Yemen: Houthis, Southern Fighters Endanger Aden Hospital

(Beirut) - Houthi forces and southern armed groups have committed serious abuses at a hospital in Yemen's port city of Aden, forcing its evacuation in late April 2015.

Staff at the al-Jumhouri Hospital told Human Rights Watch that in late March southern fighters summarily executed two Houthi fighters who were patients and used the hospital as a defensive position until driven from the area. The Houthi assault on the area around the hospital resulted in repeated firing on hospital staff and patients, killing at least two civilians and wounding a nurse.

All parties to Yemen's armed conflict should respect the neutrality of hospitals and other medical facilities and not target them or use them for military operations, Human Rights Watch said. The United Nations Security Council should remind the parties in Yemen that attacks on hospitals violate international humanitarian law, and that those responsible for such attacks are subject to travel bans and asset freezes under Resolution 2140.

"The fighting in Yemen is terrible enough without both sides bringing the battle into hospitals," said Joe Stork, deputy Middle East and North Africa director. "Attacks on medical facilities prevent people who are injured from the fighting to get critical, life-saving care."

On March 4, Houthi fighters stopped three volunteers for Inqath, an aid group that provides medical supplies to hospitals in Aden, as they took boxes of medicine by taxi to al-Jumhouri hospital. The Houthi fighters took the volunteers to a military base in Lahj, 35 kilometres north of Aden, before releasing them on March 10. One volunteer told Human Rights Watch that his captors held him in a room with a dozen other detainees and interrogated him several times, accusing him of assisting extremist groups. Also in March, fighters linked to Al-Qaeda in the Arabian Peninsula (AQAP) or Islamic State, also known as ISIS, went to the hospital and tried to force their way into a room where a Houthi commander was being treated for burn wounds. They eventually left without harming the commander.

On April 19, about 300 southern fighters deployed in and around the hospital over the objections of hospital staff. The fighters forced hospital staff to reveal the location of two Houthi fighters who had been brought in that morning, suffering from dehydration. The fighters shot both men dead in the hospital yard and left the bodies there, where people mutilated the corpses before they were buried the next day. Houthi forces in surrounding buildings fired on the hospital numerous times, eventually causing the staff and patients to evacuate on April 29, hospital staff said.

Under the laws of war applicable to the armed conflict in Yemen, hospitals and other medical facilities receive special protection. They may not be targeted, even if they are being used to treat enemy fighters. Medical facilities remain protected unless they are used to commit hostile acts that are outside their humanitarian function. Even then, they are only subject to attack after a warning has been given setting a reasonable time limit, and after the warning has gone unheeded. Armed forces or groups should not occupy medical facilities.

All parties to the conflict should ensure that medical workers are protected from attacks or interference by third parties, and take meaningful steps to prevent the military occupation of hospitals. They should not disrupt the provision of medical services to wounded enemy combatants, and they should allow safe passage of medical supplies and personnel to those in need.

Under international human rights law, attacks on health facilities, workers, or transport vehicles may impede the right of access to health care and the right to the highest attainable standard of health. In December 2014, the United Nations General Assembly passed a landmark resolution that urged member countries to take immediate steps to ensure that health workers everywhere are protected from violence.

The fighting in Aden broke out on March 19, one week before a nine-country coalition led by Saudi Arabia opened an aerial bombing campaign against Houthi forces. Houthi and southern fighters engaged in heavy clashes in Aden's Khormaksar district between April 19 and 27 with the district's al-Jumhouri Hospital caught in the middle.

The head of the statistics department at al-Jumhouri told Human Rights Watch that between March 25 and April 24, the hospital received 559 wounded and 165 dead civilians. These included at least three women and two children who had died and five women and two children who were wounded. He said that these numbers included only those brought into the hospital, so the actual number of civilian casualties was probably higher. Injuries to civilians reported by hospital staff included gunshot wounds to the back, chest, shoulder and legs, wounds from blast fragments, and various burns. During the same time, the hospital received the bodies of 22 Houthi and 41 southern fighters.

