Reem Al-Fadhli (South24)

At the start of 2025, the city of Aden entered a new season of health decline, with rising signs of epidemic diseases becoming a recurrent feature in people’s lives. Since the beginning of this year, the city, along with a number of nearby governorates, has witnessed a sharp increase in viral fever cases, resulting in the deaths of dozens of people, and with thousands of others falling ill, according to official health sources. 

This new wave of epidemic outbreak is not exceptional but follows an annual familiar pattern in Aden, a coastal city with a humid tropical climate that naturally favors the spread of insect vectors, especially with the onset of summer. Dengue fever, malaria, and chikungunya remain the most common diseases during this period, consistently ranking among the top of health threats that residents face each year, amid the lack of equivalent institutional improvements in preventive or response mechanisms.

However, what makes this year’s situation more complicated isn't just the repetition of the phenomenon but the accumulation of factors leading to its exacerbation. The ongoing power outages have caused the sewage pumps to fail, leading to sewer overflow in some streets and neighborhoods and increasing the likelihood of the spread of related diseases. Amid this backdrop, cholera has reemerged, placing an additional burden on an already strained healthcare system and renewing old concerns about the feasibility, efficacy, and the sustainability of measures in a city where viral fevers have become a part of the annual cycle.

Suffering of Patients

In a crowded emergency room in a hospital in Aden, Maymona, a young woman who had a fever that lasted for two weeks in March, died after all attempts to save her failed. Her sister Afrah Nasser, who cared for her throughout the illness, is still in shock. She told ’South24 Center‘, with tears choking her voice, “When we felt that her case required moving her to hospital, we rushed her there. The doctor informed us that her platelet count had dropped below the normal level.”

Maymona had no idea that she had dengue fever and continued taking the over-the-counter pain reliever ’Solpadeine Effervescent tablets’ thinking it is just a normal seasonal illness. According to her sister, the temporary relief she used to feel from the medicine masked her steadily worsening health condition. Afrah said: “We thought it was just a passing fever. But in her last days, she could no longer get out of bed.” 

The story of Rasha Suleiman, a pseudonym for another young woman with similar symptoms, reflects the fragility of the healthcare system. A private hospital in Aden prescribed her a fever reducer containing caffeine which worsened her condition. Her father said that “her platelet levels dropped from 130 to 70 within just a day and a half of taking the medication.”

He added that a relative working in the medical field identified that the drug was unsuitable for dengue fever cases, and warned that delay in proper treatment could lead to tragic consequences. The father added: “If we had not acted in time, we cannot imagine what could have happened to my daughter because of this disregard for human life.”

Seasonal Epidemics 

Official statistics indicate that a recurring epidemic pattern has become a constant feature each year in Aden. Dr. Majdi Al-Daeri, Director of the Epidemiological Surveillance Department at the Health Office in Aden, confirmed that the city experiences annual spikes in viral fever cases, and that the current wave is not isolated, but a continuation of similar outbreaks in previous years.

In an exclusive statement to ’South24 Center’, he said: “All cases received by health facilities over the past months have been documented and submitted to the relevant authorities as part of the Epidemiological Surveillance Program.” He said that data compiled till May 28 shows around 1,550 confirmed dengue fever cases, along with 30 deaths, primarily in Al-Buraiqeh District followed by Al-Mansoura, Sheikh Othman, and Khor Maksar. 

Dr. Sheikh Abdulhafiz, Assistant Professor of Microbiology and Immunology, Faculty of Medicine, University of Aden, stressed that dengue fever currently tops the list of prevailing infections, followed by malaria. He detailed the clinical symptoms of each. Dengue fever is typically accompanied by high fever, pain behind the eyes, joint and muscle pain, skin rash, and a notable drop in platelet count. Malaria, on the other hand, is characterized by cyclical attacks of fever accompanied by shivering and sweating, which makes clinical diagnosis insufficient and accurate laboratory tests are required to confirm the infection. 

