Healthcare accessibility in yemen’s conflict zones: comprehensive review focused on strategies and solutions | Conflict and Health

Destruction of healthcare infrastructure

Considering very few studies have been done on the healthcare system prior to conflicts in Yemen, the few showed Yemen being one of the low-middle income countries (LMIC) had a fragmented system with a struggling financial input from the public sector [19]. The conflict has further smashed an already struggling healthcare system in Yemen. Nearly half of Yemen’s healthcare institutions have been partially or totally inoperable since 2015 due to intentionally targeting and being considered as a collateral damage. In 2019, 49% of Yemen’s healthcare institutions were affected, according to the World Health Organization (WHO), which is considered as an alarming statistic highlighting the level of burden on the health system [20, 21].

Both intentional and accidental bombarding of healthcare facilities have been a terrible and recurring aspect of the war. This has tremendously occurred by attacking Hodeidah’s Al-Thawra hospital in 2018. Critical medical services were immediately cut off for thousands of patients after this attack hit one of Yemen’s biggest hospital centers in north west Yemen (Table 1.). Surgical care, emergency services, and specialized therapies that were once available to the local community, are now unavailable at those hospitals, which played a vital role in providing healthcare in a war-torn country [3].

However, the methodical damage goes beyond the most reported cases. As a result of the continued violence, several smaller clinics and rural health centers have also been destroyed. Essential health services are less accessible, and the few partially functional facilities are now understaffed, overburdened, less equipped, or far from reach [25]. Also, based on the annual health statistical report 2020 from the Yemen Ministry of Public Health and Population (MoPHP) along with the assessment of Health Resources Availability Mapping System (HeRAMS) 2023 showed in-dept numbers of 50% documented destruction in facilities, including rural clinics, understaffing, which around 10% of health workers remained in the conflict zones ensuing an average of 35% non-functional health centers due to supplies shortage [25, 26]. For further illustration, institutions often fail to stock necessary drugs, surgical instruments, and even basic personal hygiene products, which significantly lower the care standard [27].

Due to on-going conflicts and damages done to many healthcare infrastructures, many skilled healthcare personnel have relocated with their families to less dangerous regions. This has imposed a significant staff shortage in hospitals, thus resulting in dangerous work conditions, burn out, unpredictable health outcomes, and low pay for the staff that remain behind, according to a case study [5]. The health care system faced an increased bridge to service delivery, understaffed hospitals and difficult access to health facilities have increased the complexity in healthcare provision thus, increasing the morbidity and mortality rates in the country [28].

A geospatial network study conducted in 2018 showed that out of 5042 health facilities in Yemen only 149, which is 54%, were fully functional [25]. In this case, patients and their families still travel long distances, usually through hazardous combat zones, to get to the nearest treatment center available [29]. Specialized treatments such as dialysis and cancer treatment are almost non-existent or completely out-of-service in some parts of the country and patients need to fly to Egypt, Jordan, or India, which increases the patient’s financial load. The provision of basic medications or treatments are severely extended due to infrastructure damage, therefore triggering poor health outcomes.

Predominantly, a serious and continuing concern is the damage to Yemen’s healthcare infrastructure. The availability and quality of health services have been significantly diminished due to intentional and unintentional damage to health facilities as being army targets, as well as shortages in supplies and personnel [30].

Availability of medical supplies and equipment

The long-lasting war in Yemen has made it very hard to keep up the supply chains that preserve the country’s healthcare services running (Table 2). One of the major problems has been the blockades by the coalition led by Saudi Arabia. These have made it even harder to bring in necessary goods like medicines and medical devices due to listing Yemen under the seventh amendment of the UN Security Council (UNSC) according to the UNSC 2216 resolution [31]. These barriers have resulted that hospitals and clinics often must work with less than 30% of the medical goods they prerequisite [30].

