Itar Foundation for Social Development, national nonprofit organization, was funded by UN Women to implement the “Piloting Displaced Women’s and Girls’ Humanitarian-Peace Dialogue in Yemen” project. The project recognizes that women and girls often bear the brunt of conflicts and displacement, experiencing heightened risks of violence, exploitation, and discrimination. Upon that, the project initiative aims to amplify the voices, of the women and girls, displaced and host communities, in calling for permanent peace and urgent humanitarian response.

Itar Foundation is the leading implementing partner working with Thakerh for Media Production, Yemeni Women Union, Youth Without Boarders, Enough for Humanitarian Protection, and Wa3i Foundation. Thakerh for Media Production, national nonprofit organization, is responsible for implementing and managing the communication activities of the project’s deliverables.

The briefing paper is organized around both explanatory and exploratory research methods. These two methodologies are applied in tandem to gain a holistic understanding of a certain theme, viable, or event, and the linkage between these factors. The methodology is entirely based on a is a desk review of various literature such as peer-reviewed journal articles, reports, and news articles related to social connections, social networks, and humanitarian assistance, as well as vigorous key interviews that provide a comprehensive understanding of a particular factor or event. The research team investigated the concept of reflexivity[4], which involves examining one's own taken for granted assumptions. These reports and datasets were derived from a variety of popular humanitarian websites, including Humanitarian Needs Overview, Humanitarian Response Plan, NCBI.NLM[5] & Climate Change Knowledge Portal, and UN Women Publications, UNICEF. Further to these sources, the team consulted reports from recognized humanitarian actors, journals, blogs, and reports from social and cultural humanitarian-related websites.

The briefing paper's format is based on drawing notes of pertinent observations, after which it sources the meaning and interpretations of these observations. Subsequently, the deliberation of these that address "why so?" is followed by disputations over the matter and conclusions. The analytical framework comprised both quantitative and qualitative analysis approaches. Descriptive and regression analysis were used in the quantitative analysis, while latent and theme content analysis and interpretive phenomenology analysis were used in the qualitative study. In addition, the use of discourse analysis to investigate how language impacts social interactions and structures, with a focus on power relations, identity, and culture. The entire analysis process is underpinned by ethical considerations, ensuring an accurate yet thoughtful examination of the humanitarian challenges at hand.

In terms of limitations, the research endured limitations such as potentially incomplete evidence, the absence or shortcoming of specific data for certain queries, documentation coverage limitations, potential bias, and subjectivity in stakeholders' perspectives, both retroactive and proactive. However, the impact of such constraints is mitigated by triangulating various sources and validating stakeholders’ general insights with other pertinent data at the same time.

Result One: The Health Imbalance: Bridging Disparities and Reproductive Health Staggering Needs!

Before 2015, there were limited resources and services available for health care in Yemen. But after the conflict and its drivers exacerbated the situation and the needs for health care more than before. Reproductive health and the well-being of IDP women, girls, and children, as well as the marginalized communities in Yemen, have long been a pressing concern. Yemen already faced a significant health crisis, with high maternal and child mortality rates. The situation worsened with the ongoing conflict, leading to a severe shortage of healthcare services and supplies. The situation is further exacerbated by the ongoing conflict, which has led to a severe lack of access to healthcare services. This briefing paper aims to discuss the current needs of healthcare for these vulnerable groups and the ongoing efforts to support women and motherhood through various organizations and initiatives.

In recent years, the situation has worsened due to ongoing conflicts and a lack of adequate healthcare services. Various organizations, such as YAMAN (which worked closely with IDP women and girls to ensure they receive the necessary support during pregnancy, childbirth, and postpartum care), Mary Stop’s support (which aims to improve the health and well-being of women and girls in Yemen. They focus on providing access to reproductive healthcare, family planning services, and education on maternal and child health), National Alliance for Safe Motherhood (which works to reduce maternal and neonatal mortality rates in Yemen by providing training to healthcare professionals, raising awareness about safe motherhood practices, and advocating for better access to quality healthcare services), and the UNFPA (which supports vaccination programs in the south and north of Yemen. They work closely with local health facilities to ensure that women and girls have access to essential healthcare services, including prenatal care, delivery assistance, and postnatal care). Theye all have stepped in to address the issue, focusing on vaccinations and maternal health in both the south and north of Yemen.

