COVID-19 in Yemen: State Narratives, Social Perceptions, and Health Behaviours

"...highlights the need for nuanced, customised interventions in different parts of Yemen by humanitarian agencies."

Cultural and political differences in the way the Yemeni perceive the COVID-19 pandemic, linked in part to the multiplicity of actors in charge of public health across Yemen, pose a challenge for humanitarian agencies trying to operate on the ground. This report from ACAPS charts the institutional reaction to the pandemic, analyses the political narratives that have been adopted by the different authorities, examines how local communities view COVID-19, explores the ways in which these narratives and perceptions influence the public's health behaviour, and provides recommendations that are designed to help humanitarian actors tailor their COVID-19 programming and health messaging to the local context.

Perceptions and narratives included in the report were collected by ACAPS anthropologists through 15 in-depth and semi-structured interviews conducted between April 6 and 21 2020 with Yemeni interlocutors and international non-governmental organisations (INGOs), monitoring of social media, and discursive analysis of relevant political narratives. Data on key actors were collected by the VERSUS project.

As the report explains, Yemen is fractured along multiple lines: territorial, political, religious, and cultural. Competition for legitimacy among the 3 main authorities is influencing the country's response to COVID-19. The authorities are: the Supreme Political Council (SPC) of Ansar Allah (more commonly known as the Houthis), the Internationally Recognised Government of Yemen (GoY) led by President Hadi, and the Southern Transitional Council (STC), an alliance of southern politicians, militias, and tribes that is seeking to reestalish a separate state in the south. Political authorities and the public, both in areas under the control of the Houthi movement and the GoY, responded early and in differing ways to the declaration of the pandemic.

For example, the leader of the Houthis, Abdulmalik al-Houthi, delivered a comprehensive and multifaceted interpretation of the global COVID-19 pandemic, organised on two main levels. At the religious level, the argument is put forward that most disasters, epidemics, and calamities are the result of human action. The corruption (fasad) of God's creation "descends from the wrong actions of peculiar human beings who are not guided by God". At the political level, al-Houthi argues that the United States (US) and Israel are purposefully manipulating God's creation to cause harm through biological warfare. Zionist lobbies in the US are held responsible for creating COVID-19 and releasing it to damage China, an economic competitor and a rival civilisation. Thus, while most countries in the world depict the pandemic as a war-like situation, the Houthis reverse this metaphor and argue that the actual disease is war. Accordingly, spreading panic about COVID-19 is considered a hostile action, and people are discouraged from talking about positive cases in the north.

Contrary to the Houthi anti-Western political narrative on the pandemic, the response in the southern part of Yemen has been in line with Western practices. One element in the southern response to the pandemic is the central role taken by local civil society organisations (CSOs) in raising awareness among the population. For instance, civil society actors in all southern governorates have mobilised medical faculty students, women activists, social media influencers, popular artists, and radio presenters to disseminate public health messages and educate the public on good hygiene practices. Yemenis living abroad in stricken countries have produced informative videos based on their own experiences. In the face of what they perceive as GoY inaction, the southern public has taken a more proactive approach in implementing social distancing measures and has even protested against the lifting of rules that it considered positive for stopping the spread of the virus.

In short, as the report shows, "the COVID-19 crisis has become yet another politicised element of the conflict and a way for each side to point at the failures of the other or even accuse the other of helping spread the virus."

In this context, social perceptions and health behaviour vary as well. Even before the war, this study found, Yemenis viewed the public healthcare system negatively and expressed high levels of distrust about the quality of services. Most interviewees showed knowledge of COVID-19 symptoms and awareness of public health messages (e.g., avoidance of hand shaking and public gatherings, necessity of personal hygiene and self-isolation). Nonetheless, they acknowledged they are not engaging in preparedness activities. This is explained on multiple levels in the report. For instance, SPC rhetoric upholds that Houthi-controlled territories are free of COVID-19 (even after the first case was recorded in Hadramawt on April 10 2020). This rhetoric has a decisive impact on people's health behaviour, especially among those trusting the Houthi regime. The view that northern Yemen is Corona-free is upheld by several other narratives, such as that God spared Yemen. Even fatalist beliefs imply an active cultivation of Islamic piety. "If the Corona disease arrives, it's a test from God (ibtila), and if God takes the patient and you believe in God, you are a martyr (shahid). The people who are living in this state of mind don't get to panic."

Further, a pervasive feeling of helplessness due to the war is pushing people, particularly in the north, to ignore preventive measures. It is better to die as a martyr on the frontlines, rather than "dying as a sheep, locked in a house as a prisoner". (By contrast, the southern population, which has mostly been spared from the ravages of war, are more likely to adopt a more proactive approach.) Though coronavirus is equally seen as one of many evils that cause illness and death (malaria, cholera, dengue), it is considered by some to be the least worrying one in comparison.

In the interviews, medical staff from Aden expressed concerns over the lack of adequate training and diagnostic tools in identifying potential COVID-19 patients. They cite the lack of relevant documentation in Arabic, and even in English. This has resulted in a number of cases of patients that presented with symptoms similar to those of COVID-19 being refused treatment or being turned away. Interviewees have expressed the fear that ignorance will cause more deaths in Yemen than the virus itself.

Recommendations for the international community, based on the analysis, include:

• Maintain a high level of alert and continue to emphasise the risks associated with the spread of the virus in Yemen.
• Be sensitive to the different responses local society across the north/south divide has adopted against the virus in different parts of the country, and adapt strategies accordingly.
• Provide equipment, training, and clear public health messaging for frontline health workers.
• Focus on delivering clear public health messages, tailored to the local area, rather than trying to counter each and every rumour point by point. (Radio may prove a better way to disseminate messages in Yemen than the internet or TV, particularly in rural areas.)
• Support tailored public health messaging and increased disease monitoring during Ramadhan (April 23 to May 23 2020), which typically involves large gatherings for communal prayers, crowded markets, the sharing of food among households, and other social practices that are likely to increase the speed of propagation of a potential outbreak and make it difficult for the authorities to impose measures. (Then the traditional visits and travel associated with the Eid al-Fitr holiday (likely May 23-24 2020) that mark the end of Ramadhan are likely to spread COVID-19 from major urban centres to the countryside.)