A/HRC/42/CRP.1 million malnourished pregnant and lactating women and girls, with 144,000 likely to develop birth complications.1167 733. The Group of Experts spoke to two fathers who had recently lost their toddlers after several weeks of treatment for acute malnutrition in Sa'dah.1168 One of them said: “Youssuf was very skinny, and really weak. The mother couldn’t breastfeed him – she had no milk to give him. He was not even three kilos at ten months old. He died last year, and according to the doctor it was because of malnutrition. We don’t have a dispensary in our village so my family took him to Tashdan, it’s at the border with the Kingdom of Saudi Arabia. He stayed there for four days and then died. He went there a few times but he died the last time. We live in Ghamr, and it is a poor region. I have never received assistance of a food basket. We have asked but the authorities here don’t answer.”1169 734. While food insecurity is one of the causes of the large number of malnourished children in Yemen, the inadequate access to health services remains another underlying cause of malnutrition. The lack of health facilities in certain regions, impediments on the freedom of movements of the inhabitants of certain regions due to ongoing hostilities, and damage to healthcare facilities due to the fighting between parties has further impacted on already insufficient health infrastructure (see section on destruction of civilian infrastructure below). 735. An outbreak of cholera was confirmed by the health authorities in Yemen in October 2016,1170 and it has been recurring and spreading since, reportedly exacerbated by the lack of access to clean water for drinking and irrigation, as well as poor maintenance of waste management systems.1171 Halfway through 2019, already as many cases of cholera had been reported for 2019 as in the whole of 2018 (380,000 suspected cases). On 8 July 2019, OCHA reported that 460,000 suspected cases of cholera had already been registered in 2019, including approximately 200,000 children.1172 At least 193 children have reportedly died of cholera related illnesses in 2019.1173 According to MSF, “[b]etween January and March 2019, suspected cholera cases sharply increased in Yemen, even before the start of the rainy season, raising fears of a large-scale outbreak”.1174 MSF further indicated an increase of cholera patients treated from 140 to 2,000 per week between January and March. 736. By 2019, humanitarian needs in Yemen were more than 60 per cent higher than before the war broke out. In 2014, Yemen had already been declared a large-scale humanitarian crisis, with more than half of the population in need of some form of humanitarian assistance.1175 The conflict dramatically exacerbated pre-existing vulnerabilities that included the heavy reliance on food, medical supplies and fuel imports, 1167 From the outset of the crisis, 850,000 children were suffering from acute malnutrition and 160,000 children from severe acute malnutrition (OCHA, “2015 Humanitarian Needs Overview, Yemen,” December 22, 2014, (https://reliefweb.int/sites/reliefweb.int/files/resources/2015_HNO_Yemen_Final_0.pdf)); See also UNFPA Humanitarian Response in Yemen 2019, p. 1; Sanaa Centre for Strategic Studies, The Impact of War on Mental Health in Yemen, 2019. 1168 Confidential Sources on File. 1169 Testimony from a source; identity obscured for protection reasons. 1170 https://reliefweb.int/disaster/ep-2016-000107-yem 1171 https://www.unocha.org/story/yemen-over-460k-cases-cholera-registered-date-year 1172 https://www.unocha.org/story/yemen-over-460k-cases-cholera-registered-date-year 1173 https://reliefweb.int/report/yemen/save-children-more-cholera-related-cases-first-half-2019whole-last-year. 1174 See “Endemic in Yemen, cholera still hits Yemenis hard”, Project Update, 5 June 2019 (https://www.msf.org/endemic-yemen-cholera-still-hits-yemenis-hard). 1175 OCHA, Humanitarian Response Plan, 2014 (https://reliefweb.int/report/yemen/yemenhumanitarian-response-plan-2014). 176