Amid the spread of viral fevers, health concerns in Aden are rising due to the alarming signs of cholera's resurgence. The Public Health and Population Office in the capital issued an urgent warning on May 20, stressing that conditions have reached a critical level with an increasing number of cases, amid a lack of support and a complete cessation of funds.

In an official memorandum addressed to the Governor of Aden, the office explained that the withdrawal of international organizations from funding Aden’s Cholera Isolation Center at Al-Sadaqa Hospital has led to an almost complete halt in services, leaving the only medical facility specialized in combating cholera with just one doctor and three nurses.

The office pointed out that shortage of medical staff and supplies, coupled with an inability to handle growing patient numbers, threatens a total collapse in the epidemic response capabilities. It added that the center is no longer capable of receiving cases, forcing doctors to seek assistance from their homes in a situation that threatens the widespread transmission of infection, not only in Aden but in the neighboring governorates as well.

Extensive Spread and a Conducive Environment

Dr. Majdi Al-Daeri confirmed that cholera cases have been rising since late April, noting that all districts of the capital have reported suspected cases, without exception. The highest concentration of infections has been in Dar Saad, Sheikh Othman, and Al-Mualla districts, with around 850 suspected cases documented, including five deaths, till May 24. Of these, 190 were confirmed by using rapid tests, while about 30 were laboratory-confirmed cases using PCR testing.

Dr. Sheikh Abdulhafiz described the cholera situation in Aden as alarming, especially with hundreds of cases recorded daily in densely populated areas like Dar Saad, Sheikh Othman, and Al-Mualla. He believes the outbreak is directly linked to contamination of water sources, deteriorating sanitation services, and the absence of effective health oversight, exacerbated by a shrinking medical response due to drug shortages and weak diagnostic capabilities. He emphasized that these factors require an urgent and coordinated response, not just short-term fixes.

While climatic factors are common in most coastal cities with tropical weather, the outbreaks of fever cases in Aden have dimensions that go beyond nature. According to Dr. Sheikh Abdulhafiz, the city's environment supports continuous mosquito breeding due to structural issues, most notably poor drainage, open water storage tanks, the accumulation of organic waste in residential neighborhoods, and the absence of regular spraying and sustained environmental controls.

Abdulhafiz pointed out that the accumulation of litter after the rainy season creates ideal breeding grounds for mosquitoes, as stagnant water provides the perfect environment for the vectors to rapidly increase their numbers. The frequent power outages have a dual impact, as they not only disrupt the sewage infrastructure but also increase residents' exposure to mosquito bites, especially in crowded areas lacking alternative means of protection.

These factors collectively contribute to recurring outbreaks of dengue fever, malaria, and chikungunya in Aden, amid the lack of a fundamental solution to change the dynamics of the crisis. Abdulhafiz believes that part of the problem is due to the lack of urban planning and the proliferation of neighborhoods lacking sewage or safe water networks, forcing residents to store water in uncovered containers that create an ideal environment for mosquito breeding.

Regarding viral variants, he stressed that there is no clear local evidence so far about significant viral mutations. However, some regional studies suggest slight changes that could increase symptom severity or contribute to pesticide resistance in some mosquito strains.

Al-Daeri attributed the differences in epidemic prevalence across Aden's districts to the varied environmental and social patterns. He pointed out that the presence of camps for displaced people in Al-Buraiqeh district, in addition to the grazing and waste accumulation, provide a fertile ground for mosquito breeding. While in Al-Mansoura, the population density raises the risks of infection spread, in Khor Maksar, construction and urban expansion contribute to the creation of uncovered water storage pockets, doubling the risks of disease outbreaks.

Al-Daeri also highlighted the role of climate change in complicating the health situation, noting an increase in some skin diseases and a rise in viral infections, compounded by the presence of four serotypes of the dengue virus and all known malaria parasites in Yemen, which increases the likelihood of repeated infections and further complicates medical responses.

