Insulin cold chain for 14 clinics in Yemen

The problem is not supply, it is temperature

Insulin reaches Yemen. Donated stock, procured stock, humanitarian shipments — it lands, and it reaches the governorate warehouses in reasonable condition. What happens after that is the problem. Between a warehouse in Taiz and a clinic forty kilometres away sits a journey of several hours in an ambient temperature that regularly exceeds thirty-eight degrees, in a vehicle with no refrigeration, in a cool box packed with whatever ice was available that morning.

Insulin that has been above thirty degrees for an extended period loses potency in a way that is completely invisible. The vial looks fine. The patient injects it, their blood sugar does not respond, and the clinical assumption is non-adherence or disease progression rather than degraded medicine. We measured this across eleven clinics last year with temperature loggers and found excursions above thirty degrees on sixty-one per cent of deliveries.

What we are installing

A complete monitored cold chain across fourteen clinics: solar direct-drive refrigerators at each site, monitored transport boxes for the last leg, and a logger in every box that anyone can read from a phone. If a delivery breaks the chain, the clinic knows before it dispenses rather than months later when patients fail to improve.

• Fourteen solar direct-drive refrigerators, which run without batteries and survive power failure.
• Forty monitored transport boxes with a temperature logger in each.
• A shared dashboard so the governorate warehouse can see every excursion.
• Training for 60 staff and drivers, because equipment without practice fails quietly.

What the money buys

Roughly $5,300 puts one clinic on a monitored cold chain and keeps it there for three years.

• $29,400 — 14 solar direct-drive refrigerators WHO-prequalified units that store energy in ice rather than batteries, which is the design that survives eight years in this environment.
• $14,800 — Solar arrays and installation Panels, mounting and installation at fourteen sites, several of which need a roof reinforced first.
• $11,200 — 40 monitored transport boxes with loggers Passive cold boxes rated for thirty hours, each with a logger that anyone can read from a phone.
• $8,600 — Monitoring platform and three years of connectivity The dashboard, the SIMs and the alerting, for three years rather than one.
• $6,300 — Training for 60 staff and drivers Two days per site, covering packing, reading a logger, and what to do when the chain has broken.
• $3,600 — Spares, maintenance reserve and platform fees A pool of spare loggers and box liners held in Taiz, plus the campaign costs.

Sixty-one per cent of deliveries broke thirty degrees. Nobody knew, because degraded insulin looks exactly like insulin.

Who is behind this

Sahel Medical Relief has run cold-chain logistics in Yemen since 2021 and currently supports vaccine storage at nine sites. This project extends the same infrastructure to insulin, which sits outside most vaccine programmes and therefore falls through the gap. The fourteen clinics are all governorate health office facilities and the equipment is handed over to them; we do not own it and we do not run it. The temperature data is shared with the governorate warehouse, not held by us.

Risks and challenges

Access is the risk that could stop this. Two of the fourteen clinics are on routes that have been closed for weeks at a time in the past year, and installation there will happen when it can happen rather than on a schedule we can publish. Solar equipment is a theft target and each installation includes physical security, which we have budgeted for but which is never a guarantee. Import clearance for medical equipment has taken between three weeks and four months in our experience. The failure mode we most want to avoid is a monitored chain that nobody looks at, which is why three years of connectivity and a training line are in the budget rather than being treated as optional.