Abdullah Al-Shadli (South24) 

Patients in Hadramout governorate, South Yemen, suffer from the exploitation of the private health sector, after the deteriorating of the government sector as a result of terminating fund provided by the local authority to this sector. [1]

The local authority in the oil-rich governorate had allocated a percentage of the taxes on the sale of the Yemeni famous plant “Qat” plant for the benefit of the government sector before this decision was stopped in April 2020 due to the prevention of Qat entrance to the governorate.

This fund was to contribute to strengthening the capacities of hospitals, stabilizing health work, reducing the burden on low income citizens, according to official health sources to "South24".

Resignations

Terminating government fund to the health sector led to a wave of mass resignations in several health facilities in the Hadramout Coast.

The first which was the resignation of the Office Director of the Ministry of Public Health and Population, Dr. Abdullah Mubarak Kaiti on August 14, 2020.

In a letter to Hadramout Governor, Dr. Abdullah attributed the reasons for his resignation to the "deteriorating health situation" on the Coast of Hadramout, and the "lack of capabilities" that would allow providing a decent humanitarian service.

Similar to Dr. Abdullah's decision, the general health practitioners in Ibn Sina General Hospital announced on October 1, 2020, a collective resignation to protest the violation of their financial rights and the hospital's deteriorating situation.

The resignation of 110 doctors came after they carried out a series of protests and civil strikes, the last of which was on September 22, 2020.

Emergency Department - Ibn Sina General Hospital in Mukalla, 11 November 2021 (South24, Abdullah Al-Shadli)

Sources told "South24" that "the reasons for submitting the resignation are due to the suspension of fund for the hospital which amounted to about 20 million riyals and was monthly received from the local authority in Hadramout."

The sources pointed out that "the hospital fund, used to meet part of its needs," noting that the work continued well until it was decided to lift the fund completely.

As an extension of the mass resignations wave, the isolation doctors at the Infectious Center in Ibn Sina Hospital announced their resignation as of August 31, 2021.

The resignation statement, signed by 18 doctors and medical residents at the center, stated that "the lack of preparation for the repeated waves of infectious diseases and Coronavirus forced the workers to resign."

The statement stated that there is a severe shortage of bed capacity and the lack of sufficient oxygen tanks, in addition to the violation of the doctors and workers' rights in the center.

Contractors of government hospitals in Hadramout Coast entered into a series of other strikes to demand their rights, which caused paralysis in health facilities, especially after they refused to receive patients during the strike, according to citizens who spoke to "South24".

Other government hospitals contractors who work for daily wages also carried out a series of strikes to demand justice and their rights. [2]

Exploit

In light of the deteriorating activity of the government health sector and the continued strikes, many patients turned to the private sector to receive care.

In an interview with "South24", health sources accused the private sector of "providing a commission for specialists who advise patients to go to a specific hospital," considering that this increases the cost to the patient.

In their accusations against the private sector, the sources claimed that some surgeries which require 20,000 riyals to be performed in government hospitals, are performed at 100,000 riyals, not including the specialist's commission which can reach up to 60% in private hospitals.

Hadramis feel that private hospitals are exploiting their clients.

Salem Basawad - a citizen of Wadi Hadramout - told "South24" that "treatment costs are high in private hospitals, and the average citizen cannot bear the burdens," claiming that their results "are sometimes unpleasant."

Local citizens accuse some private hospitals of "greed" at the expense of the patients' health who do not have the treatment costs and refuse to receive them permanently.

However, Dr. Ayser Al-Badani, Director-General of Al-Rayyan Specialist Hospital in Mukalla, confirmed to "South24" that "critical cases are treated directly from a humanitarian standpoint".

Some say that "the cost of admission in some private hospitals varies between 20,000 riyals to 30,000 riyals per day, not including the cost of treatment, and in addition, the patient is forced to pay a deposit (guarantee) of about 100,000 riyals."[3]

South24 journalist with the director of Al-Rayyan Hospital in the city of Mukalla, November 11, 2021 (South24, Abdullah Al-Shadli)

Regarding this, Dr. Al-Badani claimed that “the average room costs range from 12,000 riyals to 18,000 riyals per day, while it can reaches 28,000 riyals for intensive care unit,” noting that costs vary from one hospital to another and that they exceed 120,000 riyals in some other governorates.

Al-Badani added that "only few hospitals ask for a deposit that is kept as a guarantee, but not all of them."