Essential supplies

Medical staff often couldn’t get basic supplies like medicines, anesthetics, intravenous fluids, and even simple bandages. This restricts their service provision and sometimes leads to preventable mortalities [27]. The war has made it even much harder to take care of people with chronic diseases, which is another catastrophic reality. People with medical conditions, including asthma, diabetes mellitus, or high blood pressure have difficulties with compliance due to gaps in medical supply, thereby at high risk of developing complications as disease progresses. For example, lack of insulin has caused many diabetic patients to end up amputated due to poor sugar management [33]. This deeply affects the quality of life alongside mental health and financial burdens on caregivers. Similarly, lack of medical supplies has resulted in irreversible damage to several people’s health.

Lack of emergency and surgical supplies

The emergency service has been severely affected as well and slowed down by a lack of surgical supplies, stationer, and other medical equipment needed to function. For example, sterilization materials, surgical gloves, and even sutures. Many times, hospitals fail to carry out elective surgeries, which lead to avoidable morbidities [34]. Furthermore, there are limited diagnostic tools such as X-ray and CT scan machines and laboratory reagents to process blood tests and other fetal biological diagnostic tests leading to some difficulties in diagnosing and treating patients in time effectively [35].

Vaccination programs

Vaccination programs, which are vital for disease prevention, have also been affected by the barriers in the supply chain such as for measles, polio, and diphtheria shortage, consequently, foremost to low vaccination coverage [36]. This results in increased mortality rates among children under 5 years than among other causes of child mortality. Yemen has been hit hard by endemic diseases, including cholera outbreak due to a fragile healthcare system according to International Organization for Migration (IOM) reports in 2024 [37]. Thus, the acceleration of these diseases had gradually deepened the health crisis [38, 39].

Healthcare workers wellbeing and mental health

Medical staff are constantly under stress because they must fight to provide care with limited resources [40]. Not being able to serve the vulnerable in need of medical treatment poses a significant amount of work pressure on them causing negative mental health problems. Therefore, to alleviate some of these shortages, humanitarian corridors will need to be established to ensure the safe distribution of medical goods and equipment. As a longer-term solution, supporting local factories that produce medical supplies to stay operational, though a challenging prospect, could significantly lessen dependence on foreign aid for essential medical provisions.

As an urgent intervention to rescue this critical shortage, many international coalition of in-field working organizations have showed truthful contributions through medical responses, including Médecins Sans Frontières (MSF), MedGlobal, International Rescue Committee (IRC), International Committee of the Red Cross (ICRC), WHO, United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), CARE International, United Nations International Children’s Fund (UNICEF), World Bank, and others. MSF individually has supported around 17 hospitals and 18 health facilities around 13 Yemeni districts in addition to its own field hospitals providing first-line medical treatment in conflict zones [41]. In addition, they are involved in providing specialists, emergency care focused on malnutrition, maternal and child health, and even outbreaks, including cholera, measles, and diphtheria. However, MedGlobal has assisted the urgency differently by delivering medical supplies to hospitals around various governorates such as oxygen cylinders, saline solutions, medical needs, and specialists [42]. The World Bank took the lead in responding to the Yemen crisis annual response plan since the conflict began for urgent funds to the situation and coordinating financial support among working organizations. While, WHO and UNOCHA ensured the delivery of almost 4000 tons of equipment, medicines, medical furniture, and other health essential technologies worth US$ 42.63 million to 470 health facilities across Yemen [43, 44]. Therefore, all this effort and more still needed due to fragile healthcare system and induced challenges that cannot be described.

Healthcare workforce

The healthcare staff in Yemen has been devastated by the continuous conflict and without them such a system cannot exist. Due to the psychological stress of working in warzones, unsafe working conditions, unpaid wages, and the loss of life, many healthcare workers have fled the country as a result of the war. This reversed immigration, more than half of Yemen’s healthcare workers have left their jobs leading to a severe scarcity of qualified medical professionals [5].

