More than one million suspected cases of cholera in two waves were reported in Yemen, which had been declared a high-level emergency by the United Nations in 2015.

Humanitarian organizations implemented a robust response to cholera despite numerous challenges including famine-like conditions, active civil conflict and destroyed health infrastructure within a shrinking humanitarian space in Yemen.

Yemen

Prior to the outbreak, Yemen did not have a sufficient cholera preparedness and response plan in place despite previous cholera outbreaks, endemicity of cholera in the region and active conflict, according to a new report from the Johns Hopkins Center for Humanitarian Health, which is based in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health.

This lack of preparedness, in addition to extreme insecurity, resulted in gaps in disease surveillance, insufficient ability to reach conflict-affected populations and social mobilization interventions, and delays in evaluating the use of the oral cholera vaccine, among other obstacles, found the researchers.

Cholera in Yemen

The new report, Cholera in Yemen: a case study of epidemic preparedness and response," calls for better anticipation of and preparedness for epidemics in complex humanitarian emergencies with vulnerable public health systems.

Recommendations include technical components, such as boosting the presence of peripheral laboratories to confirm cholera cases combined with improved surveillance in order to better monitor the outbreaks, to the humanitarian, such as improving coordination and requesting the UN to adopt a stronger stance on the protection of both health facilities as well as water and sanitation infrastructure from airstrikes.

The new report, "Cholera in Yemen: a case study of epidemic preparedness and response," calls for better anticipation of and preparedness for epidemics in complex humanitarian emergencies with vulnerable public The cholera response in Yemen remains extremely complicated, with no easy fixes," says Paul Spiegel, MD, MPH, director of Johns Hopkins Center for Humanitarian Health and the report's lead author.

"Humanitarian access in Yemen is minimal, and the humanitarian community did well in a challenging and insecure environment. Our goal was to produce meaningful recommendations for how to better prepare for future cholera outbreaks in Yemen and other emergency-prone countries, taking into account the extreme limitations of working in Yemen during an active conflict."

Lessons learned from the first and second waves of the cholera epidemic are already being applied in the current cholera outbreak," says Spiegel. "Areas such as coordination, decentralization of services, decisive use of oral cholera vaccine­ when appropriate, flexible funding, improved surveillance and improved integration of WASH and health services will serve as important aspects to address for future cholera control in extreme and complex environments similar to Yemen."