Government and private sector

Governmental hospitals provide services at affordable prices to citizens, in light of their available capabilities and in which some citizens prefer them over private hospitals.

Dr. Abdullah Kaiti told "South24", "government hospitals have not reached the stage of total collapse, adding that budgets do not arrive in full".

Dr. Abdullah claimed that "the government is not committed to its role".  

In the context of providing services in the government sector, Russian doctor Abdulrahim Akaramov, a urologist at Ibn Sina Hospital, performed an operation to remove bladder stones for a patient with a total fee of about 34,000 Yemeni riyals.

Citizens stated that "such operations in private hospitals require about one million Yemeni riyals to be performed". [4]

Al-Badani considered that health facilities should not be "framed" within what he called "large consumers", noting that the cost of renting the building and the energy and water costs are factors affecting price increases.

"The weakness of the government health system led to the growth of the private health sector," Dr. Abdullah told "South24".

While other sources considered that "the absence of the role of oversight led to the growth of its activity."

Private health sources agreed with Dr. Al-Badani that the activity of these sectors is "commercial", referring to the weakness of financial support in the government sector, which made the levels of health service low.

Dr. Abdullah explained, "The private sector provides quality services that covers 60% of the health system, due to its advanced medical devices that are not available in government hospitals," noting that this sector "covered important aspects."

He continued, "private hospitals allow the patient to choose a consultant to supervise his condition," noting that this is among the services that government centers do not provide, in addition to some other advantages such as the rooms capacity and the free time of consultants to follow-up on patients.

Mistakes or neglect?

Despite the level of good services provided by the health sector in Hadramout compared to other governorates, sources said that "medical mistakes are not the only thing that threaten the patients' lives," indicating that "unjustified failure" to perform humanitarian work has become widespread in most government and private hospitals private."

A patient in one of the admission rooms of Ibn Sina General Hospital in Mukalla (South24, Abdullah Al-Shadli)

A young man's family relatives in Mukalla told "South24" that they "rescued their son, Sami Abdullah who was suffering from "poisoning" to a private hospital on February." They added that "the emergency department that received them described the condition as "stable" and that there is no harm in the young man staying in bed until the doctor arrive in the next day's morning," noting that the young man died while they were waiting for the doctor to come.

Regarding this, Dr. Abdullah said that “medical negligence is punishable by law, and medical mistakes are possible,” noting that the penalties if proven would reach the extent of withdrawing the work practicing license for the negligent.

Dr. Abdullah attributes the persistence of medical negligence to the fact that “citizens are unaware of their rights,” noting that people do not demand them and accept that medical negligence is a “divine destiny.”

Dr. Abdullah stressed that if citizens demand their rights, they will reach a settlement, noting that this will prompt the medical staff to be more careful to ensure patient's safety. 

In turn, Dr. Al-Badani told "South24" that "cases that reach intensive care units are sometimes difficult to treat," adding that people are aware and understand that.

Treatment abroad

Despite the spread of private hospitals in Hadramout, some citizens are forced to travel abroad to receive treatment.

Activists claimed that "medical mistakes in Hadramout are staggering and the cases that go abroad, some of them become poisoned as a result of the wrong prescription of medications."[5]

Dr. Al-Badani rejected "these allegations," saying that "people's generalization of this purely commercial policy is unjust."

Al-Badani ruled out "that any doctor's morals would accept prescribing medications if the patient does not need them."

Some patients suffer from health complications; as a result of misdiagnosis and inaccurate reading of medical reports by local doctors, some patients confirmed to “South24” that doctors abroad deplore the misdiagnosis of some diseases.

It is worth noting that many patients in Yemen go abroad to receive treatment, while many Hadramis, like other governorates of South Yemen, go to the Arab Republic of Egypt, as it is the least expensive.

It should be noted that Hadramout was receiving medical cases from neighboring governorates, most notably: Shabwa, Mahra and Socotra, thanks to the capabilities available in the governorate’s hospitals and the foreign medical staff working in government facilities, before the deterioration of the government health sector.

Informed health sources confirmed to "South24" that the continuation of terminating government fund will cause a complete collapse of the government health sector, and increase the wealth, exploitation and prosperity of the private sector. 

Abdullah Al-Shadli

Journalist and editor at South24 Center for News and Studies

Photo: One of the admission rooms of Ibn Sina General Hospital in the city of Mukalla, (South24, Abdullah Al-Shadli)