The World Health Organisation (WHO) has predicted that the number of people infected by cholera in Yemen could reach 300,000 after a breakout occurred in this country that has seen intensifying civil conflict since 2015.

According to the WHO, cholera cases in Yemen could rise by 200,000 to 250,000 over the next six months, in addition to the current 50,000 people affected.

WHO representative in Yemen Nevio Zagaria told journalists in Geneva by telephone from Sanaa that the number of cases “will be very, very high” and that the disease was spreading at “an unprecedented rate.” Zagaria said that health experts had estimated that the deaths could be as many as four to five per cent of those infected.

According to reports from relief and humanitarian agencies, the epidemic began to spread last October and continued to grow over the next two months. It then ebbed to some extent, but has now made a strong comeback after the collapse of the country’s economy and healthcare system.

The war has destroyed key medical facilities in Yemen, with 45 per cent of these now being partially or completely closed. The country also suffers from a lack of medicine, with most of this already being imported. At the same time, 14 million Yemenis, or about one third of the population, do not have access to clean water, with cholera being linked to a lack of potable water, malnutrition and unhygienic conditions.

The International Committee of the Red Cross says that the war between the Houthi rebels in Yemen and the Saudi-led Arab Coalition has made it difficult to control the epidemic. The cholera outbreak has thus far killed 450 people, while between 35,000 and 50,000 people are believed to be infected, about ten per cent of them children.

This is 20 times more than at the onset of the epidemic in October 2016.

Between 6 October 2016 and 11 January 2017, humanitarian organisations logged 160 new cases of cholera a day in Yemen. According to a report by the WHO published on 21 May, there will be 65,000 cases by the end of June if the outbreak continues to spread at the current rate. Some 2,000 people are now being infected per day, one third of whom are children under the age of 15.

According to the charity Save the Children, if the epidemic is not brought under control before the rainy season in July, thousands of people will die. The group added that children whose bodies are already ravaged by malnutrition are more susceptible to being infected with cholera.

There are some two million malnourished children in Yemen, and one child dies every ten minutes for preventable reasons.

A report on the NGO Website ReliefWeb says that cholera has now spread to 18 out of the 23 Yemeni provinces, and that the WHO, the UN children’s agency UNICEF, and other humanitarian groups are working to open health clinics across the country to try to halt the spread of cholera.

However, the 50 health centres and 300 clinics that have been created thus far cannot keep up with the pace of the outbreak. The WHO is planning another 350 centres and 2,000 clinics that are ten to 12 per cent complete at present.

UNICEF has begun to operate a water-treatment plant in the Yemeni capital Sanaa to serve one million people and help in preventing the spread of cholera. The UN Population Fund has started to distribute “dignity kits” containing “hygiene items, including soap, to help prevent the spread of cholera which threatens the lives of 1.1 million pregnant women and nursing mothers,” according to a UN statement.

The statement urged women “to maintain a certain level of cleanliness, especially when preparing food for the family since cholera can easily spread through contaminated food or water.”

Meanwhile, the aid group Médicins Sans Frontiers said that in five days (14-19 May) the number of those affected had more than doubled, going up from 11,000 to 23,500 people. At the end of last year, the UN warned that Yemen was one of four countries that could suffer from famine this year, along with northern Nigeria, South Sudan and Somalia.

UN Secretary-General Antonio Guterres warned that the famine in Yemen could be the worst seen worldwide.

For two years, the Arab-Saudi Coalition has been bombarding Yemen, the poorest country in the Arab world, in support of the internationally recognised President Abd Rabbu Mansour Hadi and against Houthi rivals which Riyadh says are backed by Iran. The war has thus far killed nearly 9,000 people and displaced more than two million, with many more losing their sources of income.

Some 18.8 million Yemenis are in need of urgent humanitarian aid out of a population of 29 million.

Saudi Arabia and its Gulf allies deny that they are to blame for the terrible humanitarian conditions in Yemen. Riyadh accuses the Houthis and their ally former president Ali Abdullah Saleh of stealing humanitarian aid and compounding conditions in the country. The Houthis claim Yemen is not facing a famine or epidemic, even if it is one of the poorest countries in the region.

The cause of the cholera outbreak is not the war alone, but the airstrikes that the Saudi-led Arab Coalition has carried out have compounded the malnutrition in Yemen. The destruction of infrastructure, including water and power plants and hospitals, has increased the number of cholera victims. Most relief and humanitarian organisations believe an end to the war would be the most important move in combatting cholera and defeating the prospect of famine in Yemen.

The US desire to send troops to Yemen has waned, especially after US President Donald Trump’s attendance at the recent US-Arab-Islamic Summit meeting in the Saudi capital Riyadh. Trump said his country would not fight terrorism on behalf of the Islamic world, meaning that regional countries must solve their problems by themselves before asking for Washington’s help.

This position could cause the Arab Coalition to consider a ceasefire, especially since it has thus far failed to reinstall the Hadi government in Sanaa and there has been a crumbling of the local anti-Houthi coalition. A transitional council has been formed in southern Yemen composed of separatist elements from the country’s Southern Movement.

Stagnation on the military front, worsening humanitarian conditions, and deterioration in the political situation could all force those involved to stop the war and save the lives of tens of millions of Yemenis.