Direct Relief Navigates Medical Aid to Yemen and Sudan Through Red Sea Shipping Attacks and Sudan’s Civil War

Critical hospital supplies and insulin for children with diabetes are among requested shipments making their way through treacherous shipping routes.

By Paul M. Sherer/Direct Relief. Originally published by Direct Relief on February 12, 2024.

As Yemen’s Houthi rebels continue attacking ships in the Red Sea, many of the world’s shippers are avoiding the crucial cargo route and going nowhere near Yemen. For Direct Relief, which delivers donated medicine and medical supplies for people in Yemen and Sudan – two of the world’s most troubled and impoverished countries – avoiding the Red Sea is not an option.

Direct Relief currently has two ocean containers heading to the Red Sea – one en route to Yemen’s capital Aden carrying a broad range of hospital supplies, and another headed for Port Sudan on the Red Sea’s western shore, packed with insulin and other supplies for children with diabetes.

“We need to figure out a way to get into these dangerous places, otherwise we wouldn’t be doing our job,” said Gordon Willcock, Direct Relief’s deputy director of emergency response. “There’s a correlation between the needs and the level of insecurity, and in most cases that means logistics are challenging.”

“We work with people who know their territories and know their jobs, and we take their advice and make informed decisions,” Willcock said. “We’re not going to be foolhardy or cavalier, we have a responsibility to our donors and to ensure the security of the supply chain.”

While shipping continues through the Red Sea, options have diminished and costs have risen sharply as insurers demand steep premiums for covering ships that pass near Yemen. The original cost of shipping the Yemen-bound container from California’s Port of Long Beach to Aden was just over $6,200, but a $3,000 “Red Sea Charge” was later added, raising costs by nearly 50%. For Sudan-bound containers, carriers have imposed a $1,500 “contingency surcharge” to cover the increased security risk.

Although attacks by Yemen’s Houthi rebel group have been disrupting Red Sea shipping since November, the situation has recently deteriorated. On Jan. 26, Maersk, the world’s largest container ship operator, notified customers that it was suspending shipping through the Red Sea, citing new intelligence information about heightened security risk. Maersk is rerouting ships around South Africa rather than using the Suez Canal shortcut connecting the Red Sea with the Mediterranean.

Shipping from Europe to Port Sudan by going around Africa rather than through the Suez Canal into the Red Sea adds 10-14 days to the journey, driving up costs and reducing global shipping capacity.

“The situation currently remains untenable, and we encourage customers to prepare for complications in the area to persist and for there to be significant disruption to the global network,” Maersk said.

“It’s one less carrier we can get quotes from if we need the shipment to move through the Red Sea/Gulf of Aden for a shorter transit time,” said Alisa Harnish, associate director of transportation at Direct Relief.

Direct Relief works with logistics firms like Scan Global Logistics to manage the shipping process, including finding vessels to deliver the cargo. The firm continues booking transit through the Red Sea, but many ship owners refuse to pass that way.

While ships transiting the Red Sea and the broader region around the Horn of Africa have long been vulnerable to piracy, the largest container vessels “have traditionally been difficult to attack due to the primitive boats being used historically,” said Anders Thorsen, director of Aid, Relief & Government Services for North America at Scan Global. “Of course, the attacks are different now and [it is] really difficult to defend against missile attacks. Due to this, we also see as lot of owners / masters refusing to pass through Suez due to the dangers involved.”

Yemen Aid

Yemen has long been considered one of the world’s worst humanitarian crises, suffering through nearly a decade of civil war, with almost half of its 35 million people having limited or uncertain access to food.

The shipment en route now to Yemen contains a broad range of medical supplies including prenatal vitamins, electrolytes for hydration, surgical drapes and masks, and concentrated surface disinfectant for hospitals, which will be delivered to medical teams in Yemen operated by the NGO MedGlobal.

Last year, Direct Relief delivered donated medicine to Yemen with a wholesale value of $4.7 million, including cardiovascular and gastrointestinal drugs, hormones, wound care products, central nervous system agents, anti-infective agents, vitamins and more. Direct Relief works in the country with Yemen Aid, a Yemeni-American development organization. The supplies were successfully delivered to Yemen Aid and subsequently distributed in coordination with the Ministry of Public Health and Population to public health facilities across the country to meet specifically identified needs.

Sudan Insulin Supply Chain Remains Open, But In-Country Situation is Challenging

The Red Sea turmoil has also raised costs for a crucial program on the western shore of the Red Sea: providing donated insulin for Sudanese children with type 1 diabetes, in partnership with Life for a Child.

When civil war erupted in Sudan last April, it cut off imports of the insulin that 11,000 Sudanese children with diabetes depend on to stay alive, said Dr. Salwa Musa, a pediatric endocrinologist with the Sudanese Childhood Diabetes Association (SCDA), which provides donated insulin and related supplies at pediatric diabetes clinics all over the country.

Until April, all of Direct Relief’s diabetes donations were flown into Khartoum International Airport. On April 15, the Rapid Support Forces militia seized control of the airport, which still remains out of operation. The RSF also looted the SCDA’s insulin storage facility in Khartoum, destroying a two-year supply.

No new insulin arrived in Sudan until October, when a shipment arranged by Direct Relief arrived via a new route – by ocean into Port Sudan.

“Not a lot of freight forwarders were willing to have their craft dock at Port Sudan,” said Kelsey Grodzovsky, who leads Direct Relief’s diabetes programs. “There were a lot of issues getting anyone to transport the supplies to the country. So instead of going big and sending a lot of supplies up front, we did more of a test shipment. Since it proved effective, we’re widening the supply chain, continuing to ship aid in larger volumes.”

After the successful delivery in October, several others were dispatched. A container of blood glucose meters, test strips and pen needles arrived in Port Sudan on Jan. 31, and a large shipment of insulin and insulin delivery devices is scheduled to arrive in Port Sudan by late March.

More containers are being prepared, but Direct Relief is shipping material to Sudan in smaller quantities than would be ideal to reduce risk as the country’s civil war continues. In December, the RSA militia seized control of Sudan’s second-largest city, Wad Medani, putting about 1,000 of SCDA’s childhood diabetes patients out of reach. “The Sudanese civil war is brutal, devastating and shows no sign of coming to an end,” said a February overview published by Chatham House.

“The security situation is extremely challenging,” Grodzovsky said. “We’re not bulk shipping the insulin because of the security situation, so that if something happens, we’re not losing a whole annual supply.”