Five-year-old Amina Nasser clutches her toys in a decrepit cancer ward in Yemen, her life in the hands of a healthcare system pushed to the brink of collapse by bitter conflict.
The rudimentary equipment, peeling paint and stench of urine are constant reminders of how Yemen’s seven-year war ravaged essential public services.
Amina, who has been undergoing treatment for leukemia for two months at Al-Sadaqa Hospital in the southern Yemeni port city of Aden, is one of millions whose lives have been turned upside down.
“We had no other choice,” said her mother Anissa Nasser, sitting with her daughter in the dilapidated pediatric oncology ward.
Amina gets free chemotherapy, but her unemployed parents have to find the money to somehow pay for more drugs and tests.
“We wanted to send him for treatment abroad,” the mother said, but that was way beyond their reach.
The World Bank estimates that only half of Yemen’s medical facilities are fully functional and that 80% of the population have problems accessing food, clean water and health services.
Three-quarters of Yemen’s 30 million people depend on aid.
– Die of hunger –
It is the legacy of a war that began when Iran-backed Houthi rebels seized the capital Sanaa in 2014.
The internationally recognized government fled south to Aden, and a Saudi-led military coalition intervened in 2015.
The fighting continues. The UN has estimated that the conflict has killed 377,000 people, both directly and through hunger and disease.
Parts of Al-Sadaqa Hospital are funded; the malnutrition centre, supported by UN agencies, has waxed floors and smells of detergent.
Tiny, emaciated children, shriveled with hunger, hang on drips.
The UN, which has called Yemen the world’s worst humanitarian disaster, warned this week that the number of people facing starvation is expected to quintuple this year to 161,000.
Some 2.2 million children are expected to suffer from acute malnutrition in the coming months, and more than half a million children are already at risk of starvation.
And the UN itself has warned of a serious funding shortfall ahead; a pledging conference on Wednesday raised less than a third of the money needed to avert a humanitarian catastrophe.
At the hospital, donor funding means that at least in the ward for malnourished children there is electricity and staff have been paid.
But with doctors stretched, funding one area means other areas can be overlooked.
If there is support for a section of the hospital, then “everyone wants to work there, hoping to improve their living situation,” said Kafaya Al-Jazei, the hospital’s general manager.
– ‘Deplorable’ –
In Aden, public hospitals lack basic equipment as well as staff – with doctors and nurses preferring the higher salaries of private clinics or international organizations.
At another Aden hospital, Al-Joumhouria, a weathered bronze plaque in Arabic and English marks the year 1954, during British colonial rule, when Queen Elizabeth II laid the foundation stone.
Today, the building is in a pitiful state, with shortages of staff, medicine and equipment.
“The hospital is neither maintained nor air-conditioned,” nurse Zubeida Said said. “There are leaks in the bathrooms. The building is old and dilapidated.”
Hospital staff protested “deplorable” conditions, said the hospital’s acting head, Salem Al-Shabhi, which hires medical students to fill staffing gaps, for 10,000 riyals (about $9) per day.
Final-year medical students have no illusions about what to expect, with some hoping to leave Yemen once they graduate.
“We want a job with good pay in a safe place,” said Eyad Khaled.
But her classmate Heba Ebadi, who plans to major in gynecology, is determined to help her country “even if the health system is deteriorating”.
“We want to help people here,” she said. “Who else is going to help them?” We must stay here.