Followers of the Al Houti movement have fought five wars in Saada Governorate against the state since 2004. Before the most recent and intense "sixth war" began in August 2009, sporadic fighting in Saada in this spring injured dozens of civilians. MSF teams working in the hospital in the town of Razeh treated men, women, and children. The hospital itself and the MSF staff house were not immune from the violence. Fighting in the area restricted patient access to the hospital; slowing the facility's daily emergency, surgical and nutrition services.

Violence escalated sharply in August as Yemeni Army forces began ratcheted up its offensive against the rebels. Fighting raged in 13 of the governorates 15 districts, affecting almost the entire population. In November, Saudi forces entered the conflict, further complicating the plight of civilians.

In the town of Al-Talh, the violence ultimately forced MSF to halt its work in the town's hospital. In mid-October, rockets struck Razeh Hospital, forcing its closure and the suspension of MSF activities there and the evacuation of staff. Now the vast majority of the population was without access to any health care.

As another result of violence, thousands of civilians fled northward within Saada, and tens of thousands into neighbouring Hajja, Amran, and Al-Jawf Governorates, all of which feature little to no healthcare services.

In Mandabah, in Baqim District, on the Saudi border, MSF provided health care services and access to drinkable water to the thousands of displaced people as well as establishing a hospital in the town. MSF also responded to a spike in malnutrition among displaced children in al-Mazraq camp, in Hajjah Governorate.

In Mandabah, the local Health Unit has been rehabilitated and extended in order to run outpatient consultations, hospitalizations, gyneco-obstetric care and surgery. [Yemen 2009 ? MSF]

In August 2009, the "sixth war" since 2004 broke out in this region. In this context, MSF began working in Saada governorate in partnership with health-ministry staff. Mobile health clinic activities are also performed in some peripherical health units of the governorate, depending on the changing security context. [Yemen 2009 ? Arnaud Drouart / MSF]