The forty-year-old man, Murad Al-Sayyadi, a resident of the Qa’taba area in Al-Dhalea governorate (southern Yemen), was a victim of an antibiotic injection that ended his life instead of saving it after a medical misdiagnosis by one of the doctors.
The victim’s brother, Abdulwahed Al-Sayyadi, tells “Khuyut”: “My brother Murad went on his foot to the “Al-Inaya Medical Center”, located in the Qarin Al-Fahd area, administratively affiliated with Al-Dhalea governorate, to get a medication that would reduce his pain and end his suffering after he was exposed to urinary tract infections and swelling in the feet, but his fate led him to the hands of torment instead of mercy, so he came out a dead body”, as he described.
On the other hand, medical errors have increased in Yemen since the outbreak of war at the beginning of 2015, especially in rural areas far from the control of the competent authorities. Those areas are witnessing an increase in the number of health centers randomly, with many of them lacking appropriate medical standards. Besides, some of them are attracting and hiring doctors, many of whom are unqualified doctors, whether from Yemen or abroad in particular.
Further, death has become an inevitable fate that haunts those who visit health centers in rural areas. They are often the last option the patient resorted to, which may succeed or fail. This is due to the deterioration of medical facilities, which have become a source of concern and fear for the citizens living in these areas.
In the rural health dispensary “Al-Inaya Medical Center” of this area of Al-Dhalea governorate, the so-called “medical staff”, who works as a doctor’s assistant, examined the patient and directed him to perform kidney function tests and abdominal ultrasound. Then, based on the results, the doctor’s assistant ordered to inject the patient with a ceftriaxone injection (used to treat infections, intravenously), in addition to a prescription of some other medications, according to the medical staff’s confessions in the investigation of the medical committee assigned by the Health Office in Qa’taba district.
Al-Sayyadi continues: "The staff at the center ignored the voice of my brother, who informed them that there is an allergy in the skin from the injection of antibiotics; however, this "medical staff" in the dispensary's emergency room—who have only certificates of First Aid—did not pay any attention to the matter, and the patient was injected with an intravenous injection of ceftriaxone, which ended his life a few minutes later, after it caused him hypersensitivity and heart failure with shortness of breath, while he was still in the center's pharmacy, buying the medications prescribed by this "medical staff," as it appeared in the surveillance camera video, obtained by “Khuyut”.
This doctor, who came from outside Yemen from an Asian country, works at the rural health dispensary “Al-Inaya Medical Center”, as a general practitioner and consultant by experience only, with a qualification of a doctor’s assistant, specializing in ear, nose, and throat, according to confessions he made to the competent authorities, reviewed by “Khuyut” at the police center of Qa’taba district.
Although the work of this doctor contradicts Medical Council Law No. 28 of 2000 in its ninth article, which stipulates that any doctor is prohibited from practicing as a specialist unless he obtains a specialty certificate (diploma, master's) or their equivalent after the bachelor's degree and is approved and licensed by the Council, he worked in the dispensary as a general practitioner and consultant. According to social activist Ghanem Saleh, it is an unsuccessful step for the health center, which does not check the qualifications and records of doctors who are recruited from abroad or even from inside Yemen. In addition to the failure of these doctors to take into account the appreciation of Yemeni society for the medical staff in general and for foreigners, whom they describe as the best in particular, in light of the absence of the role of monitoring and accountability by the Ministry of Health and the Medical Council.
Pharmacology Specialists
The dean of the Faculty of Pharmacy at Sana'a University, Ahmed Al-Sabati, a professor of clinical pharmacy at the university, tells “Khuyut” that using the antibiotic ceftriaxone in some cases—which are rare—may cause severe allergic reactions, especially if it is administered intravenously.
According to Al-Sabati, this medication, ceftriaxone, leads to hypersensitivity in some cases, resulting in a severe drop in the heartbeat rate, which may lead, as he confirms, to death. If the case is highly sensitive to antibiotics, it becomes very difficult to save it, even if the patient is given "dexamethasone," which is the antidote to the allergy.
For his part, Abdrabbuh Al-Shawish, a community pharmacy specialist, explains to “Khuyut”, by saying, "Doctors forbid using the “Ceftriaxone” solution with Lidocaine intravenously. However, “Ceftriaxone” can be mixed with Lidocaine in the intramuscular needle (syringe), not intravenously. So, if the patient is injected into a vein, in some cases, it may cause complications leading to death."
Al-Shawish points out that the ceftriaxone medication should not be used for a patient with an allergic reaction to “ceftriaxone” and other “cephalosporins” without consulting a specialist doctor.
Contradictory Reports and Ink of Law
On Wednesday, August 23, 2023, the report of the medical committee assigned by the Public Health and Population Office in the Qa’taba district, following its arrival at the district’s police center to investigate with the Medical Center staff, acknowledges the occurrence of an error in the diagnosis of the case by "one of the health staff" and in the method of using the medicine, as well as the mismanagement of the patient's condition, with the participation of all the staff working in the center. The writer of this investigation has obtained a copy of the confessions of the medical staff along with the report of the medical committee.
The report also confirms that all the staff working in this health center hold the same professional specialized qualifications, which are as follows: a first aid certificate for the staff working in the emergency room, a doctor’s assistant, and a laboratory diploma for the laboratory doctor, in addition to not having the certificate of practicing the profession, recommending closing the center due to the lack of a medical license for the facility, and taking the necessary legal procedures.
However, the report of Dr. Alaa Abdulghani Al-Dhab’i, the forensic doctor's assistant at the Public Prosecutor's Office, of which “Khuyut” obtained a copy, shows that the death was caused by angina pectoris in the heart wall at the lower ventricles and the lower wall of the heart, resulting from a complete blockage of the coronary artery, stressing that the medications sent by the prosecution had nothing to do with causing the angina pectoris for the patient.
