Yemen. A Low Profile

Michel-Olivier Lacharité

In 2004, an insurrection led by former member of parliament Hussein Al Houthi broke out in the northern Yemeni governorate of Saada. His supporters objected to the Yemeni government’s political rapprochement with the United States, and demanded the return of Zaydism— the school of Shi’a Islam whose imams ruled Yemen until 1962. Lasting from June 2004 to February 2010, the Saada War was characterised by periods of intense conflict interspersed with relative calm.
The French section of Médecins Sans Frontières conducted an initial exploratory mission in northern Yemen in July 2007, after the signing of a ceasefire a month earlier under the auspices of the government of Qatar. After four episodes of fighting, the government had failed to suppress the Houthist movement, which had failed to gain control of any territory. MSF’s objective was to improve access to secondary healthcare in the Saada region, which had few hospitals and was at risk of renewed hostilities with the predictable consequences (war wounded, population displacements, etc.). The organisation started working in Haydan hospital in September 2007, in Razeh hospital in December 2007, and in Al Talh hospital in April 2008. While all three hospitals were in government-held areas when MSF first arrived, they progressively came under Houthi control during the course of the war—Haydan in 2008, and Razeh and Al Talh in 2009.

There was very little media coverage of the Yemen conflict between 2004 and 2007. The lack of war images and reports was due to the Yemeni government’s extremely tight control over information, exercised through physical persecution of journalists and legal prosecution of the regime’s opponents.1 These prosecutions stepped up in 2001, helped by Yemeni involvement in the “global war on terror”, which signified its alignment with the United States.2 The government also controlled the communications of the supporters of Al Houthi’s movement. Journalists close to the government created a think tank and a website,3 the analyses of which were aimed at limiting the rebels’ capacity for political mobilisation, leaving them with almost no way to get attention, aside from pamphlets distributed to the population and rare contacts with the few journalists who dared cover the conflict.
However, by the time MSF launched its project in September 2007, the situation had evolved over the previous months. Qatar’s diplomatic intervention had brought media attention to the conflict—notably by Qatari satellite channel Al Jazeera. The insurgents began distributing DVDs with footage of the war, their military victories and speeches by their leaders, and posted information via electronic mailing lists, allowing them to circumvent the pro-Houthi websites that had been taken down.
MSF was the only international aid organisation to reach the combat zones, aside from the ICRC, which was acting through the Yemeni Red Crescent. One of the few foreign witnesses to the conflict and its disastrous consequences for the population, the organisation faced a dilemma; should it help expose the violence of this little-known war, at the risk of jeopardising its work? Between 2007 and 2009, the shifting context of intervention prompted MSF to choose caution. Its room for manoeuvre depended largely on the goodwill of the government, which required that travel by international staff, drugs and MSF supplies all be approved on a case-by-case basis by the Ministry of Planning, the police, and the governor of Saada. In 2009, MSF deliberately limited its communications to only making its activities in Yemen known locally—in other words, to gaining acceptance from the parties to the conflict.

A Convenient Silence?

Between August 2009 and February 2010, the town of Al Talh came under Houthist control and the hospital where MSF was working found itself on a frontline that advanced and retreated between Al Talh and Saada city. It was hit by bullets and shell fragments on several occasions in August and September.
On 8 September 2009, the MSF hospital teams treated seven children and one woman wounded by the air strikes that hit the centre of the town. Only two of them survived their injuries. On 14 September government planes bombed Al Talh market: thirty-one wounded and nine dead were brought to the hospital. Within moments, Houthist supporters burst in, en masse, to take pictures of the wounded, until MSF teams convinced them to leave by pointing out that the presence of insurgents made the hospital a potential military target. The governmental authority in the region contacted the project coordinator several times that day, assuring her that it had not given the order to bomb, and anxious to know whether MSF was going to say anything publicly about the event. The next day, the central authorities issued a press release in which they denied any responsibility4 for the air strikes. Two days later, a government plane dropped pamphlets giving the population two options: fight the rebels or leave town.
In the days that followed, the fighting around Saada intensified. MSF teams worried about the impact of the growing insecurity on their ability to continue their work at the hospital. The evacuation routes toward the capital and Saudi Arabia were becoming increasingly dangerous, and the possibility of evacuating the international staff seemed less likely with each passing day. Members of the national staff, who travelled the road between Saada and Al Talh several times a week, were being stopped and harassed by the army, and prevented from moving around. Contacted by MSF in the hopes of obtaining assurances of safety, a high-ranking Yemeni military official advised the organisation to leave. On 22 September, MSF suspended its surgical programmes and arranged to transfer patients to the Saada hospital, about fifteen kilometres away. A few days later the expatriate staff were evacuated from Al Talh, and the national staff left the hospital.
The organisation said nothing publicly about the air strikes it had witnessed, thus failing to honour the commitment that had been made by the MSF movement as a whole in 2006: “We have learned to be cautious in our actions […] without precluding MSF from denouncing grave and ignored crimes such as the bombing of civilians, attacks on hospitals and diversion of humanitarian aid. Taking a stand in reaction to such situations and confronting others with their responsibilities remains an essential role of MSF”.5 How did MSF justify remaining silent about a serious crime that few direct witnesses relayed to the outside world?
Operational managers at MSF felt that condemning the air strikes would amount to placing blame squarely on the government, and would jeopardise MSF activities in Yemen with little clear benefit. Would speaking out about civilian deaths in the fighting prompt the combatants to show restraint in their use of violence?
More generally, in 2009, MSF was expelled from Darfur, its activities in Niger were suspended by the government and, at the time of the air strikes in Al Talh, a public statement by MSF on internment conditions for people displaced by the Sri Lankan conflict had angered the authorities there. The perceived trade-off between speech and action was being hotly debated within MSF, with some managers demanding that the organisation just keep quiet and deliver care. During an Al Jazeera interview several months earlier in the wake of the Darfur expulsion, MSF’s operations director had stated: “You have to be able to distinguish between human rights and international justice activists and relief organisations”.
MSF had little desire to risk its entire Yemen operation by denouncing a crime that didn’t affect it directly; nor did it want to demand publicly that the warring parties spare the hospital and guarantee the safety of its teams and their freedom of movement. As the fighting intensified, the teams decided to move the staff and patients to safety and evacuate the facility, saying nothing, seeing no immediate tangible benefit to speaking out. On 5 October, however, once the few caregivers who had stayed to receive patients after MSF’s departure had all left the hospital, MSF issued a statement to the national press agency and several Yemeni newspapers. Hoping to be able to relaunch its activities in Al Talh someday and fearing the hospital would be looted and bombed, it “called for respect for [Saada governorate] healthcare facilities and their purpose”—in this case, for the deserted building itself and the equipment.

