Building critical care capacity for resource-limited countries with complex emergencies in the World Health Organization Eastern Mediterranean Region: Developing and Implementing a Critical Care National Training Program in Yemen

Main Article Content

Chiori Kodama Gary Kuniyoshi Basel Abdullah Salem Obaid Eudaldo Gonzalez Martinez Annette Heinzelmann Adham Rashad Ismail Abdel Moneim Saeed Mohammed Saeed Baraiah Ahmed Taha Makki Alaa Hashish Kamila Al Alawi Nathalie Khawam Jean Yaacoub Jabbour Abdinasir Abubakar Richard John Brennan


Background: Caring for critically ill patients is challenging in resource-limited and complex emergency settings such as Yemen, where the burden of disease and mortality from potentially treatable illnesses and injuries is higher than in resource-rich areas. Barriers to delivering quality critical care in these settings are numerous and include deficiencies in health systems structure, a limited capable healthcare workforce, insufficient financial resources, and access constraints due to insecurity, among many other factors. Methods: Potential solutions include the development of focused practical and educational programs for capacity building of national healthcare professionals’ knowledge and skill sets in the care of critically ill patients. This requires adaptation of proven curricula into a national training program to promote implementation of evidence-based critical care. Results: Yemen successfully introduced a 9-week national critical care training program that targeted both physicians and nurses from 11 of 12 southern governorates from 5th June to 11th August 2022. The procedures for its development and its implementation are described in this report. Successful continued development and implementation are contingent on ongoing adaptation, secured financial resources, and support from academic institutions such as the Faculty of Medicine and Health Sciences University of Aden (Yemen), the Oman Medical Specialty Board (Sultanate of Oman), health care authorities and partners. Technologies utilized included tele-education and a simulation skills center using high fidelity manikins, in addition to the lectures and bed-side training sessions in Intensive Care Unit (ICU). Conclusion: Critical care training is a vital need and of paramount importance in resource-limited and complex emergency settings such as Yemen and programs should be developed and sustained under country ownership with support from internal and external partners. The current challenges and shortfalls require new approaches such as a comprehensive, focused critical care/ICU national training program to build a cadre of critical care professionals in the country together with the provision of human, material, and financial resources support. Through producing a cadre of critical care/ICU national professionals, this course is contributing to enhancing the emergency preparedness and response capacities in Yemen, as well as building sustainable critical care capabilities within the national health system that will further save many lives in Yemen.

Article Details

How to Cite
KODAMA, Chiori et al. Building critical care capacity for resource-limited countries with complex emergencies in the World Health Organization Eastern Mediterranean Region: Developing and Implementing a Critical Care National Training Program in Yemen. Medical Research Archives, [S.l.], v. 10, n. 10, oct. 2022. ISSN 2375-1924. Available at: <>. Date accessed: 16 apr. 2024. doi:
Research Articles


1. Al-Mandhari AS, Brennan RJ, Abubakar A, Hajjeh R. Tackling COVID-19 in the Eastern Mediterranean Region. Lancet. 2020;396:1786-8. doi: 10.1016/S0140-6736(20)32349-7
2. OCHA. Global Humanitarian Overview 2022, published 2 Dec 2021.
3. UNHCR. Global Trends Forced Displacement in 2021, published 31 Dec 2021,
4. OCHA. Humanitarian Response Plan Yemen 2022, published April 2022.
5. World Health Organization Yemen. Yemen Health Cluster Bulletin, November - December 2021, published December 2021.
6. World Bank Report 2021: Health Sector in Yemen Policy Note, published 14 September 2021.
7. Kodama C, Kuniyoshi G, Abubakar A. Lessons learned during COVID-19: Building critical care/ICU capacity for resource limited countries with complex emergencies in the World Health Organization Eastern Mediterranean Region. J Glob Health. 2021 Jul 17;11:03088. doi: 10.7189/jogh.11.03088. PMID: 34326987; PMCID: PMC8286446.
8. Marshall JC, Bosco L, Adhikari NK, et al. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care. 2017;37:270-6. doi: 10.1016/j.jcrc.2016.07.015.
9. Diaz JV, Riviello ED, Papali A, Adhikari NKJ, Ferreira JC. Global Critical Care: Moving Forward in Resource-Limited Settings. Ann Glob Health. 2019;85:3. doi: 10.5334/aogh.2413.
10. Narasimhan V, Brown H, Pablos-Mendez A, et al. Responding to the global human resources crisis. Lancet 2004;363(9419): 1469–72. doi: 10.1016/S0140-6736(04)16108-4.
11. The WHO Clinical Care Training Short Course for Severe Acute Respiratory Infection (SARI) for clinicians who are working in intensive care units (ICUs) in low and middle-income countries and managing adult and pediatric patients with severe forms of acute respiratory infection. Geneva: World Health Organization; 2020.
12. The WHO/European Society of Intensive Care Medicine C19 Skills Preparation Course (C19 SPACE) to orientate and supplement clinical learning for nurses and doctors not regularly or newly engaged in intensive care units (ICUs). Geneva: World Health Organization; 2022.
13. Joynt GM, Zimmerman J, Li TST, Gomersall CD. A systematic review of short courses for nonspecialist education in intensive care. J Crit Care. 2011;26(5): 533.e1–533.e10. doi: 10.1016/j.jcrc.2011.01.007.
14. MacLeod JB, Okech M, Labib M, Aphivantrakul P, Lupasha E, Nthele M. Evaluation of trauma and critical care training courses on the knowledge and confidence of participants in Kenya and Zambia. World J Surg. 2011;35(1):9–16. doi: 10.1007/s00268-010-0810-z.
15. Society of Critical Care Medicine. Fundamental Critical Care Support Course.
16. Nirupa S, Satish B, Diaz JV, Gopaland PD, Appiahe JA. A roadmap for acute care training of frontline Healthcare workers in LMICs. J Crit Care. 2017;41:313–317. doi: 10.1016/j.jcrc.2017.07.028.