Consequently, the victim's relatives demanded that the case be transferred to the Damt Court of First Instance after they felt that the forensic doctor's report was manipulated, according to the victim's brother, and that tribal mediation sought to resolve the case in accordance with tribal custom; however, they expressed their rejection of these endeavors and their adherence to their legal right to re-autopsy the body and hold the perpetrators accountable.
According to the Medical Council Law, any person who practices medicine or any of its branches and jobs without the appropriate license or certificate to practice the profession from the medical council is considered a “medical impersonator”, in accordance with Law No. 28 of 2000, which stipulates in Article 10 that the Medical Council shall issue licenses, set rules for the ethics and conduct of practicing the profession, and determine the qualifications and experience necessary to obtain consultant and specialist certificates for those practicing the profession.
Likewise, Article 4 of the same law stipulates that no person shall practice medicine without obtaining the appropriate license or certificate from the medical council. This provision also applies to doctors applying for work and foreign visitors before they start working in public and private facilities.
Increasing the Number of Victims
Al-Sayyadi's incident was not the only one resulting from such practices in Yemen; the child Anas Abdulhakeem Amer (12 years old) was also another victim of a medical error at the Al-Masjidain public hospital in Raymah governorate (western Yemen) by a doctor whom this medical facility attributed to being of Russian nationality.
The child lost his life after performing a tonsillectomy by the doctor who turned out to be of another nationality, a Pakistani (H.K.), a general surgeon specialist—as stated in the announcement of the hospital that announced his arrival, which indicated that he is a general surgeon, specializing in performing the following surgeries: appendix, hernia, gallbladder, tonsils, hemorrhoids, intestinal adhesion, glands, fractures, stone removal, and pediatric surgery.
According to a private source from one of the people of Al-Salafiya district in Raymah governorate (western Yemen), who preferred not to mention his name, he told “Khuyut” that the child went to Al-Masjidain hospital to remove his tonsils, accompanied by his uncle, his mother’s brother; however, after the surgery was performed, the child suffered severe bleeding until he died.
On the other hand, he adds that the hospital lacks qualified capabilities to perform surgeries, stressing that there is no intensive care room and its needs. It does not stop there, but rather, this medical facility does not have a "heater" (a special machine to block the blood veins after the operation to prevent blood flow), and this is what happened with the child Anas, who continued bleeding until he died.
For its part, “Khuyut” tried to communicate with the victim's father and relatives, but they refused to disclose information on this matter, confirming that the hospital administration had reached a tribal reconciliation with them, which ended with the arbitration of the blood parents, who accepted the arbitration and were satisfied with that, and then pardoned the perpetrator of the incident.
According to this source, the doctor fled after the surgery. He remained in the hospital for only three days and then left—after the medical error incident—to Ibb governorate (central Yemen).
The People's Trust in Foreign Cadres
In his interview with “Khuyut”, human rights activist Mutahar Al-Khadhmi attributes the reason for the increase in medical errors in the Yemeni rural areas to the mentality of the owners of purely commercial health centers, their exploitation of society’s ignorance, and the negligence of the official authorities regarding their credentials as doctors practicing medicine, given that they are foreigners and highly experienced, as well as the absence of the role of monitoring and inspection by the Ministry of Health and the Medical Council.
He continues: "In the event that a foreign doctor causes the error, he returns to his country without people knowing the fact of the qualification he holds. Consequently, this matter requires the keenness and scrutiny of the official authorities on foreigners who practice medicine, according to many standards and criteria."
Besides, Yemeni law considers the medical error a serious crime if it results in the death of the patient. As legal expert Antar Nasser explains in his interview with “Khuyut”, Article 241 of the Yemeni Crimes and Penal Code No. 12 of 1994 stipulates: “Punished with the doubled blood money and imprisonment for a period not exceeding three years whoever makes an assault on the safety of another person’s body by any means and did not intend to murder, but the assault has led to death.”
Nasser believes that the judiciary does not issue its verdicts in accordance with medical laws only, but goes back to the Yemeni crimes and Penal Code No. 12 of 1994, in proportion to the merits of the case, and then the judicial verdict is issued accordingly, while what is expected is higher than that, given the lack of awareness of reporting errors as well as resolving many of them in the framework of tribal reconciliation with the perpetrators.
According to the statistics of the Medical Council, available on open sources, the number of foreign medical staff working in Yemen without licenses reached about 4,000 in 2012, including doctors, laboratory technicians, and nurses. However, the number has decreased since the end of 2014 and early 2015, with the beginning of the war in Yemen. Today, there is no accurate statistic on the number of foreign doctors working without licenses in 2023.
In this regard, it is noteworthy that in February 2019, the House of Representatives of the Sana'a Authority held a special session to discuss the increase in medical errors in private and public hospitals. In this session, the Minister of Public Health and Population in the Ansar Allah government (Houthis), Taha Al-Mutawakel, explained that “the total number of medical errors, negligence, and shortcomings in Yemen is equivalent to 20.4% compared to the rest of the world. In addition, the percentage of errors is divided equally between Yemeni and foreign medical staff working in Yemen."
In 2018, the number of complaints received by the Supreme Medical Council reached about 785 files, although the expected number was higher than that, given the lack of awareness of reporting the errors as well as resolving many of them within the framework of tribal reconciliation with the perpetrators.
“Khuyut”, in this concern, asked a number of specialists about the reasons for the increase in medical errors and deaths, and their responses were summarized in two main reasons: the first is the increased migration of qualified doctors from the country in search of better opportunities in light of the deteriorating economic conditions, and the second is the employment of unqualified nurses and health workers in the health sector who have no qualifications or capabilities to deal with emergency cases.