Despite the efforts of those organizations, the healthcare system in Yemen continues to struggle, with a lack of funding and resources being a significant challenge. The number of beneficiaries needing assistance remains high, as many women and children are still without access to adequate healthcare services. This has led to a growing disparity between those who can access proper healthcare and those who cannot. As per the latest report by UNOCHA[6] that in the field of health the latest funding was 163,698,658 US$, and the coverage was only 41.8% of all the needs while the current requirements is 392,000,000 US$. This is a proof that the gap is 58.2% which will increase as the conflict continues.

One of the main reasons for the ongoing disparity in healthcare is the design of the projects themselves. Many initiatives focus on specific regions or populations, leaving others without access to essential services. Additionally, the limited funding available often leads to a focus on immediate needs, rather than long-term sustainability and growth. This issue of the health imbalance and reproductive health disparities in Yemen needs to be addressed urgently. The lack of access to proper healthcare facilities, the role of historic, current, and pervasive racism, and the increasing early marriage[7] are some of the factors that contribute to the staggering disparities in maternal mortality rates among women. The future of the problem depends on the implementation of humanitarian action programs that address the root causes of the problem.

In Yemen, family planning can be traced back to the early 20th century when the country began to experience rapid population growth which was exacerbated by the lack of access to quality healthcare, education, and socio-economic development. In the 1990s, the Yemeni government introduced the National Population Policy, which aimed to address the issue of high fertility rates and promote family planning. However, the policy faced several challenges, including cultural resistance, lack of resources, and weak implementation. In recent years, the issue of early marriage has emerged as a significant contributor to the problem of family planning in Yemen. Several Arab and local newspapers discussed the phenomenon of the spread of lunatics in Sanaa and the rest of Yemeni cities. A story, like other stories, was told by CNN[8] that a girl named Elham Mahdi of 12-year-old who was married off to an older man and died of internal bleeding following intercourse three days after she was. 

According to UNICEF, child brides are common in Yemen, where the United Nations estimates that one in three girls are married before age 18. Most are married off to older men with more than one wife. Early marriage places girls at increased risk of dropping out of school, being exposed to violence, abuse, and exploitation, and even losing their lives from pregnancy, childbirth, and other complications. A report the case of a 12-year-old Yemeni bride who died of internal bleeding following intercourse three days after her marriage. The girl was married to a man at least twice her age, and her death is a "painful reminder of the risks girls face when they are married too soon."[9] Early marriage places girls at increased risk of dropping out of school, being exposed to violence, abuse, and exploitation, and even losing their lives from pregnancy, childbirth, and other complications.

Afterall, we can work towards a future where all Yemeni women, girls, and children have access to the reproductive healthcare services they need and deserve. In order to bridge the gap and ensure equal access to healthcare for all, it is essential to redesign and reevaluate current projects. This includes developing more inclusive initiatives that cater to the needs of marginalized communities and investing in long-term solutions that promote sustainability and growth. By working together and prioritizing the needs of vulnerable populations, we can create a more equitable and just society. In conclusion, addressing the health imbalance and supporting women and motherhood in Yemen requires a concerted effort from all stakeholders. By working together and implementing sustainable projects, we can help bridge the disparities and improve the lives of vulnerable populations, particularly women and girls.

Result Two: Mental Health and Psychosocial Support: Stigma and Suicide Prevention!

Wherein so much is to be observed that Yemen's prolonged conflict along with the internal displacement movement and COVID-19 has had a tremendous impact on the population's mental health and well-being, particularly IDP women, girls, and children. The war has resulted in heightened trauma, stress, and psychological discomfort, particularly among disadvantaged groups who are already dealing with a number of issues. However, there is a scarcity of data and research to show how the conflict, relocation, and repeated displacement have impacted this vulnerable community group. While the impact of the war on IDP women, girls, and children is undeniably troubling, stating that everyone is traumatized and insane is based on a lack of data and generalizes individual experiences. According to research conducted by a group of researchers, "Displacement is another serious issue that has harmed people’s mental health as a result of war. Many people living in crisis zones have been internally displaced to camps in big cities and relatively safe places. Displacement had an impact on the mental health of internally displaced people (IDPs). Participants stated that IDPs were compelled to leave their homes and cities of habitual residency, which harmed their mental health in various ways."[10]

