half of all suspected cholera cases in the country, according to the UN’s children agency.

Sana’a-based Taha Yaseen, from the Mwatana Organisation for Human Rights, said obstacles that stand in the way of controlling and containing cholera today in Yemen, include but are not limited to the ongoing war.

“During [the war] almost all health facilities and healthcare services reached a point of thorough collapse and thus are unable to respond to the increasing need to address fatal diseases and civilian victims. Many hospitals [have] shut down and many others were hit either by air or ground strikes, occupied by militias or used as military barracks,” he told the Guardian.

“Most [people] cannot afford even the transportation from their countryside areas or displacements communities to the nearest medical centres to treat them for cholera,” he added.

MSF’s Roger Gutiérrez, who has just returned from a seven-month service in Abs, said the wards in the hospital there, the only public hospital in the area, “are bursting at the seams … what’s happening in Abs sums up the current state of Yemen.”

The district hosts more internally displaced people than anywhere else in the country but most health facilities are not functioning; there is a lack of staff and medical supplies are running short.

“When a plane flies overhead, many patients and staff feel that fear, that vulnerability. For seconds everything stops,” he said, according to a testimony provided by MSF. “You see mothers disconnecting their children’s feeding tubes so they can run out of the hospital’s nutrition ward.”

Ayed Ali, a Yemeni caretaker based in al-Sharq district of Hajjah governorate, said most people in the area drink from exposed wells and tanks, “no matter the water is clean or not”. “There are no salaries and no services,” he said, according to MSF. “Even public hospitals are down. There are no drugs. If you have money, you get treatment. Otherwise, you’ll die.”

The conflict in Yemen is between Houthi rebels controlling the capital Sana’a, who are allied with former president Ali Abdullah Saleh, who led the country from 1990 to 2012, and forces loyal to the ousted president, Abd-Rabbu Mansour Hadi. Since March 2015, Saudi Arabia has led a US-backed military intervention in Yemen, aimed at reinstating Hadi, who lives in exile in the Saudi capital, Riyadh, and countering advances of Iran-backed Houthis.

Yemen expert Adam Baron, speaking to the Guardian, said “the key thing to remember is that while combat deaths continue to get more attention, it is the indirect results of the conflict – things like the cholera outbreak, the hunger crisis and the rise of deaths from preventable disease – that remain the largest killers.”

While Houthis have taken some significant losses this year, Baron said the conflict has largely seen a continued stalemate on most key fronts. “By and large, the war in Yemen continues to flare,” he said. “Airstrikes and shelling continue as civilians continue to get caught in the crossfire. But even as the conflict proves to be the catalyst for the collapse of Yemen’s already weakened healthcare system, the country continues to get little attention. The worry is that this won’t change until it’s far too late.”

According to the World Health Organization, suspected cholera cases have been reported in 95.6% of Yemen governorates. Apart from Hajjah, the other three affected areas are Amanat al-Asimah, al-Hudaydah and Amran. Only 45% of health facilities in Yemen remain with limited functionality, the UN has said.