Idle Words

Every year MSF compiled and published its “Top Ten Humanitarian Crises”, a public relations effort aimed at increasing its visibility in the media. December 2009 was no exception and Yemen was on the list.
In particular, MSF said that, “Violence escalated sharply in August as Yemeni army forces began carrying out air strikes and artillery assaults against Al Houthi rebels”, and reported that “tens of thousands [of civilians fled] into neighbouring Hajja, Amran, and Al Jawf governorates, where they had little to no access to healthcare services”.
The information was picked up by Al Jazeera and many other Arab media outlets. The Qatari satellite channel even ran a special edition on MSF’s statements on Yemen in December 2009, its analysts wondering publicly about the negative impact this speaking out would have on the credibility of President Saleh.
The government’s response was instantaneous. Right in the middle of the war, it immediately suspended authorisation for all of the organisation’s activities in Yemen—the movement of people and vehicles, imports, new projects, and the renewal of MSF’s framework agreement. In a meeting, government representatives laid out their main grievances to the head of mission: MSF had failed to remain neutral in the conflict by only condemning military violence and not that committed by the Houthists, and it had offered an unfounded evaluation of the healthcare services in government areas where it worked little, if at all. One of MSF’s government contacts concluded, “It was this kind of purely political report that got you expelled from Darfur”.6
Yet listing Yemen as one of the Top Ten Humanitarian Crises served no clear political or operational objective—other than “to attract media attention to a neglected crisis”.7 That lack of intention and objective resulted in a vague description of the conflict and its consequences in which the government may have seen a kind of empathy with the insurgents’ cause. And the brief account did present the government as the main culprit in escalating hostilities and impeding aid, cracking down on an uprising “claiming social, economic, political, and religious marginalisation”.
The authorities were explicit regarding the terms of the negotiation: if MSF agreed to deny that the Yemeni government was creating problems of access and that there was a lack of healthcare services in government zones, and to stress that the media’s sole use of the Yemen case out of the Top Ten report reflected that same media’s viewpoint only, the government would lift the sanctions. MSF accepted the deal. In December 2009, MSF operational managers sent the Yemeni government a letter acknowledging that the report may have appeared biased, and that the issues with civilian access to healthcare services were not sufficiently documented. The national press agency issued two press releases with headlines that spoke for themselves: “MSF apologizes for ‘inaccurate’ report on Saada”, and “MSF: apology to Yemen for wrong report on the health conditions of IDPs”. These were texted to a number of Yemeni mobile phone subscribers and picked up by about twenty national media organisations and a few international news agencies. The government immediately lifted all sanctions against MSF.
When Al Talh was being shelled, MSF saw speaking out publicly as a threat to its operations, rather than as a way to pressure the government to guarantee the safety of civilians and aid teams. It would have been difficult for the government to challenge immediate and first-hand testimony by a medical organisation treating the civilian victims of the air strikes, and itself affected by the lack of safety. But the Top Ten episode—which proved how sensitive the Yemeni government was about its media image during the war—showed how vulnerable MSF can be when it speaks out without a clear political or operational objective. At that point, the association had nothing to bring to the showdown with the national authorities. It had given the government fodder for its propaganda by denying that there were problems with access to care—problems for which both the government and the rebels were to blame.

Translated from French by Nina Friedman