The remaining staff is struggling to handle the increasing demand for medical services due to the widespread migration of healthcare workers since they face terrible working conditions, including working under threat of violence, lacking basic supplies, and an immense amount of pressure to treat a high volume of patients with limited resources. In times of war, many healthcare workers do not receive regular salaries, which is devastating to an already existing struggling workforce. Many end up fleeing the country for better or safe opportunities, which further affects delivery of quality treatment [45].

Healthcare workers in Yemen face additional danger on their shifts. Patients and healthcare personnel are always in danger as hospitals and clinics have been targeted by shelling and airstrikes. Numerous assaults on healthcare facilities were documented by WHO in the form of injuries or deaths on duty [46]. The hazardous conditions contribute to an unsafe work atmosphere and highly discourage current employees from staying and serving their communities.

The huge psychological effect on medical personnel causes substantial amounts of stress, burnout, and mental health problems. Also, during continuous exposure to senseless deaths, avoidable medical complications, infrastructural damage, and trauma to mention a few more. Many are unable to cope with the cumulative pressure without enough support systems and mental health services, which lead to additional labor loss. The shortage of healthcare workers in facilities forces patients to face longer waiting times in contrast to receiving limited specialized treatment. Medical errors and incompatible treatments are more likely to occur since the remaining healthcare staff are overworked and frequently go without breaks during their shifts [47].

One of the successful projects that showed an impact in strengthening the skills of healthcare provided, is the Yemen Emergency Human Capital Project (YEHCP) funded by the World Bank Group and implemented by the UNICEF, WHO, the United Nations Office for Project Services (UNOPS) [48] in order to enhance the delivery of primary healthcare in partnerships with local authorities through training, deploying, and retaining professionals on various programs, including maternal health, nutrition, noncommunicable diseases, infection prevention and control, integrated management of childhood illnesses, mental health, essential program on immunization, and clinical mentorship [49]. Therefore, this project has supported 2,200 health facilities, 10,360 healthcare personnel, 1,800 health officers, and more than 200 practitioners [50, 51]. Also, over 53,000 people, healthcare providers, and displaced people due to the conflict have benefited from the mental health support implemented by UNICEF [52].

Nevertheless, it is critical to pay healthcare professionals on a regular basis if you want to keep them and hire new ones. To accomplish this, we need to open systems for wage distribution and financial backing to support the failing economy. Furthermore, it is critical to enhance healthcare facility safety and security in order to safeguard healthcare personnel and motivate them to stay employed. International diplomatic measures can be utilized to ensure the safety of medical staff and facilities in areas affected by violence as well as to promote human rights.

Restricted access to healthcare services

Patients are facing significant obstacles while attempting to access healthcare services due to security concerns, destroyed infrastructure, and economic worries. Many people in Yemen are forced to travel great distances through risky and war-torn regions just to get to the medical facilities, according to ICRC [53]. Some of the common barriers are listed in (Table 3.).

(The table was illustrated by the authors based on the relevant available literatures and reports from NGOs [40, 45,46,47, 53,54,55].

The main problem is security as it is a core pillar of any development and stability. People seeking healthcare services are put at extreme risk and discouraged from obtaining it due to the fear of violence, the long distances, planted landmines, and checkpoints to access these facilities. Damage to transportation means, including roads and bridges, has made access even more difficult. Traveling to the closest functional medical institution can be a dangerous and stressful ordeal for many distant communities, particularly for individuals who are sick or hurt. Therefore, difficult financial circumstances, unemployment rate, inflation, and income loss have all been brought about by the war’s devastating impact on the economy. Fuel shortages and damaged roads increase transportation costs, putting financial hardship on households [56]. Consultation fees, prescriptions, and diagnostic tests are all part of medical care, and many Yemenis simply cannot afford them. As a result, many people tend to postpone getting the medical care they need early, which worsens their health conditions and raises the mortality rate overall.

