War-torn Yemen is now being convulsed by cholera.
Over the past six weeks, more than 124,000 suspected cholera cases have been reported. To put this in perspective, there were only 172,000 cases reported globally to the World Health Organization for all of 2015. To be fair, many cholera cases go unreported each year, but by any standard the current outbreak in Yemen is huge.
"And geographically it is expanding," says Mohamed El Montassir Hussein, the country director for the International Rescue Committee, based in the capital Sanaa. "It's not a small area. It's almost the whole country." Cases have now been reported from 20 of the country's 22 provincial governments. The IRC, along with other international aid groups and WHO, is attempting to set up treatment centers for the growing number of people suffering from the violent form of diarrhea. Left untreated, cholera can cause victims to lose so much fluid so quickly that it can kill them within a matter of days or even hours.
The outbreak in Yemen began last year, but a second wave of the waterborne disease is now spreading rapidly. WHO blames it for more than 900 deaths since the end of April.
Hussein with the IRC says cholera is the latest crisis to hit the beleaguered country.
"The situation is definitely deteriorating," he says. "It's is absolutely getting out of control.
"Yemen has been facing war for the past two years. There is food insecurity throughout the country. There are pockets of famine. Now cholera. It's three crises in the same time happening in Yemen."
He says one of the challenges of combatting the cholera outbreak is that much of the health system has collapsed.
"Health workers' salaries have not been paid for the last eight months; basically essential preventive health services are not being provided," he says.
UNICEF has started paying "incentives" to local doctors, nurses and other health care workers to make up for their missing wages. In an email exchange with NPR, a UNICEF spokesman in Yemen says the U.N. children's agency is paying incentives to "at least 1,500 health workers in 512 cholera treatment centres and 27 diarrhoea treatment centres for a period of three months." UNICEF is also giving stipends to other health care workers in an effort to prevent a "complete collapse" of Yemen's health care system.
Yemen's civil war broke out in 2015, when Houthi rebels ousted the sitting president from the capital. Forces loyal to both sides have clashed for control of the country ever since. Saudi Arabia's military has been involved in the conflict, launching airstrikes in support of the ousted regime.
Even where there isn't active fighting, the collapse of the government has caused health clinics to close. Schools have shut down. Telecommunication and power grids have broken down. The economy is in shambles.
"There is nowhere in the country you can say this place is better than another," says Hussein. "Every family is suffering from something whether it's cholera or lack of food, having child soldiers in the family or having someone go join the rebels or the military. There's been a whole collapse of the social life."
And there's no end to the suffering in sight. The war shows no sign of letting up, and the World Health Organization predicts there could be an additional 200,000 cholera cases in Yemen over the course of 2017.