Weak Response

In addressing the spate of viral fevers and other epidemics, Aden’s health response appears fragmented and constrained by limited resources and poor coordination. Although the Health Office conducted field campaigns across the eight districts, including spraying operations in 90% of the areas and deploying awareness teams for several days, these actions have been insufficient to contain the spread of the infections, according to field evaluations by the authorities.

Dr. Sheikh Abdulhafiz believes that basic preventive tools, such as pesticides and mosquito nets, remain somewhat effective but are gradually losing their efficacy due to random use and lack of updated environmental control programs. He emphasized the importance of covering water storage tanks and organizing campaigns to eliminate potential mosquito breeding sites. He also underscored the need for coordination between health authorities and local bodies to implement preventive spraying programs, distribute mosquito nets, and conduct regular cleaning and environmental monitoring campaigns.

However, the resource gap remains a major obstacle to any organized response. According to Abdulhafiz, the lack of sustainability hinders long-term implementation, making any intervention vulnerable to collapse when the external support is withdrawn. He advised residents to use mosquito nets throughout the day, eliminate standing water, and visit health facilities if the fever persists beyond two days, or if alarming symptoms such as skin rashes, bleeding, or joint pain appear, warning against relying solely on antipyretics without accurate medical diagnosis.

For his part, Al-Daeri called for strengthening the prevention system, by ensuring access to safe drinking water, launching vaccination campaigns in high-risk zones, repairing sewage networks, and providing essential medicines and medical supplies. He also pointed to a clear deficiency in community awareness and suggested expanding educational campaigns via social media and relying on local communities as a more sustainable collective prevention tool.

Absent International Role

Amid the ongoing rise in infections, the dwindling presence of international organizations in Aden has become another factor exacerbating the fragility of the healthcare system. The problem worsened when the International Rescue Committee (IRC) announced on May 8 its withdrawal from its emergency response in Yemen, after a period of combating the cholera outbreak. Despite its pullout, the committee warned that the country remains at risk of future epidemics unless an urgent global intervention is activated. According to its data, over 260,000 suspected cholera cases and 870 deaths were recorded in 2024 alone.

In an attempt to prevent the situation from exploding, the Ministry of Planning and International Cooperation issued a distress call on May 26, calling on international partners to provide urgent medical support, including medicines, supplies, fumigation campaigns, and public awareness efforts. The ministry also declared its readiness to offer all facilitation and coordinate with local authorities to ensure an effective response.

Despite some limited efforts, such as UNICEF's provision of medicines and medical supplies, Dr. Majdi Al-Daeri acknowledged that the decline in external support, especially from American entities, has led to the withdrawal of organizations and a reduction in medical personnel, particularly at Al-Sadaqa Hospital. Official requests have been made to reinforce medical staff, but the responses have been minimal. As part of internal efforts, regular awareness campaigns have been coordinated, though their impact remains limited due to weak media coverage and community outreach.

Dr. Sheikh Abdulhafiz stressed the need to develop a permanent awareness strategy in partnership with local media and community leaders to break the chronic silence surrounding fevers in the city. He noted that the absence of accurate media coverage contributes to the normalization of the epidemic situation and weakens the necessary pressure on health authorities.

In a related context, ‘South24 Center’ submitted an official memorandum to the Director of the Health Office in Aden, Dr. Ahmed Al-Bishi, requesting permission to film a field report inside the epidemic Isolation Center at Al-Sadaqa Hospital. However, till the time of the report's publication, no response has been received. The author also attempted to contact the center's director, Dr. Saleh Al-Dubhi, who said that he is prohibited from making media statements. This reflects the challenges local media face in accessing the truth within public health facilities.

Despite scattered efforts by local authorities and limited spraying and monitoring campaigns, there remains a general feeling that the city has been left to fight a long battle alone against epidemics that have become endemic, reproduced annually due to a deteriorating environment, absent urban planning, and the withdrawal of partners who once served as the first line of defense.