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Coronavirus in Yemen hard to gauge amid "chaos," so experts left to count graves

Amman, Jordan — Chaos in war-torn Yemen is obscuring the "horrific" extent of the coronavirus epidemic in the country, leaving scientists to make educated guesses at the number of deaths caused by the disease based on burials. The estimates are grim: the crippled city of Aden alone has likely seen a five-fold increase in deaths since COVID-19 arrived.

Virus Outbreak Yemen
Gravediggers bury a body at Radwan Cemetery in Aden, Yemen, May 21, 2020. AP

The international aid group Doctors Without Borders has issued a stark warning about the severity of the health crisis in the crowded southern port city. The group, known by its French acronym MSF, supports 17 hospitals across the country Yemen, including two COVID-19 treatment centers in Sanaa and Aden.

"The number of deaths occurring in the COVID-19 treatment center that MSF runs in Aden, Yemen, speaks to a wider catastrophe unfolding in the city," the group said in a statement, calling on the United Nations and donor countries "to do more urgently to help the response."

"The situation in Aden is bad, for lack of other words. We have no beds anymore," Claire Ha-Duong, head of the MSF mission in Yemen, told CBS News. "The problem is that in private hospitals [COVID-19] patients are refused and there is very little capacity for other patients in other hospitals."

She said MSF initially had to refuse one patient admission to a hospital because there was literally no space. "He stayed at the door for hours until, it's horrible to say, one patient died and then one bed was free."

Disaster masked by war

Last month, Aden was struck by heavy flooding that killed 10 people and further dilapidated the already-crumbling infrastructure. 

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Workers from the Yemeni separatist group, the Southern Transitional Council (STC), prepare to drain sewage water from a camp for people displaced by war that was flooded by rainwater in the Khor Maksar district of Aden, May 5, 2020. SALEH AL-OBEIDI/AFP/Getty

Meanwhile, Yemen's Saudi- and Western-backed government is fighting two wars: one against separatists who control large parts of the south, and another against Iranian-backed Houthi separatists who control the more populated north of the country.

Even before the outbreak of COVID-19, Yemen's health services had all but collapsed under the pressure of mass starvation and outbreaks of cholera and diphtheria — diseases considered obsolete in most of the world.

"It's quite difficult to know the real extent of [COVID-19] because there's not been enough testing to be significant. It's only reasonable to assume that the disease has already spread throughout Yemen," Ha-Duong told CBS News.

Virus Outbreak Yemen
Gravediggers bury bodies at Radwan Cemetery in Aden, Yemen, May 21, 2020. AP

In the absence of official data, health workers have resorted to counting the number of burials at Aden's biggest cemetery to get some idea of the extent of the tragedy. This month, gravediggers at Radwan cemetery have reported a disturbing five-fold increase in daily interments.

Epidemiologist Dr. Abdulla Bin Ghouth, professor of community medicine at Hadhramout University's College of Medicine, east of Aden, has compiled his own data using records of burial permits from civil records offices in Aden.

The data show 950 deaths in the city over the first 17 days of May. He told CBS News he expects the total "will not be less than 1,300 deaths for the whole month of May." Bin Ghouth's assessment jibes with the anecdotal evidence from the gravediggers; the monthly figure he foresees would be about five-times higher than the number of deaths recorded in May of last year.

Virus Outbreak Yemen
Gravediggers bury a body at Radwan Cemetery in Aden, Yemen, May 21, 2020. AP

The scientist notes that, "with 85% of deaths happening outside the hospitals, it is hard to know the real cause of death. However, the increase [in burials] has coincided with the outbreak of corona in Aden."

"Costly" chaos of war and disease

Officially, the entire country has reported only 240 COVID-19 cases to date.

When asked by CBS News what the real number of infections might be, a government source, who didn't want to be identified, acknowledged that the beleaguered health care system doesn't "have an active testing mechanism to practically know how far the pandemic is spread in Yemen, nor do we have enough testing kits to check all reported cases."

"Aden is living in chaos. STC [the separatists in the south] are the de-facto authority, yet they exercise no duties. The health system is badly run and overwhelmed. Hospitals are not functioning except few. Some health workers and doctors stopped attending due to poor precautions and lack of management," the official said. "This dilemma will be costly for the lives of people."

Yemeni Pediatrician Dr. Dhekra Annuzaili, who has worked with global organizations including UNICEF and the World Bank, described the situation in her country as "horrific." She told CBS News that none of the warring parties are providing accurate numbers COVID-19 infections.

"Maybe they do not want to create panic, especially amongst the health workers, who have suffered the most from the pandemic," she said.

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Jordan-based political cartoonist Emad Hajjaj's depiction of the situation in the Yemeni city of Aden, which portrays the city as a woman caught between warring factions as she battles a COVID-19 infection. Courtesy of @EmadHajjaj

"The poor doctors and front-liners are heavily affected. Most deaths in Aden, in the beginning, were amongst health care workers," Annuzaili said. "The only solution to deal with COVID-19 now is to stop the war."

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