Children, pregnant women, and the elderly are among the most susceptible groups that suffer disproportionately from the combined effects. Higher rates of maternal and neonatal mortality are caused by pregnant women facing elevated risks owing to inadequate access to maternal health services [57]. Preventable deaths occur when children do not receive routine immunizations and treatment for common illnesses. However, telemedicine and funded mobile clinics have proved their efficiency in lessening the outcomes. NGOs have well-involved the option of using mobile clinics as alternatives. For example, MSF has set up a couple of mobile clinics in different governorates, including Marib and Taiz providing trauma care, chronic disease management, reproductive healthcare, treatment for malnutrition, vaccinations, and mental health services [58]. However, during 2023, MoPHP along with partnership of UNICEF, IOM, and other several partners established a scale-up of integrated management of acute malnutrition programs supporting over 4,655 outpatient therapeutic programs deploying 203 mobile clinic teams into hard-to-reach areas [59,60,61]. Indeed, mobile clinics have effectively delivered predominant primary health and nutrition services in areas, which face infrastructure challenges, reaching communities in the farthest corners of districts and governorates, more financial support is needed to keep these clinic mobiles running to benefit more people, especially displaced persons [62].

Public health and outbreaks

The ongoing conflict has contributed drastically to the spread of communicable and non-communicable diseases remarkably. However, more organized and collaborative initiatives are needed, and new potential long lasting resolutions should be executed in order to save the human capital and reduce the death toll of these outbreaks in a very fragile situation.

Communicable diseases and outbreaks

Long-lasting conflicts coupled with an economic recession have severely undermined vital social services and means of living, placing vulnerable children in dire humanitarian circumstances. Many children lack access to safe water, sanitation, and hygiene facilities while the country continues to experience regular outbreaks like cholera, measles, diphtheria, and other vaccine-preventable illnesses [63]. Therefore, a research study carried out in 2019 validated the link between rising diphtheria cases, vaccination rates, and persistent conflict. The likelihood of an outbreak rose eleven times higher in districts facing ongoing conflict, with a significance level of p < 0.05 [64]. In addition, in October,2017, WHO in Yemen received notifications regarding potential cases of diphtheria from the Ibb governorate, where a total of 333 suspected cases were reported across 20 governorates only between August and December 2017, including 35 fatalities, resulting in a case fatality ratio of 10.5%, nevertheless, this outbreak is still ongoing. Also, WHO reports that diphtheria cases in Yemen as of October 2023 are 57% higher than in 2021 and 2022, with a significant increase observed in 2023 since there have been 1,671 suspected cases of diphtheria reported nationwide, leading to 109 related deaths, in comparison to 1,283 cases reported for all of 2022 individually [65].

Cholera outbreaks are strongly associated with armed conflicts and humanitarian crises due to the contaminated water supplies as they are the main cause of its spread [66]. It appeared during 2016 after a year of the war, but it truly became widespread the year after. Up until now, there have been around 2.5 million reported cases [67]. By June 2017, the UN declared that the country is experiencing the most severe cholera outbreak globally [68]. Therefore, only from 2016 till 2022, Yemen has faced the most significant cholera outbreak recorded in recent history with approximately 4,000 fatalities during this ongoing conflict across Yemen [37]. In response, 8 diarrhea treatment centers and more than 20 oral dehydration centers were supported through a combined fund from European Commission for Humanitarian Aid department (ECHO), USAID, and Yemen Humanitarian Fund (YHF) led by IOM targeted around 70,038 individuals [37].

Another critical preventable outbreak is measles but facing additional problems due to vaccination [69]. However, the vaccination rate in Yemen before the conflict was relatively consistent and stable by achieving 70–80% of the targeted population and due to the conflict, the vaccination rate reduced to 54% [70]. Therefore, the cases have increased gradually from 400 to 10,640 only from 2014 till 2018 leaving the concern of more challenges in deliciated healthcare system [71]. In contrast, there has not been a serious response to measles outbreak as it is reported during cholera.

