As conflict in Yemen continues into its second decade, midwives and doctors at MedGlobal Yemen are seeing married girls as young as nine years old seeking care.

Even before the war, Yemeni families arranged marriages for 12-year-old daughters, said Dr. Wafa Al-Shaibani, the NGO’s country director. While current numbers aren’t available, she said about 30% of marriages before the war began involved girls under 18.

“We try to educate people that she’s a child, that she will have complications” with early pregnancies, Dr. Al-Shaibani said. But it’s most often poverty, exacerbated by years of war, that motivates the decision.

“The people, they get hungry,” she explained. A family that can’t feed a daughter may feel compelled to agree to an early marriage so she and their other children can survive.

MedGlobal Yemen’s midwives care for pregnant women and girls at local clinics, many located in rural communities where health care is otherwise inaccessible. Dr. Al-Shaibani said that while education about reproductive health and the risks of child marriage are available to patients, midwives’ work is often preventing the worst from occurring.

“When a child comes to the health facilities, she has to have special care,” she explained. “At least we can help these mothers not to die.”

The War on Women’s Health

War, no matter when or where, is disastrous for the health of women and girls. And in Yemen, where an uncertain period of calm has given way to new U.S. airstrikes across the country (the most recent attacks occurred overnight and into Monday morning) and escalating hostilities, the consequences of war have been devastating. A Yemeni woman dies in childbirth every two hours, most often from preventable causes, according to the United Nations Population Fund, and 5.5 million women lack access to reproductive and maternal health services.

Dr. Al-Shaibani said that women and children currently make up 77% of those displaced in Yemen, and a growing number of households are headed by women alone and dependent on women’s income.

Breast cancer, the most common cancer among women worldwide, is a growing threat in Yemen, where cancer treatment centers have closed and those that remain are overburdened, doctors have fled the country, and funding and cancer medications are difficult to come by. Dr. Amani Hussein Saleh Shehab, an oncologist at the Pink Clinic in Yemen’s Lahj Governate, said that most women with breast cancer have an advanced case by the time they are able to be diagnosed.

To meet women’s health needs in Yemen, Direct Relief is supporting both MedGlobal Yemen and the Pink Clinic, founded by longtime partner Yemen Aid. MedGlobal Yemen received a 2024 grant of $100,000 to train midwives to operate maternal health and family planning clinics in remote areas where health care is much less accessible. The Pink Clinic was funded through a grant of $16,000, part of more than $360,000 in grants Direct Relief has provided to Yemen Aid.

MedGlobal Yemen also received 20 midwife kits, each containing enough medical instruments and consumables to facilitate 50 safe facility-based births, and other medical supplies.

In addition, through Yemen Aid, Direct Relief provided a delivery of the breast cancer medication trastuzumab, a biologic agent requiring precise cold-chain transport, monitoring, and logistics, and valued at a $1.77 million, to the Ministry of Health.

“Despite very limited refrigerated storage at the Aden airport, disruptions in regional flight schedules, and restrictions on cargo size, these critical temperature-controlled medications were delivered safely,” said program operations specialist Holland Bool.

“Her Families and Her Tribe”

Restrictions on women’s movements, a lack of health care access, and men’s control over family decision-making present ongoing threats to health outcomes for mothers and babies, Dr. Al-Shaibani said. Women may not be allowed to have a skilled birth attendant, or deliver outside the home, making infections like tetanus or complications like a ruptured cervix much more likely.

To make maternal health care and skilled delivery more accessible and routine, MedGlobal Yemen is training midwives to operate clinics in remote communities.

“There are very remote areas where there are no health facilities, no access to any health care,” Dr. Al-Shaibani explained. Families have no money to travel to faraway health clinics, and are often more trusting of their own communities.

In response, MedGlobal developed the idea of Female-Friendly Community Clinics, working with midwives who were already part of remote communities but who would primarily have worked in patients’ homes, receiving money or even food for their services. “She is one of the community, so these are her families and her tribe,” Dr. Al-Shaibani said of the midwives. “They do this work but it is not organized, so we will organize it.”

Midwives trained by MedGlobal and outfitted with Direct Relief maternity kits will operate in about 50 small local clinics, providing family planning, maternal and antenatal health services, and women’s health education. Complicated cases and young mothers can be referred to a health facility to receive additional monitoring and care.

Those who have completed the training have described using new techniques to save a mother and baby during a breech delivery; working through the night to attend critical cases; learning to use portable ultrasound devices and insert IUDs during patient care; and rejoicing in their ability to reduce complications for mothers and babies.

For women who are their family’s sole source of income, too – increasingly common during the war, Dr. Al-Shaibani said – or who have struggled to feed their children as the conflict drags on, midwifery offers a valuable career, providing financial stability while benefiting the larger community.

“She is also a woman who needs to feed her children,” Dr. Al-Shaibani explained.

Critical Care

Breast cancer is the most common cancer for women worldwide, but Yemen reports a high rate of young women with breast cancer, a high likelihood that the cancer will not be diagnosed until advanced stages. where oncological treatment centers have closed and those that remain are overburdened, and where funding and cancer medications are difficult to come by.

The Pink Clinic, in Lahj, is focused on breast cancer, and hopes to soon offer treatment for cervical cancer as well. Dr. Shehab, the oncologist, said that the decline in services has also meant less awareness – “many families don’t know about this cancer” – and most people can’t afford treatment even if a woman develops breast cancer. Shame is an additional factor, with women who show symptoms often preferring to hide them until pain or symptoms become untenable.

“Most cases that attend the Pink Clinic are in the critical or late stage,” she said.

Despite the challenges, Dr. Amani said, the clinic has had remarkable success. One woman came to the clinic seven months pregnant, but urgently needed treatment for breast cancer. She and her baby are both healthy now. A new mother who came to the clinic with a rare type of cancer was quickly treated and able to return home.

For many women with breast cancer in the surrounding area, the Pink Clinic is their best hope. There are hospitals in Aden, a major city, but it’s far to travel. Moreover, Dr. Amani explained, women in Lahj Governate are particularly vulnerable to cancer because of contamination from nearby laboratories and factories.

Loss of international support threatens the Pink Clinic’s work, and Yemen Aid staff are concerned about funding the clinic’s services, as well as other programs focused on women and children, after July.

“A New Normal”

War doesn’t just kill people directly, Dr. Al-Shaibani said. It threatens their health, and merely surviving is just too low a bar.

“A mother may survive, but she survives with a ruptured cervix” when health services are cut off by conflict, she said.

MedGlobal Yemen’s goal isn’t just to meet the most emergent needs, but to rebuild the health services that Yemeni people need to live good lives, even as the conflict goes on – what Dr. Al-Shaibani calls “a new normal.”

“We [build] qualified health services that will help them in the future,” Dr. Al-Shaibani said. “It’s not just life. It’s quality of life.”