If you need to see the debilitating effects of war on a county's population, look no further than Yemen. The misery lies not just in the direct devastation of bombs from the air – although thousands have been killed that way, too – but in the knock-on consequences when a country's ability to feed itself, treat its sick and provide fresh water is destroyed.
Cholera is raging through Yemen. There has always been cholera in the country, but the destruction of water-treatment plants and sewage systems has made the problem much worse. There were 26,000 cases of cholera in the lasts six months of 2016, resulting in 112 deaths, according to the International Committee of the Red Cross. There are currently 313,000 cases of cholera in Yemen and more than 1,700 deaths have been recorded, the ICRC says.
"This is not just a cholera outbreak, it is a direct consequence of the terrible conditions in Yemen due to the conflict," said the ICRC's Iolanda Jaquemet in a phone interview from her office in Geneva.
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That conflict is a bitter war that began in March 2015, when a coalition led by Saudi Arabia began bombing Yemen to drive out the Houthi rebels, who had overthrown the government and are backed by Iran. Both sides have been accused of dreadful acts. But it is the coalition's bombing of civilian infrastructure – including hospitals and schools – that has drawn what little public condemnation there has been. (Yemen, despite the huge scale of suffering, is largely off the media radar, partly due to a shortage of journalists on the ground.)
On April 17, the sewage system in the capital, Sanaa, failed. Less than two weeks later, Ms. Jaquemet said, the cholera outbreak began in the city, then spread to other parts of the country where access to fresh water is severely limited. (Human Rights Watch estimates that 10 million Yemenis have lost access to clean water since the civil war began). Garbage collection has also broken down, with no fuel or spare parts available for trucks. Pictures show the streets of Sanaa piled high with waste.
"Cholera is water-borne," Ms. Jaquemet said. "For the cholera not to spread, you need clean water, you need a proper sewage system, you need garbage collection … but access to clean water is a luxury for most Yemenis."
A healthy population would be better equipped to fight off the disease, but Yemen struggles with both hunger and a lack of medication. The UN estimated in April that nine million Yemenis were on the brink of starvation, many of them children. Millions more are malnourished and dependent on food aid.
About 20 per cent of cholera cases are typically classified as severe, Ms. Jaquemet said, which means they require treatment at a hospital or clinic. But in Yemen, around 40 per cent of the cases are severe, because the people affected are already suffering from malnutrition and other illnesses.
They'd need to find a hospital to treat them in the first place. About half the country's health facilities have shut down, either because they've been bombed or because staff haven't been paid in a year. There is a crippling lack of medication and critical supplies: The aerial and naval blockade of Yemen's harbours by the Saudi-led coalition has choked off the supply of medicine, equipment and food.
All this human suffering occurs against an uncaring geopolitical backdrop. Western countries continue to supply Saudi Arabia with arms, despite the protests of human-rights groups. (The Canadian government's controversial sale of armoured vehicles to Saudi Arabia made it one of the chief arms suppliers in the region. Saudi Arabia purchased $142-million worth of arms from Canada in 2016).
In Britain this week, the High Court rejected a challenge to the government's sale of arms and fighter jets to Saudi Arabia. The group Campaign Against Arms Trade had argued unsuccessfully that the use of the weapons contravened international law, as they were used against civilians in Yemen. The United States, of course, recently bragged about its $110-billion (U.S.) arms deal with Saudi Arabia, which makes it extremely doubtful that President Donald Trump used his recent trip to Riyadh to criticize the continued bombing.
"Crisis is not coming, it is not even looming, it is here today," the UN's Stephen O'Brien told the Security Council in May about the situation in Yemen. Like disease, that crisis has spread, with no end in sight.