In Yemen, malaria is a prevalent infection with a reported incidence of 35.7 cases per 1,000 population in 2013, which rose to 45.8 cases per 1,000 population by 2018 that reflects in the 77.2% of reported cases found in six governorates, including, Al Hudaydah, Hajjah, Taiz, Dhamar, Sa’adah, Al-Mahweet respectively [72]. Therefore, these outbreaks and other should be included in the annual response plan of Yemen as they impact the healthcare system intensively.

Reproductive healthcare

The situation for women and girls in Yemen is incredibly challenging with the ongoing conflict worsening their vulnerability and amplifying existing gender inequalities [73]. In 2017, Yemen ranked at the bottom of the Global Gender Gap Index, coming in 144th out of 144 countries [74]. In the regions under Houthi control, Yemeni women are required to be accompanied by a male relative, known as a mahram, while travelling. This restriction significantly impedes women’s freedom of movement in Yemen [75], which has become one of the barriers to accessing healthcare services.

The fertility rate of the country is around 3.72%, which means that, on average, each woman experiences four pregnancies during her lifetime and potentially faces childbirth complications four times [76]. Additionally, according to UNICEF, 31.9% of women become mothers before they reach 18 years of age [77]. Most Yemeni women cannot access reproductive health services for various reasons.

In 2023, the United Nations Fund for Population Activities (UNFPA) reports highlighted an alarming trend of increasing maternal mortality rates varying [78]. Shockingly, every two hours, a Yemeni woman loses her life during childbirth due to preventable causes. Approximately 8.1 million women and girls in the childbearing age group require support in accessing crucial reproductive health services, including antenatal care, safe delivery services, postnatal care, family planning, and emergency obstetric and newborn care. Among this group, 1.3 million women are expected to give birth this year, with 195,000 anticipated to face complications necessitating urgent medical intervention to safeguard their lives and the lives of their newborns [79].

In Yemen, over half of hospitals and health facilities are non-operational, with only 20% of these providing maternal and neonatal care services [80]. Access to reproductive health services is limited for most women in Yemen since only 25% of women aged 15–49 years old receive the recommended four or more antenatal care visits during pregnancy, often provided by untrained health practitioners due to the lack of specialists. Additionally, about 45% of deliveries are attended by skilled health personnel, and only 20% of women receive postnatal care within 2 days of giving birth. Lastly, just 11% of newborns receive neonatal care within a week of birth [81, 82].

Furthermore, the utilization of modern contraceptives saw a rise from 10 to 29% between 1997 and 2013. However, this advancement has been impeded by conflict and restrictive political circumstances, resulting in a decrease in contraceptive use. Moreover, accessing reproductive health services in areas near conflict zones presents challenges due to scarce health facilities and supply chain disruptions resulting from the ongoing crisis and economic decline [83]. Moreover, a report from Mwatana for Human Rights states that the banning of contraceptives in the northern areas, which are under the Houthis targeting women rights [84].

In the rural areas of Yemen, only 35% of women had access to skilled health professionals for maternal health care services [85]. Challenges such as frequent relocations and residing in rural or remote areas pose significant barriers for pregnant women in accessing urban maternity hospitals or healthcare facilities. Financial constraints further exacerbate the situation, as many Yemeni families struggle to afford medical expenses and transportation to urban areas. Consequently, expectant mothers in critical conditions are forced to undertake grueling 7-8-hour journeys on foot or using other rural means of transportation, including using animals to reach hospitals [80].

Humanitarian aid and international response

Prior to the conflict outbreak, Yemen’s healthcare system was already struggling with health service provision, among other natural disasters and had a few humanitarian organizations step in to support a few development related projects [86]. However, the healthcare system has been heavily weakened by the conflicts since 2015 resulting in severe lack of financial resources to support the health sector. The humanitarian interventions and projects have also been shifted towards emergency response to the outbreak of civil war, varying its impact on country’s development and younger generations if the conflict keeps going [87].

