Hundreds of people in Aden, southern Yemen's main city, have died in the past week with symptoms of what appears to be the coronavirus, local health officials said in interviews with The Associated Press.
The officials fear the situation is only going to get worse: Yemen has little capacity to test those suspected of having the virus and a 5-year-long civil war has left the health system in shambles.
One gravedigger in Aden told AP he'd never seen such a constant flow of dead even in a city that has seen multiple bouts of bloody street battles during the civil war.
Officially, the number of coronavirus virus cases in Yemen is low 106 infections in the southern region, with 15 deaths.
Authorities in the Houthi rebel-controlled north announced their first case on May 5 and say there has been only two infection, one of whom died, a Somali migrant.
But doctors say the Houthis are covering up an increasing number of cases to protect their economy and troops. And the surge in deaths in Aden more than 500 in just the past week, according to the city registrar has raised the nightmare scenario that the virus is spreading swiftly in a country with almost no capacity to resist it.
The upswing in suspected COVID-19 cases in Yemen is sounding alarms throughout the global health community, which fears the virus will spread like wildfire throughout the world's most vulnerable populations such as refugees or those impacted by war.
If you have a full-blown community transmission in Yemen, because of the fragility, because of the vulnerability, because of the susceptibility, it will be disastrous, said Altaf Musani, the World Health Organization chief in Yemen.
WHO says its models suggest that, under some scenarios, half of Yemen's population of 30 million could be infected and more than 40,000 could die.
Half of Yemen's health facilities are dysfunctional, and 18 per cent of the country's 333 districts have no doctors. Water and sanitation systems have collapsed. Many families can barely afford one meal a day.
Yemen has no more than 500 ventilators and 700 ICU beds nationwide. There is one oxygen cylinder per month for every 2.5 million people.
WHO provided some 6,700 test kits to Yemen, split between north and south, and says another 32,000 are coming.
The health agency says it is trying to procure more protective equipment and supplies to fight the virus.
But WHO said efforts have been hampered because of travel restrictions and competition with other countries.
The ongoing civil war pits the Houthis, who occupy the north, against a U.S. and Saudi-backed coalition that formed an internationally recognized government in the south.
Now that coalition in the South has fragmented: separatists backed by the United Arab Emirates rose up and expelled the government from southern capital Aden last summer and declared self-rule last month.
The two factions are fighting in Abyan, a province adjacent to Aden.
The war has already killed more than 100,000 and displaced millions.
The two warring sides in Yemen's civil war have taken vastly different approaches to dealing with the pandemic, each in its own way fueling the possible spread of the virus.
The south is a picture of utter collapse: Rival factions within the U.S. backed coalition are battling for control. No one appears to be in charge as an already wrecked health system seems to have completely shut down.
Health personnel, with little protective equipment, are terrified of treating anyone suspected of having the coronavirus.
Many medical facilities in Aden have closed as staffers flee or simply turn patients away. No one is answering a hotline set up by U.N.-trained Rapid Response Teams to test suspected cases at home.
If you are suspected of having corona and you are in Aden, most probably you will wait at home for your death, said Mohammed Roubaid, deputy head of the Aden's health office.
From May 7 until Thursday, the city's civil registrar recorded 527 deaths, the head of the office Sanad Gamel told AP.
The causes of death weren't listed, but the rate was many times higher than the usual average death rate of around 10 people a day, city health official said.
Multiple doctors said they were convinced the deaths are COVID-19 related. In a statement Thursday, Save the Children put the toll of people with COVID-19 symptoms in Aden the past week at 385.
In the north, meanwhile, the Houthi rebels in power there are waging a campaign to aggressively suppress any information about the scale of the outbreak, even as doctors told the AP of increasing infections and deaths.
The Houthis have refused to release positive test results and intimidated medical staff, journalists and families who try to speak out about cases, doctors and other officials say.
Doctors and local health officials said they believed many people are dying of COVID-19 in their homes, undocumented.
Doctors in three northern provinces, including the capital Sanaa, told the AP they have seen increasing numbers of suspected coronavirus cases and deaths. All spoke on condition of anonymity, fearing reprisals from the rebels.
Houthi militiamen have shut down several markets in Sanaa and locked down streets in 10 neighborhoods, barring families from leaving their homes, after suspected cases arose.
Medical staffers said they are under surveillance and can't speak about what they see inside health centers.
Both local health ministry and international aid officials have been warned not to discuss cases or of possible local transmission of the virus, since the rebels insist the north's few cases came from abroad, according to two officials with knowledge of the discussions.
In the first week of May, a surge of patients entered the Kuwait Hospital, the sole fully operating COVID-19 treatment center in the capital, said four officials.
One official said 50 of them were likely infected with the coronavirus and 15 died later died. Staffers say they believe the patients were infected because Houthi authorities never revealed the results of their tests.
When it's negative, they give the results to us, the official said.
An internal document with test results at the hospital on May 4 showed three positive cases. On one page was scribbled the name of a woman who died.
The AP obtained a copy of the document, which also circulated on social media. Two officials confirmed its authenticity.
Families of those who died of suspected coronavirus infection say they are left in the dark.
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