The United Nations reported that as of June 3, 2,288 people had been killed since the beginning of Yemen's conflict, including 1,160 civilians, Another 2,800 civilians had been injured. The conflict has displaced over a million people. More than 15 million people are without access to basic health care, up 40 percent since March.

"As fighting rages on in Aden, hospitals need to remain safe havens for those in need of medical care," Stork said. "Any commander allowing his troops to use hospital premises to carry out attacks should be held accountable."

For more details on the attacks, please see below.

Al-Jumhouri Hospital
Salah Qassem Muhammad Abdo, 26, head of the statistics department at al-Jumhouri Hospital, told Human Rights Watch that 11 armed men whom he took from their dress to be members of AQAP or ISIS entered the hospital grounds on March 25. Human Rights Watch interviewed three other people who said that they saw AQAP fighters at the hospital. Abdo said that four of the men, including one the others treated as their commander, entered the hospital and tried to gain access to the room where Maged Ahmed Hussein al-Moa`ead, a Houthi commander, was being treated for burns. Abdo said that he and a colleague managed to dissuade them and that they left the hospital without harming al-Moa`ead.

The same armed men returned during the following two days with two of their own wounded to the hospital's surgery department and remained while the men received treatment. This caused most of the hospital staff to evacuate the department out of concern that the armed men's presence might prompt an attack by Houthi forces, Abdo said. He said the armed men then maintained a presence at the hospital until it was totally evacuated in late April.

Sameh Qassem, 32, general manager of the Red Cross staff at al-Jumhouri Hospital, told Human Rights Watch that on April 4, Houthi fighters took up positions in the Russian consulate building, two blocks from the hospital. He saw gunmen using the consulate's roof and windows to aim at buildings in the area. Two weeks later, southern fighters began using the hospital to attack the Houthi forces. They took up positions on the roof and elsewhere, and fired from the roof on at least one occasion, Qassem said. He told them to leave the hospital but they denied using it as a firing position and refused to leave.

Conditions at the hospital became increasingly dire as fighting in Aden escalated in April. On just one day, April 19, the hospital received over 100 casualties: 11 dead Houthi fighters, 6 dead southern resistance fighters, and 97 wounded. Abdo told Human Rights Watch:

We couldn't control the crowd. The hospital was in complete chaos. There was a shortage of doctors, nurses, and medical supplies… The morgue was full of bodies - we couldn't fit any more in so we were putting the dead bodies in a small room in the first floor and turned on the air conditioning.

On April 19, southern fighters who had installed themselves at the hospital soon learned that two Houthis had been admitted with dehydration. They forced a hospital security guard to hand over the two men, Abdo Thabet Yehia, 24, and Ali Abdullah Yehia, 50, and executed them in the hospital yard. The southern fighters left the two men's bodies in the yard along with the bodies of eight other Houthis they had killed in fighting that morning. Abdo, the hospital staff member, said:

People started going crazy at the hospital, they started chanting that these men were apostates and start beating, mutilating, and urinating on the bodies. We tried to fight them off, to preserve the integrity of the bodies. That night one man snuck out with a bucket of urine and threw it on them… It was so barbarian.

On April 19, three bullets fatally struck a hospital maintenance worker, Anwar Muhammad Saeed, in the chest and hands as he crossed the hospital yard to turn on the generator. Abdo said that Houthi forces controlled the area surrounding the hospital and that he had seen Houthi gunmen in neighboring buildings pointing their weapons at the hospital, but he did not know whose forces shot Saeed.

Houthi gunmen were responsible for fatally shooting another civilian, Hafeth Ahmed al-Katubi, 49, on April 24, Abdo said. A Houthi gunman atop a residential building near the hospital shot al-Katubi as he stood next to his parked car by the main entrance in the hospital yard, Abdo said. Al-Katubi had brought his daughter to the hospital because she had been shot.

