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It wasn’t the airstrikes that was bringing the intensive care unit at Sabeen hospital to the brink of collapse, nor was it the wave of children beginning to show up with signs of cholera or the shortages of medicine to treat them. It was the bus fare.
Staff at the hospital in the Yemeni capital Sana’a had not been paid salaries in months and though they were eager to come to work, many did not have even the 100 riyal (30p) for the bus each day. Some nurses were walking two hours to reach the hospital.
Dr Najla al-Sonboli, the hospital’s head of pediatrics, knew the situation was not sustainable. The intensive care unit and the A&E could not keep running with ragged staff who often did not have food for themselves or their families.
So Dr al-Sonboli did as she often did when she needed advice and turned to old friends at Liverpool School of Tropical Medicine, where she obtained her masters and PhD before the outbreak of war in Yemen in 2015.
Her former colleagues in Liverpool moved quickly to start raising funds in £5 and £10 increments from a global network of epidemiologists and public health experts. Soon a lifeline was opened from Merseyside to distant Sana’a.
Each month the group sends £500 to £1000 to help make sure staff can get to work and afford a meal during long shifts. “The amount of money is small but it’s made a great difference,” Dr al-Sonboli told The Telegraph. “The emergency room didn’t collapse and we can cope with patients.”
The doctor and her team at Sabeen hospital are on the frontline of Yemen’s cholera epidemic, which has killed more than 1,800 people this year and spread to 21 of the country’s 23 provinces. More than 400,000 people have had the disease.
Each day Sabeen hospital, which is being supported by Unicef, takes in around 200 cholera patients. Often they are young children whose malnourished bodies shudder with constant vomiting and diarrhea as their helpless parents look on.
“I wish we could do more,” said Dr Luis Ceuvas, one of the Liverpool physicians who helped organise the funds and supervised Dr al-Sonboli’s PhD. “This war has taken Yemen back 20 years but people like Najla are still there working and showing a lot of courage.”
Abdul Hamed al-Zalab, a 42-year-old school administrator, was one of the desperate parents in Dr al-Sonboli’s ward. His two daughters Alanoud, 8, and Azahraa, 14, both came down with cholera after the holy month of Ramadan and both survived after treatment at Sabeen.
The family sold their furniture to raise money for rehydration tablets and other medicines to keep the girls alive. Their brother Ali had been killed a few months before in an airstrike conducted by the Saudi-led coalition, which is armed and supported by the UK and US. More than 10,000 civilians have been killed, according to the UN.
Doctors recommended that the older girl be kept in hospital for treatment but she refused to stay among the screaming women and sobbing children who crowd the hospital’s halls. Each day her family would navigate through streets where uncollected rubbish is piled like small mountains to get her to treatment.
“In Yemen, we are killed by the bombing or the cholera or the starvation. If you are not killed by the aggression then you are killed by the cholera or the starvation,” said Mr al-Zalab wearily.
Although Sabeen's bare wards are overstretched and they are badly short of basic medicines, the patients who arrive there are the lucky ones. Half of Yemen’s hospitals have been destroyed in the fighting and in rural areas there are often no medical facilities left.
“Many people die silent and unrecorded deaths, they die at home, they are buried before they are ever recorded,” said Jamie McGoldrick, the UN humanitarian coordinator for Yemen.
Humanitarian agencies say the cholera outbreak is “a man-made crisis” that has exploded out of an almost perfect storm of misery in Yemen.
The country was already the poorest in the Middle East before the war began and fighting has systematically toppled the pillars of a healthy society - the economy, the healthcare system, electricity infrastructure, clean water provision, and food supply have all collapsed.
Out of the country’s 28 million people around more than half are food insecure and around 7 million are severely food insecure. “In layman’s terms it means those 7 million don’t know where their next meal will come from,” said Dr Sherin Varkey, the deputy Unicef chief in Yemen.
Facing a crippling shortage of healthcare facilities, Unicef has tried to mobilise a volunteer army to go house to house to counter the spread of cholera. The goal is to have people telling their neighbours about best practices to avoid the disease and carrying simple treatments to help those who already have it.
Fathyah Ahmed Faraj, a stout 45-year-old woman and a mother of nine, walks through her neighbourhood of Raisin Hill in a full niqab knocking on doors and issuing brisk advice to frightened residents.
In one home she finds a 35-year-old man with cholera and his family are afraid to go near him. Make him bath with soap and don’t eat near him, she tells them, but don’t isolate him all the time. “He will become melancholy otherwise,” she says. Two of her own children had cholera and she knows how crushing it can be for a sick person to be alone.
Mrs Faraj goes wherever there are people, including to weddings and engagement parties that still take place amid the bombed out rubble of many areas of Sana’a. She urges people to use boiled water to wash their food and their khat, a plant that Yemenis like to chew to provide a mild stimulant.
Back at the Sabeen hospital, Dr al-Sonboli arrives for another day of work and walks through a lobby that has been hit countless time by bombs dropped from Saudi or UAE aircraft. She has moved house three times because her own home has been continually hit.
“Nowhere is really safe,” she mused. “Whenever we move from one place to another the danger is never far away.”
She thinks about Liverpool sometimes and how homesick she was during her first three months in the city. Over time she made friends with both locals and internationals and she remembers long nights at Kimos, a restaurant that serves Middle Eastern fare alongside British staples.
“I think of Liverpool now as a second home,” she said. “Maybe one day, if the good times come back, I can go back to Liverpool.”
For more information on Unicef's work in Yemen or to donate visit Unicef.org.uk/donate/yemen