functional sewage treatment plants (STPs) and a growing population, the country's sewage systems are ill-equipped to meet the needs of citizens and serve just 7% of the population. Actual flow rates through the STPs in Yemen exceed the flow rates they were designed to accommodate, which reduces their efficiency. The treatment processes used are also suboptimal, with 68% of STPs using only stabilization ponds - which are generally intended as a primary treatment - to remove pathogens from sewage. This has resulted in high quantities of infectious agents in effluent, which is hazardous to health and can enable the spread of cholera. Moreover, wastewater in Yemen is frequently reused for irrigation purposes by farmers due to a lack of awareness about safety risks. High concentrations of Escherichia coli, Streptococcus faecalis, Klebsiella pneumoniae, Enterobacter aerogenes, Salmonella typhi, S. typhimurium, and Shigella sonnei - among other harmful fecal coliforms - are present in this wastewater, and transmit to humans when they consume foods irrigated by it. Official dumping sites for solid waste are being created increasingly close to communities, which has increased the risk of infection and general health issues among citizens. This is especially true for the roughly 70% of citizens without access to potable water, who consume water from wells near dumping sites. El Niño The El Niño–Southern Oscillation phenomenon is a major driver of climate variability associated with health outcomes, including influencing cholera dynamics due to changes in rainfall. For example, in East Africa, there was an upsurge in cholera cases in areas with increased rainfall, along with an increase in cases in areas with decreased rainfall. In the 2015-2016 El Niño event, there were an additional 50 000 cases of cholera in East Africa. Based on genomic approaches, there was a linkage found between the epidemic in Yemen starting in 2016 and the earlier outbreaks in East Africa. This alludes to a possible connection between cholera in East Africa and Yemen. Chironomidae are natural reservoirs and carriers of the Vibrio cholerae bacterium. It has been suggested that adult chironomidae may aerially carry the bacterium between bodies of water, assisting in the transmission of cholera. Based on this evidence, it is hypothesized that the El Nino conditions over the Gulf of Aden may have contributed to the transmission of cholera from the Horn of Africa to Yemen through wind effects on cholera-contaminated flying insects. Health services and infrastructure collapse