“She died before she reached the health center; she died with her baby before it saw the light,” Salma Al-Bahr of Taiz said, grieving over her sister.

While Yemen covers 555,000 square kilometers, it only has approximately 2,000 reproductive health centers, with 60 percent of them offering different services such as labor and pregnancy, after-delivery and family planning methods. 520 centers offer more extensive emergency services, and 69 hospitals cover essentially everything else, according to Dr. Iman Al-Qubatti, general manager of reproductive health at the Ministry of Health.  

Al-Qubatti said that according to international standards, for every 500,000 people, there should be a comprehensive emergency delivery hospital, in addition to four basic health centers. However, Yemen is a special case as much of its population lives in potentially inaccessible rural areas.

“Yemen has roughly 130,000 residential areas, sometimes in very remote areas,” Al-Qubatti said.

Because some areas are far from health centers and only accessible by rough roads, when people have medical emergencies, then they often reach hospitals too late for effective care.

Only 2,000 reproductive health centers cover Yemen›s 550,000 square kilometers.

According to Hadi Mosed, the Ministry of Health will be able to provide finances to governorates by 2013.

Ali Al-Seraji, head of a health unit in Sahar, Sa’ada, said most patient fatalities happen in rural areas, especially near the Saudi Arabian and Omani borders, which are unreachable by health services.

“The mortality rate for mothers giving birth is increasing because of the lack of services as well as the rugged roads,” Abdol–Ellah Al-Mwtawakel, health officer in the Executive Center in Sahar, Sa’ada, said.

Al-Qubatti said the Ministry of Health is trying to overcome the challenges facing medical services in the country, and geographical and cultural problems in rural areas are recognized as serious challenges.

“We try to build facilities so that for every 250,000 people there is one comprehensive emergency delivering center and four basic service emergency delivering centers,” she said.

Al-Seraji said there are several different obstacles preventing teams from effectively working such as a lack of financial support, medicine, doctors, medical equipment and more, which add up to too few facilities in rural areas.

“Most health centers don’t have enough doctors; they only hire one general practice doctor who assumes the role of doctor, midwife and pharmacist,” he said.

Al-Qubatti said recruiting enough medical staff is also a challenge. She also said a system where doctors rotate shifts doesn’t exist in medical centers. Thus, there is limited time dedicated to emergency cases.

“The lack of budget has caused the disappearance of the shift system for doctors in health centers,” Al-Qubatti said.  

Hadi Mosed, manager of Sahar’s health office, said they presented the issues to local councils but have not seen any serious action as a result.

“Even if there were financial support, it wouldn’t be enough to cover the center’s different needs,” Mosed said.

In the aftermath of last year’s political unrest, in many rural centers, financial support comes from donors providing medical teams or equipment, even furniture.

“Most of the health units in our area were given as gifts such as medicine and furniture from organizations to aid our missions,” Al- Seraji said.

The Ministry of Health has focused on increasing the number of midwives, particularly in areas without a health center to serve women, in an effort to improve the lack of immediately available healthcare. Midwives come to other women’s houses to provide pregnancy and delivery services.

Mobile medical teams also visit rural areas to serve people about four times annually, according to Al-Qubatti.

Mosed said suggestions they are given are taken very seriously, such as creating committees to survey the needs of health centers in rural areas.

He said that in 2013, the Ministry of Health will support ten governorates with additional finances and will increase the number of health centers from 69 to 93.