Throughout the conflict, medical care has been a priority on a larger scale by international humanitarian aid response. Delivering emergency medical supplies, operating field hospitals, and assisting local health services have been made possible in larger part by organizations such as WHO, MSF, and the ICRC [3, 20]. Significant obstacles to these initiatives include access limitations, security risks, and a lack of funds. Attacks on its facilities, for instance, have forced MSF to halt operations several times [88] and despite that, Yemen is still on the top of humanitarian targeted countries for relief.

International humanitarian aid plays a crucial role in mitigating the impact of the conflict on the healthcare system [87]. WHO has been an instrumental leader by coordinating international medical responses with other organizations, ensuring the delivery of essential medical supplies, and supporting the establishment of field hospitals in conflict zones as one mobile resolution in reviving the medical urgencies. WHO’s efforts have been complemented by the dedicated work of MSF, which has provided critical on-the-ground medical care despite of the challenging and dangerous conditions but still operates in most of Yemen [89, 90]. The ICRC has also been a key player in this response as providing emergency medical aid, supporting local health services, facilitating the evacuation of injured civilians, and mediating in free prisoners and captives of war [91, 92]. Their efforts have been particularly vital in areas, where local healthcare infrastructure has been decimated by the ongoing conflict [93].

However, security risks are ever-present with aid workers frequently operating in life-threatening conditions, consequently, affecting the ability of organizations to maintain continuous support according to OCHA since it has contributed so much to projects funded by donors to various local associations [94].

Humanitarian organizations are required to collaborate with local political leaders to enforce their interventions, however, local partners tend to have their own political agendas and sometimes fight for control of aid resources and distribution, which results in lacking transparency. Additionally, humanitarians are hindered from distributing supplies freely in certain areas controlled by armed forces, these armed networks have been reported to charge transit fees or bribes for passage [3]. Eventually, civilians are disproportionately affected by both the humanitarian limitations and the ongoing disasters caused by conflicts.

Critical analysis: healthcare crisis in yemen’s conflict

Wars catastrophically rip to pieces systems critical to human survival like regimes, economies, development, technological advancement, and most significantly healthcare systems through which lives are saved, pain is lessened, injuries are treated, casualties are aided, and death toll can be somewhat controlled by quick response. Therefore, Yemen’s decade-long conflict epitomizes the collapse of the healthcare system amid politicized aid dynamics and chronic underfunding. This analysis synthesizes gaps in understanding the war’s long-term impacts on healthcare and proposes reforms grounded in evidence from humanitarian reports and NGO assessments. This review highlights the significant deficiencies and constraints that impede a thorough comprehensive understanding of how the healthcare system got affected by the war and consequently propose an efficient response to the world’s worst humanitarian crisis in the current era [95].

In 2015, the YHF was established in aid to find a rapid, flexible funding mechanism connecting local authorities, international NGOs, and operating UN agencies in the ground by allocating, distributing donor resources to the most critical needs based on the Yemen Humanitarian Response Plan, which gets actualized every year [96]. Leaving around 18.2 million people in need of humanitarian assistance, protections, access to dignified service, including clean water, food, healthcare, housing, and other basic needs, therefore, more sustainable interventions, frank voices, solid timely collaboration between national authorities, policymakers, stakeholders, and donor to impact more long-last resolution since this conflict has set the country decades backward and rebuilding process would take years to recovery to what the situation was before war.

