In June, after spending 11 months in a makeshift camp for people displaced by violence, 19-year-old Dawlah Muslih, then seven months pregnant, returned to her home in an area of Yemen where safety was supposed to have improved. It was a move her family would come to regret.
Two months ago, the government announced that the militant group Ansar al-Sharia had been routed from the southern Abyan Governorate by a large-scale military offensive. Hundreds of displaced families have since returned to their homes in Jaar and Zinjibar cities, according to Abdullah Al-Duhaimi, manager for a government-run office for internally displaced people and returnees based in Zinjibar city.
But just two weeks after Muslih returned from a shelter in Aden, violence returned to Abyan. Suicide bombings have resumed, as have clashes between remaining Ansar al-Sharia fighters and armed tribesmen on the one hand, and criminal gangs on the other, Muslih’s brother, Mohammed, told IRIN.
On 4 August, Muslih’s water broke and her family set out for the nearest hospital in Jaar City.
“We were just two or three kilometers far from al-Razi hospital in Jaar, but couldn’t make it to the hospital after we heard a huge explosion in the main street leading to the hospital that had shaken the car we were in,” Muslih’s older sister, Habibah, told IRIN.
Muslih was unable to deliver normally, and unable to reach a facility that could perform a caesarean section. On 7 August, she died at home, her baby still unborn.
Insecurity obstructs healthcare
Despite the government’s insistence that stability has improved since it regained territory taken by militants last year, insecurity remains a key problem in Abyan.
“We stay home most of the time. We fear being killed if we go out,” Mohammed Muslih said.
Nashwah Hassan, a local midwife in Jaar City, told IRIN that insecurity prevented too many pregnant women, who have returned from displacement over the past two months, from obtaining prenatal care.
“To my knowledge, Dawlah is the fifth mother to die from dysfunctional labour over the past month. They couldn’t go to al-Razi Hospital for fear of suicide bombers and landmines,” Hassan said. “All these five mothers had to undergo a C-section because their CT-scans [taken while in displacement in Aden] show that the baby’s head wasn’t descendant enough to ease delivery.”
While in displacement, many pregnant women had better access to antenatal healthcare services provided by the government and aid agencies. This was particularly true for those who sheltered in Aden.
Antenatal healthcare services have historically been poor and limited in southern Yemen.
In Abyan Governorate, nine public hospitals and 128 health centres serve an estimated 480,000 people. The hospitals lack specialized staff, equipment and funding, and the health centres are largely limited to providing primary healthcare services, according to Al-Khadher Mohammed al-Saeedi, head of the Ministry of Health’s regional office in Abyan.
In 2010, the UN Population Fund estimated that 22 women die in Yemen every day due to pregnancy- and birth-related complications and that antenatal care coverage was 47 percent - the lowest in the Middle East.
Months of clashes between the army and Ansar al-Sharia militants have only made the situation worse, al-Saeedi said. While he could not give an exact number of deaths resulting lack of healthcare access, “pregnant mothers are the most affected by such a dire security situation,” he said.
Following their return, “recurrent sounds of landmine blasts and suicide bombings made women returnees traumatized. They fear going out to seek medical consultations,” al-Duhaimi told IRIN.
More than two hundred people have been killed in the governorate and several dozen injured since mid-June, said Mohammed Fadhl Monasser, acting chief of Abyan’s security department.
“No security has been restored yet. You could be killed by a suicide bombing or in a landmine explosion at any time,” he told IRIN. “Suicide bombings have become a daily scene since the military offensive ended in mid-June.”
On 4 August, the day Dawlah couldn’t make it to hospital, at least 45 people were killed and another 50 injured when a suicide bomber attacked a funeral service taking place in Jaar.
“Levels of violence have not decreased, but the nature of violence in Abyan has changed. In towns like Jaar, armed clashes have been replaced with indiscriminate violence from bombing attacks and accidents involving landmines,” said Anne Garella, project coordinator with Médecins Sans Frontières (MSF) in Aden.
According to al-Saeedi, local health centres in the governorate are either understaffed or have no staff at all. He added that persistent insecurity in Abyan discouraged dozens of doctors and nurses from resuming work in public hospitals and health centres. Sometimes people venture out to their nearest health post, only to find that doctors are not on duty, MSF’s Garella said.
Abyan Governor Jamal al-Aqel said popular committees of armed tribesmen - which backed the government in the fight against Ansar Al-Sharia militants - and some local NGOs have been collaborating with the government to protect public and private properties amid the very limited presence of security personnel.
“Interior Minister Abdulqader Qahtan pledged to provide us with more security personnel and required equipment such as vehicles and radars. We are waiting for this pledge to be fulfilled,” al-Aqel said. “This could take several weeks, if not months.”