The stigma surrounding mental health issues in among the IDP communities, particularly women, girls and children exacerbates the problem. In the Yemeni society in general and in the IDP community in particular, mental illness is often seen as a taboo subject, leading to discrimination and social exclusion for individuals seeking help. This stigma prevents many people from accessing appropriate mental health services or disclosing their struggles openly. Consequently, individuals with mental health conditions may suffer in silence without receiving the necessary support and treatment. In this ultra-sensitive social context, stigma was and is still one of the main issues and obstacles to be faced in realizing. Stigma is deeply rooted in the tribal system in Yemeni society on health and a red line that community members NEVER EVER can even think to try to cross. In UNICEF's report, stigma was described as "Stigma was also cited as an obstacle for girls and women in seeking help. A representative from the Yemen Women’s Union stated that: “Culture and tradition with the fear of being exposed to the community if you seek help seriously affect women and girls to access any kind of services.”[11] Also, according to research, "there are many causes of suicide in Yemen, but the war crisis is directly affecting mental health of individuals. When we talk about war, people are exposed to stress for a long period which is a risk factor for mental disorders."[12]

Suicide prevention is another critical aspect of addressing mental health challenges in Yemen. The conflict and its associated hardships have significantly increased suicide rates among both adults and children. Limited access to mental health services, coupled with the stigma surrounding suicide, hinders effective prevention efforts. It is crucial to raise awareness about suicide prevention strategies, promote mental health education, and establish accessible support systems to tackle this issue effectively. Suicide prevention initiatives are hampered by limited access to mental health care and the stigma associated with it. Early marriages can lead to early pregnancy, which can result in difficulties such as mortality and hemorrhage in pregnant women and children. This is especially true for IDPs community in Yemen, who frequently face additional challenges as a result of the ongoing conflict, trauma and displacement and lack of access to essential services, including child marriage, gender-based violence, breakdown of social support, and limited opportunities for education and empowerment. These factors make them more vulnerable and raise their risk of mental health problems, including suicide. To effectively address this issue, it is critical to raise awareness about suicide prevention techniques, promote mental health education, and build accessible support systems. WHO provides comprehensive information on mental health, psychosocial support, and suicide prevention strategies. Their reports and guidelines offer evidence-based recommendations for addressing mental health issues globally and reported that suicide is considered one of the leading causes of death in Yemen, with 1699 suicide-related deaths in 2020, representing 1.09 of the total deaths all over the country.[13]

As a result of the collapsed infrastructure of the Ministry of Health in Yemen, the infiltration of insane people into the streets of Yemeni cities and villages continued before and after the conflict, but this phenomenon worsened after the conflict with no action taken neither by Yemen's concerned authorities, hospitals, centers specialized in psychological treatment, nor humanitarian organizations working in this field. These previously mentioned organizations have not provided any assistance these persons who have mental disorders or those suffering from psychiatric problems, particularly those IDP women, girls and children, as the most vulnerable group of people. The number of them is still even there was not any effort to collect any data on their cases.

This crisis is totally neglected. In the main findings of FAO's report, it was stated, "the main causes of the severe situation are the compounding effects of the escalated conflict and insecurity, which have resulted in dwindling employment opportunities and income combined with high inflation and exchange rate fluctuations. In addition to man-made events, the situation is also aggravated by natural disasters i.e. desert locust, cyclones and floods."[14] The demand for mental health and psychosocial help is growing significantly. Such health requirements continue to be among the most culturally stigmatized and underserved.

Result Three: Accountability: The Health Emergency Response and the Engagement of Female Displaced!

The issue of accountability related to the Health Emergency Response in Yemen is critical requiring a comprehensive approach, in the engagement of female displaced persons, especially women, girls, and children. When it comes to discuss the funding for addressing this very issue, as one of the primary challenges in addressing mental health and psychosocial support in Yemen is the lack of funding and resources. The situation has worsened due to the ongoing conflict and economic crisis, leaving the country with limited access to mental health services. Here is below a statistics of Funding progress by cluster/sector according to Yemen Humanitarian Response Plan (2015 – 2023)[15]:

The above table doesn't specifically mention any number of IDP women, girls and children, in terms of accessibility, awareness, arranging the beneficiaries, dispensation of medicines, information sharing, community involvement in decision-making, staff attitudes and behaviors, evaluations, visibility, and gender equality and equity. Though, according to UNFPA, "Of the 4.3 million people displaced within Yemen, more than three-quarters are women and children. Some 1.3 million women are currently pregnant, of whom nearly 200,000 are at risk of developing life-threatening complications yet have only precarious – if any – access to reproductive health services."[16] Again, one should know when the financing for Yemen's health sector is reduced in 2023 compared to prior years, it has serious implications for accountability, notably in terms of the Health Emergency Response and the participation of female displaced individuals. This issue is aggravated further by the country's increasing demand for mental health and psychosocial assistance.

