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Impact of Air Raids on the Reported Incidence of Cholera in Yemen, 2016-2019

28 Pages Posted: 25 Jan 2023

See all articles by Maia C. Tarnas

Maia C. Tarnas

University of California, Irvine - Department of Population Health and Disease Prevention

Najwa Al-Dheeb

Public Health Network

Muhammad H. Zaman

Boston University - Department of Biomedical Engineering

Daniel M. Parker

University of California, Irvine - Department of Population Health and Disease Prevention

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Abstract

Background: Yemen continues to endure cholera outbreaks during ongoing conflict and destructive environmental events. Air raids have been used throughout the conflict to target military and civilian infrastructure. This study aims to quantify the impact of these air raids on cholera incidence while accounting for other geographic, environmental, and demographic drivers.

Methods: ​​We utilized data between 2016 – 2019 on air raids from the Yemen Data Project, vegetation and surface water from satellite imagery, precipitation and temperature from the Climate Change Knowledge Portal, economic variables from the World Food Program, and cholera case and population data from published work. These data were transformed into weekly intervals and governorates were categorized by air raid severity, ranging from Low (≤3 annual air raids) to Severe (173+). We measured the impact of air raids using a negative binomial generalized additive model that accounts for geographic location as well as environmental, temporal, economic, and demographic variables.

Findings: After controlling for relevant factors, air raids had a significant impact on cholera incidence across all severity levels, with a maximum of 5·38 (95% CI: 3·87 – 7·48) times the risk in governorates with severe air raid levels compared to governorates with low air raid severity. The economic downturn was also significantly associated with increased cholera incidence.

Interpretation: Air raids significantly contribute to the burden of cholera in Yemen, even when controlling for other relevant factors. Quantifying their impact on cholera incidence further illustrates the man-made nature of the cholera outbreak and conflict’s devastating effects on health.

Funding: None

Declaration of Interests: All authors declare no competing interests.

Keywords: cholera, Yemen, conflict, generalized additive model

Suggested Citation

Tarnas, Maia C. and Al-Dheeb, Najwa and Zaman, Muhammad H. and Parker, Daniel M., Impact of Air Raids on the Reported Incidence of Cholera in Yemen, 2016-2019. Available at SSRN: https://ssrn.com/abstract=4336143 or http://dx.doi.org/10.2139/ssrn.4336143

Maia C. Tarnas (Contact Author)

University of California, Irvine - Department of Population Health and Disease Prevention ( email )

Najwa Al-Dheeb

Public Health Network ( email )

Muhammad H. Zaman

Boston University - Department of Biomedical Engineering

Daniel M. Parker

University of California, Irvine - Department of Population Health and Disease Prevention

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