Travelling through northern Yemen, the scars of a decade of internal conflict abound - bullet-pocked store fronts, bombed out homes, abandoned villages.
On the roads in Sa’dah Governorate on the border with Saudi Arabia, travel is slowed by repeated checkpoints manned by the military, local militia or fighters from the opposition Houthi movement, a Shia (Zaydi) group in a country with a Sunni majority.
Less visible wounds come to light in the crowded camps and homes for the at least 300,000 internally displaced persons (IDPs). Many complain of nightmares, panic attacks, despondency and other debilitating psychological afflictions from the fighting, says Basel Mousa, who works for the UN Refugee Agency in Haradh, close to the border.
“I’ve seen a particularly worrisome trend in child IDPs expressing their untreated trauma through aggression.”
Arab Spring protests in 2011 shifted north Yemen’s political-military landscape, but conditions for IDPs have largely stagnated. The destruction of so much of the region’s physical and social infrastructure, and the continuing sectarian and tribal violence mean most have not yet returned.
Displaced in the capital
In the capital Sana’a, the Adventist Development and Relief Agency (ADRA) is assisting about 15,000 IDPs, many of them with special needs, who live in low-income suburbs around the capital.
Forty-three-year-old Mohammad*, and his wife and five children, fled Harf Sufyan District in Amran Governorate, north of Sana’a, when an aerial bombardment destroyed their home and killed several family members during the sixth Sa’dah war in 2010.
ADRA referred Mohammad to al-Amel Psychiatric Hospital in Sana’a, where he was diagnosed with depression and obsessive compulsive behaviour related to his traumatic experiences in the conflict.
“When he arrived [in Sana’a], he was convinced that everyone was spying on him,” said Mohammad’s psycho-social counsellor at ADRA, who wished to remain anonymous.
“He’s better now because Sana’a is getting more stable, but he still feels like an outsider. It’s difficult enough to find a job in Sana’a if you are Sana’ani. Because he’s from Sa’dah, no one will consider hiring him,” he said.
To generate income, Mohammad sells part of the food rations he and his family receive from a joint WFP-Islamic Relief assistance programme. Lately he has not earned enough to cover hospital costs associated with shrapnel lodged in the back of his head from an explosion in Harf Sufyan, nor those of his 10-year-old daughter who suffers from severe physical and mental handicaps, including epilepsy.
“He doesn’t have 50 rials [25 US cents] for a bus ride to the hospital, so he’s stopped going,” said his psycho-social counsellor. “As head of the household with no way to support his family, the pressures of life are building.”
Asked what his plans are for the future, Mohammad said: “If things get better, we’re definitely going back to Harf Sufyan. But the Houthis brought preconditions to the National Dialogue. I’m not optimistic.”
Many Yemenis hope the National Dialogue conference, which got under way in mid-March, will be able to resolve many of the country’s most divisive issues including southern separatism and bringing peace and stability to the north.
For six years starting in 2004, ex-Yemeni President Ali Abdullah Saleh’s autocratic regime in Sana’a fought Houthi rebels in and around the fertile Sa’dah Governorate.
But instead of conquering or even weakening Houthi power, the six consecutive wars ended with the tumultuous 2011 Arab Spring uprisings that led to the overthrow of the ruling regime.
The Houthi opposition movement consolidated control of its isolated northern enclave and established footholds in urban Sana’a and Taiz to the south.
“Before the revolution, it was unheard of to openly identify with Houthis. Now, Houthi influence is everywhere,” said a local humanitarian worker in Sana’a.
Forty-year-old widow Amel* and her five children abandoned their home in Sa’dah’s central al-Safra District during the sixth Sa’dah war when her husband was killed by gunfire while farming their plot of land.
With no vocational skills, Amel has taken to collecting plastic bottles for resale, something which pays about 200 rial (US$1) for each full gunny sack.
For almost four years the six of them have lived in a one-room cinderblock structure with no windows. Rainstorms flood its dirt floors and soak their belongings.
Amel’s teenage daughter Haloud suffered severe trauma as a result of the conflict. “There were constant air raids. Haloud saw a lot of death,” Amel told IRIN. “She rarely eats or sleeps, and without notice will run into the street crying and screaming.”
ADRA referred Haloud’s case to a psychiatrist at al-Amel Hospital, where she was diagnosed with “mental retardation” and “epilepsy”. Amel can’t always afford the medication prescribed for Haloud’s conditions.
“I’m fighting every day for my daughters so they can study and stay in school,” said Amel, thrusting her hands in the air.
Amel’s son, the eldest of four siblings, refuses to attend school. “He chooses to go out in the street with his friends because of the war and the social situation here. He says he will kill himself one day.”
Of late, Amel says their situation has improved because she has been able to purchase Haloud’s medications more regularly.
Regarding the option of returning to Sa’dah, Amel said: “That’s not an option. What is there to go back to? The only solution is to stay here and survive. I’ll fight to the death for them,” she said pointing to her daughters.
While Yemen’s overall IDP figures have declined by more than 100,000 since 2011 when roughly 463,000 sought temporary refuge around the country, progress has been lopsided and resource flows disproportionate.
The military expulsion of al-Qaeda groups last summer in Abyan and neighbouring governorates in the south paved the way for the return of 143,187 returnees, but in the north only 36,845 IDPs returned to Sa’dah.
"I’m fighting every day for my daughters so they can study and stay in school", Amel, IDP in Sana’a
Of the quarter of a million people displaced by the conflict in the north, most are in Sa’dah and Hajjah governorates.
But despite the humanitarian needs in Yemen, donor money has fallen short of requirements, in part, because of needs elsewhere in the region with the crisis in Syria. This year’s Consolidated Appeal for $716 million, has so far only received $196 million (27.3 percent).
Some of the mental health complaints have lessened with time. Abdullah Salem from the World Health Organization, co-chair of the health cluster working group in Haradh (Hajjah Governorate, northwestern Yemen), reports that since starting a mental health programme there in 2010 after the sixth Sa’dah war ended with a ceasefire, the overall caseload of patients has decreased from around 450 per month to 120-200.
“The situation is better than before,” Salem said, “because of the coordination of organizations now providing psycho-social and mental support.”
“A lot of people come to the clinic just to talk to someone, and this is healing,” adds Moussa.
Even so, health officials say there remain thousands of IDPs who need mental health care.
The lack of funding and a clear strategy for a sustainable solution are the main reasons the northern IDP crisis is “protracted”, according to Moussa.
“Generally, economic opportunities are absent. What we need is capacity and support-building projects, reintegration activities, assistance in the rebuilding of properties, and grassroots initiatives like helping farmers get seeds and tools they lost during the wars,” he said.
Additional funding and a comprehensive, integrated humanitarian strategy will almost certainly require broader political stability in order to produce sustainable solutions.
Until National Dialogue negations are concluded, the government’s current policy is to focus on seeing the displaced returned to the north, though many are far from ready to go back.
*not a real name