Mostly, there is a significant lack of comprehensive studies investigating the long-term effects of infrastructure destruction on the healthcare system involving multidimensional gaps between research and response. Most current available studies roughly examine the immediate and short-term consequences, including the extent of infrastructure destruction, the immediate scarcity of resources, degree of destruction, or even investigation of targeting medical facilities. For example, weaponization of land resulted in 51% of hospitals non-functional, water scarcity affecting more struggles in war zones, in the long run, would cause more deaths and collapsing the agricultural livelihood [97]. Therefore, more longitudinal research is needed to monitor the gradual decline of healthcare services and its wider socio-economic consequences in term of over-time interval even by hitting the economy, where people cannot afford the private health sector because they do not get salaries resulting even in high spiked treatment prices, including medications due to hardship access since roads, bridges, and vessel infrastructures are targeted as military targets because a very serious lack in medical supplies, equipment, medications, healthcare workforce, operating facilities, and mostly providing very basic medical necessities, including but limited to primary healthcare, but also mental health according to a survey carried out by Action Contre La Faim (ACF) [98, 99]. However, destruction of 50% of health facilities by 2022 are well-documented, thus, longitudinal studies on the socioeconomic current effects remain scarce. Therefore, gaining a comprehensive understanding of these enduring outcomes is essential for formulating sustainable plans for rehabilitation, reconstruction of the healthcare system, setting the priorities, and mostly plotting out the risk-beneficiary assessments, which favor implementing the intervention safety.

Another challenge is the inadequate international aid and political obstructions in which provision and transparency play a tremendous role in flowing the future funds. Although multiple international organizations have participated in delivering humanitarian assistance, there is a scarcity of empirical data evaluating the efficacy and sufficiency of these efforts. Additionally, creditable comprehensive assessments are necessary to determine the relief techniques that have yielded the best results. For example, UNOCHA calls seek $4.7 billion as 2024 HRP and $2.7 billion only for 2025 urgency but got funded only 28% resulting in forcing cuts rise to 60% of the preplanned projects [100]. However, this aid delivery is mostly compromised by the multi-interference due to imposed taxes on aid, which could up to 80% on medical supplies, restrict female healthcare workers in the northern Yemen, while politicizing aid distributions by favoring aligned groups in the southern Yemen based on the 53 in field working NGOs Joint Statement [101]. As a solution, more local Yemeni NGOs and initiatives should be enabled to deliver services such as assistance in hard-to-reach regions freely.

Forthrightly, the healthcare crisis in Yemen is a multidimensional problem influenced by an intricate politicalized interaction of elements. Therefore, adopting interdisciplinary techniques can provide a more thorough knowledge of the situation enabling the development of more effective and comprehensive responses. By integrating economic studies with health data, one can identify the ways in which financial instability and poverty worsen health outcomes. Similarly, political analyses can highlight the influence of governance concerns and conflict dynamics on healthcare delivery. This basically leads to understanding the restricted access to health service because one of the main obstacles in understanding the Yemen nature in terms of geo-economics, geographic, and geospatial view, subsequently, data contributes in delivering assistance to such risky places either under attacks or hard reached regions. A serious peace truce is needed as the 2018 Stockholm Agreement showed potential outcomes [102]. Although the international efforts have been fragmented, but more pressure on the playing parties in the ground should come to a peace resolution in order to commence the rebuilding of the multisector crisis hindering the Yemeni people live in dignity [103].

Consequently, this healthcare crisis has led to other related problems as Yemen facing a good fertility rate, but this contrasts the fluctuating maternal mortality due to lack of professional specialists, facility readiness, hardship during transport to the nearest hospital or facility, and mostly the absence of postnatal care within the first few days. Therefore, the international committee has shown the initiation to aid the situation in multidisciplinary sections and established the Humanitarian Response Plan (HRP), which began in 2016 and recently adjoining in ensuring the HRP of 2024 [104, 105]. The international humanitarian aid and response has been a great supporter of reviving the situation in Yemen by providing the fund, expertise, supplies, assistance, and equipment and this response is not only limited to the humanitarian situation but also to the political and economic divisions.

Yemen’s healthcare crisis is not a standalone emergency but a symptom of systemic failures in funding, governance, and international cooperation. While the 2024 HRP’s focus on “durable solutions” marks progress, bridging the 72% funding gap and mitigating multi-authority obstruction are urgent [101]. Therefore, a goal is achievable only through equitable resource allocation, localized leadership, and unyielding political advocacy.