We will go into the numerous components of this topic in this extensive examination, including the reasons for the lower budget, the influence on accountability, and the challenges faced in treating mental health requirements. On top of that, this is due to the lack of an important accountability role, which is due to a lack of seriousness in noting the lack of funding in previous years, despite the fact that Yemen is still suffering from a conflict that continues to be cruel to everyone, especially the most vulnerable groups of society, namely displaced women, girls, and children.

In the future of this issue and the reduction in funding for Yemen’s health sector in 2023 has significant implications for accountability, particularly in terms of health emergency response and the engagement of female displaced individuals. Limited resources hinder the ability to respond effectively to emergencies, impede the provision of gender-sensitive healthcare services, and curtail initiatives aimed at empowering women in the health sector. Additionally, the growing demand for mental health support remains unmet due to insufficient funding, exacerbating the mental health crisis in Yemen.

Result Four: Climate Change: The Invisible and Visible Threat!

Climate change is a global phenomenon caused by a variety of variables such as the use of fossil fuels, deforestation, and industrial activities. However, in the context of Yemen's protracted crisis, a country already dealing with climate-related difficulties such as water scarcity and food insecurity, the situation has been compounded by the region's ongoing conflict, leading to a humanitarian crisis. According to UNFPA's new research, "Yemen is among the 14 countries most vulnerable to climate change: Extreme weather events ranging from cyclones to droughts to flash flooding have been rising in frequency and ferocity over the past decade. Since the start of the year, climate disasters in Yemen have displaced over 200,000 people, many of whom had already been forced to move multiple times, losing their way of earning an income along with any access to basic health care."[17] 

The impacts of climate change are both visible and invisible threats. Visible threats include rising global temperatures, melting ice caps and glaciers, sea-level rise, extreme weather events like hurricanes and droughts, and changes in ecosystems. These visible changes have direct consequences on human societies, economies, and natural systems. In the Climate Change Knowledge Portal website, the below table provides high-level information on Yemen, Rep.'s climatic zones and seasonal cycle for mean temperature and precipitation from 1991 to 2020. 

The Köppen-Geiger climate classification system separates climates into five major climatic groups based on seasonal precipitation and temperature trends. Climate zone classifications are derived from this system. A (tropical), B (dry), C (temperate), D (continental), and E (polar) are the five major groupings. Except for the E group, all climates are assigned a seasonal precipitation sub-group (second letter).  Hovering your cursor over the legend reveals the climate categories. Following the visuals is a narrative analysis of Yemen, Rep.'s country setting and climate.[18]

There are also reasons that can be hidden in the threats associated with climate change. These include impacts on human health, displacement of populations, and challenges in coordination and collaboration among vulnerable groups. Addressing these challenges requires a multi-dimensional approach that considers both the visible and invisible aspects of climate change. Climate change is also contributing to the displacement of communities, as people are forced to leave their homes due to environmental factors such as flooding, drought, and extreme weather events. In Yemen, the combination of conflict and climate change has led to a significant number of internally displaced persons (IDPs), who are often unable to access essential services, including healthcare. According to a UNFPA's report, "Yemen's[19] conflict has displaced more than 4.5 million people within the country and left over 21 million in need of urgent humanitarian assistance. Meanwhile, the climate crisis in Yemen is only tightening its grip. Millions more lives and livelihoods hang in an increasingly fragile balance." In describing the natural hazards and displacement movement in Yemen, " This situation worsened in 2020 due to extreme flooding events which devastated communities and fueled the spread of diseases like cholera, dengue, malaria, and diphtheria. More than 300,000 people were affected, most of them IDPs who had fled conflict areas who now lost their shelters, incomes, and any form of livelihoods."[20]

