Ghasan Saleh starts digging graves at the break of dawn to prepare for the dead bodies that will come in droves. Two men in white hazmat suits appear atop an approaching pickup truck. They hastily drop a corpse into a hole and cover it with dirt.
The health workers come and go in near-silence. Fear of infection means there are no mourners for those suspected to have died from Covid-19.
The Al Radwan cemetery has quickly expanded over the past few months, with new graves creeping closer to the residential buildings that border it. “You can see my digging machine,” says Saleh. “Just now I dug 20 graves.”
Local medical authorities say that death rates in Aden are soaring this year, despite a relative lull in a war that ravaged the place in previous years.
In the first half of May, the city recorded 950 deaths – nearly four times as many as the 251 deaths in the whole month of March, according to a Ministry of Health report.
Those 950 deaths in two weeks in May represent nearly half the number of casualties the city suffered in all of 2015, when the country’s civil war was raging.
Back then Aden was devastated by heavy fighting, its streets blasted by rockets and its houses peppered with bullets. Now the city’s biggest killers are silent.
On top of Covid-19, there’s also a mosquito-transmitted virus outbreak, known as Chikungunya virus, and more than 100,000 known cholera cases across the nation. Many malnutrition centers and hospitals have closed due to funding shortfalls and doctors’ concerns about their personal safety from coronavirus. Flash floods this spring destroyed the city’s power grid.
“Yemen has faced wars and cannot handle three pandemics, economic collapse and a war and the coronavirus,” Dr. Ishraq Al-Subei, the health official responsible for the response to the disease told CNN.
The official Covid-19 death toll in southern Yemen stands at only 127. Health workers say they don’t know what the actual number is, because of low testing capacity. But the huge surge in deaths in Aden is being seen as a warning of worse to come, as the health sector becomes overwhelmed and more people die of treatable diseases.
In pursuit of a hospital bed
Hmeid Mohammed, 38, had an agonizing journey that started with a mild fever at home.
His family couldn’t find a hospital to take him to when his fever started to rise rapidly in early May. He was in a coma when he was admitted by the only hospital in Aden designated to treat Covid-19 at the time.
“They brought him back to life,” his brother-in-law Anwar Motref recalled.
He was diagnosed with meningitis, another disease common in Yemen. As soon as he showed signs of improvement, doctors advised him to leave the hospital to avoid becoming infected with Covid-19.
About a week later, his health deteriorated. Again, the family went to different hospitals in an effort to have him admitted, but with little success. Eventually they found him a bed in an emergency ward that he shared with six other people. Fluid filled his lungs and his kidneys were failing.
The family had the funds for medical treatment, but Aden’s hospitals were either closed or full. A hunt for admission to a hospital that could perform surgery and dialysis in time to save him failed.
Mohammed died in late May, robbing his three children and widow of the family’s only bread-winner.
“Who is to blame for all of this? We do not have a government or a state or anyone to help us in this country,” Motref said at the family home in the rocky hills around Aden.
“Who should we complain to? We are tired of this life. Every morning we wake up to hear of 10-15 people who died,” he added.
Disappearing aid and a collapsing health sector
The guns in Aden have become quieter in recent months but Yemen’s war has not gone away.
Five years of conflict has beggared the nation. Today more than half its population relies on aid to survive.
But the United Nations is now facing a potentially catastrophic shortfall in funds – around $1 billion – for this year. It is warning of a collapsing heath sector and the possibility that Yemen’s death toll may continue to rise dramatically – possibly exceeding the total number of dead during five years of war, when the country endured what was considered the world’s “worst humanitarian crisis.”
“We are a billion short of our minimum target,” Lise Grande, the head of the UN’s humanitarian operations in Yemen, told CNN. “So In the time of Covid what this means is that we’re going to see approximately half of the hospitals which we are currently supporting in the country closed down – and that’s going to be happening in just the next few weeks.
“A week before the first Covid-19 case was confirmed in Yemen we ran out of money and had to stop allowances for 10,000 frontline health workers across the country. In the middle of Covid, it’s devastating,” she added.
There are just 60 hospital beds dedicated to Covid-19 in Aden, which has a population of roughly 800,000. These are in two hospitals operated by Doctors Without Borders (MSF). The city has 18 ventilators, all constantly in use, according to MSF.
Doctors and aid workers say patients mostly seek hospital treatment in late stages of the disease, when it is likely too late to save them. And in most cases, there is no capacity to treat them.
“Most cases are rejected because there are no available ventilators,” Dr. Farouk Abduallah Nagy, head of the isolation department at the Gomhuria Hospital, told CNN.
“The health sector was already weak before the outbreak. And it is getting worse and worse. The health sector is collapsing,” said Caroline Seguin, MSF communications officer in Aden.
Outside the city, the fighting between southern separatists and the government rages on, compounding the effects of the ongoing five-year war between Houthi rebels in the north and the fractious coalition backed by Saudi Arabia and the United Arab Emirates in the south.
More than 112,000 people have been killed in airstrikes, shelling and bombing, according to the Armed Conflict Location and Event Data Project (ACLED).
Hundreds of thousands of people have been driven into camps as refugees from the war. There they face the risks of endemic disease, malnutrition, and overcrowding – all ideal conditions for the spread of a disease like Covid-19.
Mokhtar Ahmed, originally from the port city of Hodeidah in the north, came to a camp on the outskirts of Aden three years ago.
“Cholera and the wars are one thing and corona is something else,” he told CNN, flanked by his two children.
“With war, we moved from one place to another and we settled down… But with corona, no matter where you go, it will find you.”
Ahmed Baider contributed to this report from Sanaa. Mahmoud Nasser and Mohammed Khaled contributed to this report from Aden.