Suggestions and potential resolutions

The situation calls for a broader approach that incorporates both short- and long-term plans. Key actions that need to be prioritized include safeguarding and reconstructing healthcare infrastructure based on urgency, ensuring the uninterrupted flow of supplies by establishing safe humanitarian corridors, and promoting local production of medical supplies. Additionally, supporting the healthcare workforce by addressing their financial concerns, and initiating training programs to enhance professional development and practical skills are critical steps.

Improving access to healthcare services through mobile clinics and telemedicine is another effective approach that has demonstrated significant benefits. Facilitating collaboration among foreign aid organizations and identifying sustainable and long-term solutions for delivering healthcare services to vulnerable populations, particularly those in rural areas, are also essential.

Several key strategies can be applied to Yemen, including:

Developing structured partnerships

Fostering collaborations between Yemeni institutions, international academic organizations, and humanitarian NGOs are essential for supporting research and capacity building. A successful example of this approach is the Research for Health in Conflict (R4HC-MENA) project [106], which effectively engaged both local and international stakeholders to strengthen research efforts in conflict zones. This model could be adapted to Yemen helping to bridge the gap between local expertise and global support, thereby enhancing research in challenging environments.

Capacity Building and training

Investing in training programs to equip Yemeni researchers and healthcare professionals with the necessary skills to conduct research in resource-constrained environments is crucial. By embedding research education within the healthcare system, as seen in other conflict settings, long-term sustainability can be ensured. This approach will empower local professionals to continue research efforts despite ongoing challenges and limited resources.

Securing international funding for locally led research

Advocating for international research funders, such as National Institute for Health and Care Research (NIHR), WHO, and global health organizations to prioritize Yemen in their funding calls is essential for fostering meaningful research. Yemeni researchers should be actively involved in shaping funding proposals, ensuring they are not merely passive recipients of funds, but leading an active role in directing research initiatives that address the country’s unique challenges.

Leveraging digital solutions for data collection and health research

Given the challenges of on-the-ground data collection in conflict zones, digital health systems and remote data collection techniques could be effectively applied in Yemen. These solutions can help overcome logistical barriers and enable more efficient health research in difficult environments.

To improve the feasibility and specificity of the recommendations:

1. Timelines for Implementation.

• Short-term: Establish partnerships locally and internationally within 1–2 years.

• Medium-term: Develop capacity-building programs and secure research grants within 2–5 years.

• Long-term: Integrate research findings into policy and health system reconstruction efforts over 5 + years.

2. Coordinating International Aid More Effectively.

• A Yemen Research Consortium could be established bringing together key local and global health actors to foster collaboration.

• A coordination body, similar to the Idleb Health Directorate in Syria [107], could oversee health research efforts in Yemen, ensuring that findings directly inform healthcare policies and interventions.

3. Rebuilding Healthcare Infrastructure Through Research-Driven Strategies.

• A Yemen-focused health system strengthening project, inspired by NIHR’s R4HSSS program in Syria, could address critical challenges like service provision, governance, financing, and digital health integration involving local researchers to ensure that initiatives are sustainable and context-specific.

• Involving Yemeni researchers in shaping these initiatives ensures that the solutions are locally relevant, sustainable, and responsive to the country’s unique challenges.

Limitations

To improve our understanding of Yemen’s healthcare situation, it is crucial to address the existing research gaps and methodological limitations. Establishing a strong evidence base will facilitate the design and implementation of more targeted interventions that effectively address both acute healthcare needs and long-term resilience. More research efforts should prioritize the inclusion of Yemeni voices and experiences, ensuring that their needs and perspectives are central to the development of solutions.

A significant number of studies rely on small sample sizes, which may not accurately reflect the experiences and needs of the wider population. Expanding research parameters to include larger, more diverse samples would provide a more comprehensive and accurate picture of the healthcare situation. Additionally, the lack of longitudinal data limits our understanding of the healthcare system’s progression over time and the long-term health consequences for the Yemeni people. Long-term studies on the effects of infrastructure destruction, thorough evaluations of international aid interventions, larger and more inclusive sample sizes, and interdisciplinary research methods are essential.