The situation of IDP girls and children in Yemen is particularly dire, as they face unique challenges in accessing education, healthcare, and protection. Limited coordination and collaboration among local authorities, international parties, and organizations have further hindered their ability to receive adequate support. The situation has impacted harmfully on the IDP women, girls and children particularly, and this is proved in a report by YFCA in the website of Reliefweb that Climate change has specific impacts on vulnerable communities, including women, IDPs and refugees, children, and older people. Women are particularly impacted by water scarcity, it is usually their job to fetch water, even where it is kilometers away. In addition to the challenges women face stemming from their responsibility to fetch water, early marriage has increased."[21] In another report by USAID states, we are taken to the fact that "The ongoing conflict in the country has exacerbated water scarcity and food insecurity issues, leaving 2 million people (including 1.3 million children) malnourished, with projected losses in agricultural productivity due to impacts of climate change expected to intensify Yemen’s severe food insecurity."[22]

The role of Local Yemeni Authorities, International Parties, and Organizations is still not visible on the ground. That's to say that addressing the health challenges posed by climate change in Yemen requires a concerted effort from various stakeholders, including local Yemeni authorities, international parties, and organizations. the problem of climate change and its impact on health in Yemen is complex and multifaceted. Addressing this issue requires a collaborative effort from local authorities, international parties, and organizations. By working together, these stakeholders can help to mitigate the effects of climate change on health and ensure a more resilient and sustainable future for the people of Yemen.

Future Directions and Considerations

Sustainable Healthcare System Strengthening: Beyond immediate humanitarian response, efforts should focus on rebuilding a resilient and sustainable healthcare system in Yemen. This entails investments in healthcare infrastructure, capacity-building of healthcare workers, and the establishment of robust disease surveillance and health information systems.

Integration of Mental Health and Psychosocial Support (MHPSS): The protracted conflict has taken a toll on the mental health and well-being of the Yemeni population. Humanitarian healthcare programming should prioritize the integration of MHPSS services to address the psychological impact of the conflict, including trauma, anxiety, and depression.

Result One Recommendation:

1.        Expand and sustain services for vulnerable populations:

Broaden the reach of existing healthcare initiatives to ensure access for all, especially IDPs, girls, children, and marginalized communities. Design projects with long-term sustainability and growth in mind, including collaboration between organizations, secure funding, and community-based approaches.

2.       Empower healthcare systems and women:

Enhance local-international collaboration for a coordinated response. Scale up community-based healthcare services in remote areas.

Train and equip healthcare professionals, particularly in maternal and child health. Advocate for women's rights and gender equality to break down barriers and improve overall health.

Result Two Recommendation:

To improve mental health services in Yemen, it is crucial to secure adequate funding and resources from both local and international sources. This includes allocating budgets for mental health programs, providing training for healthcare professionals, and investing in research and innovation to develop new treatments and interventions. Additionally, it is to address the mental health needs of IDPs, local and international organizations must work together to provide specialized services, including counseling, psychological support, and access to medications. Additionally, it is essential to raise awareness and educate IDPs and their communities about mental health issues and available resources. This can be achieved through conducting training sessions.  

Result Three Recommendation:

Bridging the critical gap in healthcare provision demands a robust accountability structure within the health sector. This requires a multifaceted approach: 1) transparency through effective monitoring and evaluation, 2) empowering local communities in healthcare decisions, 3) fostering robust coordination and collaboration, 4) amplifying investment in mental health and psychosocial support, 5) championing gender equality and equity, 6) making services accessible and awareness widespread, 7) facilitating information sharing and community involvement, 8) tackling negative staff attitudes, and 9) ensuring transparent and impactful evaluations. Only through such comprehensive and interconnected efforts can we ensure equitable resource allocation, proper health service management, and ultimately, bridge the critical gap in essential care and support.

Result Four Recommendation:

1.        Building resilience amidst climate and displacement:

Strengthen healthcare systems and infrastructure to handle climate-related health risks, implement early warning systems, and promote climate-resilient shelters. Raise public awareness on climate-health impacts and support research for effective adaptation strategies.

2.       Prioritizing mental health and protection for vulnerable populations:

Integrate mental health support into disaster response and recovery, provide psychosocial services, and train healthcare professionals to address climate-related mental health issues. Improve coordination for IDP girls and children, ensuring access to education, healthcare, protection, and addressing gender-based violence and child exploitation.