By April 20, conditions at the hospital had become so dire that a group of local people negotiated an agreement with the Houthis to enable family members and volunteers to bury the mounting number of dead whose bodies had been placed in the yard of the hospital's Faculty of Medicine.

By then, said Qassem, the Red Cross manager, surgeons were operating on as many as 50 people a day, instead of the usual three before the fighting. There were then 10 doctors and 30 nurses at the hospital who were under great pressure because security conditions prevented a Red Cross medical relief team from reaching the hospital for three days, until April 22. Abdo told Human Rights Watch that by then the local phone network no longer functioned and the hospital had exhausted most of its reserve of medical supplies and was running out of water. He said drivers told him that Houthi fighters had established a checkpoint at Hadid Mountain, a five minute drive from the hospital, and were preventing food and other supplies from passing through.

A hospital staff member told Human Rights Watch that he had seen Houthi gunmen at the windows and on the roofs of nearby buildings pointing their weapons toward the hospital and sometimes firing at staff. Qassem said that they had fired at him five times without hitting him. For instance, on March 29 Houthi fighters in military uniform atop a nearby residential building shot at him and Abdo as they crossed the hospital yard to the emergencies wing. They ducked behind a car until the firing subsided and they could run back inside.

On April 19, a Houthi fighter in a building opposite the hospital shot and wounded a nurse, Ali Zain Ahmed, 47, who was in the hospital's third floor staff rest area, Qassem said.

Houthi gunmen also fired at the water tank on the hospital roof on April 22, causing water to flood the rooms beneath that contained the remaining medical supplies and food. The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) stated that this caused the hospital to run out of water. Abdo told Human Rights Watch that no one dared repair the leaking tank for fear that they would be shot. It is unclear whether the Houthi fighters were aiming at the tank or whether southern fighters were on the roof. The loss of food from this incident contributed to the decision by the hospital staff to evacuate the hospital on April 27 with the help of patients' families, volunteers, and local taxis.

OCHA reported that Houthi forces entered the hospital after the evacuation. Human Rights Watch has not been able to determine whether they still occupy the hospital.

Detention of Aid Workers
On March 4 at 4:30 p.m., Omar al-Haddar, 19, a naval engineer by training, and two friends, took a taxi from Aden's Qalooa district to Khormaksar district to deliver medical supplies to the al-Taawon pharmacy, connected to al-Jumhouri hospital. The three men were volunteers for Inqath, an aid organization that provides medical supplies to hospitals in Aden. Al-Haddar told Human Rights Watch that they were transporting 10 boxes, including eight filled with medicine for diabetes patients. Near the hospital, seven Houthi fighters in military uniforms at a checkpoint stopped the vehicle. After seeing the medicine boxes, the fighters accused the three of trying to deliver the medicine to ISIS-backed groups. They took the men and their driver into custody and took them to a building nearby, where they held them in dark rooms until the evening.

The Houthi fighters then drove them by military bus to Azal Hotel in the Mualla district. The fighters took the men to the third floor, where they saw at least 10 prisoners, blindfolded and their hands tied, in one of the rooms. The next day, at 2 p.m., fighters transported the group along with three bound Somali men to al-Anad Military Base in Lahj. Al-Haddar said that these Somali men were held because they were accused of possessing anti-Shia literature. Al-Haddar saw two tanks and about 40 fighters guarding the base. He said:

We started pleading with our captors to be released, we even cried. But instead they stripped our clothes off to search us and then forced us into a tiny room of 4x4 meters. We were 13 in there. They did give us food, and did not abuse us, but the room was always dark, and we had to sleep while sitting because it was so cramped. They would interrogate three of us a day, for about three hours each. During my sessions they kept trying to get me to confess I was working for ISIS and to give names of other people who are working with them.

During his time at the military camp, al-Haddar estimates that he saw rooms holding at least 100 other detainees. On March 10, fighters drove al-Haddar and his two friends back to Aden and released them.