Kundeya school, in the city of Axum, central Tigray, where thousands of displaced people have taken refuge in recent weeks. 2021
Armed conflict

Tigray violence scatters people across two countries

Since November 2020, our MSF teams have been providing medical care and other assistance in response to the conflict in Tigray, Ethiopia.

Our priorities remain trying to cover basic health needs for the most vulnerable populations across the region. This includes running mobile clinics, supporting (including rehabilitating damaged and looted) primary and secondary level health facilities across the region to ensure lifesaving services are available and establishing alternative referral systems to restore access to health care for communities. 

Our Doctors Without Borders (MSF) teams are supporting five hospitals in collaboration with the Regional Health Bureau. We are also supporting health centres and running mobile clinics in dozens of locations. The number of locations we reach with mobile clinics changes constantly as our teams expand access and outreach activities to new areas. Our teams also donate emergency and essential supplies such as medications and oxygen to local facilities and provide water and sanitation support to the sites for Internally Displaced People (IDP) and in communities where the water system has been damaged.   

As of mid-June, MSF had a total of about 838 international and local staff working on our projects in Tigray.

A displaced woman and her children stand at Abdimalaha school, Adwa, a town in central Tigray. 2021

Our ongoing activities range from providing primary and secondary healthcare to South Sudanese refugees in the camps of the Gambella region, to running mobile clinics in remote areas of the Somali region and responding to flooding, and emergency outbreaks like cholera and measles. Our teams assist people who have been displaced by fighting in Benishangul Gumuz and SNNPR regions through primary health mobile clinics, and improving access to clean water and sanitation for communities in the area.

We also treat people for neglected diseases like Kala-Azar and snakebites in Amhara region, and in Addis Ababa we provide medical and mental health support to Ethiopian migrants deported from Saudi Arabia, Yemen and Lebanon. We also provide medical care to the population of Sababuru woreda in Guji zone, in Oromia region. We rehabilitate facilities to make them functional for providing services, and conduct mobile clinics in rural areas. In January 2021, MSF opened an emergency medical program to improve access to primary and secondary healthcare for people affected by conflict, as well as the host community, in Metekel.

The current conflict in this area has forced out more than 200,000 people from their homes. EPREP – including monitoring, preparedness planning, and prepositioning of supplies and teams – is also ongoing for the upcoming elections on 21 June, 2021.

Eastern Tigray

We support the hospital in Adigrat, the region’s second-largest city. Our team arrived there on 19 December to find the hospital, which serves over one million people, only partially functional. Since 23 December, our medical teams have been running the emergency ward, as well as inpatient, surgical, pediatric, maternity, and mental health services in the hospital. We also provide outpatient care for children under five.

From January through May, 4,766 ER consultations, 386 surgical interventions have been carried out and 1,913 deliveries, including 174 C-sections, have been assisted. We are supporting 15 health centres in the area. Two mobile outreach teams have carried out thousands of emergency consultations since January through mobile clinics in the peripheral areas of Adigrat.

Central Tigray

In the towns of Adwa and Axum, We are providing displaced people and the local community with basic health care, and supporting health centres with essential supplies such as medications, oxygen, and food for patients. In Adwa, we support two health centers as well as Don Bosco hospital, where we recently set up an ITFC. In Axum, we support the university hospital and two health centres. From January through May, 1,885 ER consultations and 251 surgical interventions have been carried out, as well as 1,132 deliveries, including 148 C-sections, have been assisted.

We also support the displaced population in IDP sites in Axum and Adwa and provide outreach mobile clinics to 15 sites in the surrounding area. From the end of March through May, our outreach teams were blocked from reaching many communities. We were recently able to access some areas again for the first time and found extensive health needs among the populations due to their inability to access medical services.

In the town of Abi Adi, we have been supporting the health centre since February. Abi Adi General Hospital was occupied by soldiers until March, then looted again by armed actors, before MSF rehabilitated the hospital and restarted services in partnership with the Regional Health Bureau. We are supporting the emergency, inpatient, maternity, surgery, and outpatient departments in the hospital. MSF outreach teams conduct mobile clinics in surrounding communities and refer emergency cases by ambulance to the hospital. 
 

Map of Response to Tigray crisis in Sudan and Ethiopia

Northwest Tigray

In Shire, we are supporting the hospital’s paediatric ward and ITFC and have given donations to several health centres.  We are conducting mobile clinics in sixteen informal IDP sites inside Shire town, as well as providing primary health and mental health services, and support with water, sanitation and relief items. 

In the town of Sheraro, we are providing support to Sheraro health center, which now also provides inpatient services and facilitates emergency referrals to Shire hospital. MSF is also providing support to IDP locations in Sheraro. Currently, three outreach teams regularly provide medical care as health posts are not functioning. From January to May, we carried out 58,346 medical consultations in Shire and Sheraro (excluding outreach activities). This included 8,453 consultations for children under five years and 8,977 ante-natal consultations.

The top morbidities were upper and lower respiratory tract infections, parasite infections, and skin diseases. Our teams in Shire and Sheraro are supporting the Regional Health Bureau (RHB) with the administration of an EPI program as well as COVID-19 vaccinations for all at risk groups seen in the IDP camps in Shire Town and to frontline health care workers in Shire and Sheraro. The teams are working in Shire with other actors to provide community sensitization on the COVID-19 vaccine, including addressing community concerns and rumors.

A measles vaccination campaign started in May in Shire and Sheraro. A total of 2,728 people have been vaccinated. Malaria cases are also on the rise, and we can expect cases to increase further with the onset of rainy season. The team is also supporting World Health Organization for cholera vaccination in all locations.
 

Haragu Masfem, 40, a mother of five, sits outside of the Basin school in Axum, a city in central Tigray that has received thousands of displaced people over recent weeks. 
Haragu Masfem, 40, a mother of five, sits outside of the Basin school in Axum, a city in central Tigray that has received thousands of displaced people over recent weeks. 
Igor Barbero

Western Tigray

We are conducting mobile clinics for vulnerable populations left behind without necessary protection and assistance, as well as giving donations and support to health facilities in the surrounding areas of Humera, Adi Goshu, Dansha, Adi Remets, Gonder, Debark, May Cader, Adebay and near the border. MSF also provides support to Humera hospital. On the border with western Tigray, in Abdurafi, Amhara region, we continue supporting the remaining IDPs in town and run a health centre for snake bites and Kala Azar.

South East Tigray

MSF has just opened a project in Samre, 60kms from Mekele, where the hospital was damaged (but not destroyed) during the conflict. The health staff had fled along with the local community, but are coming back now that troops have left the area. As the team scales up, they will support the maternity ward, in-patient department, and out-patient department at the local hospital, as well as starting mobile clinics in the surrounding areas. The initial MOU (memorandum of understanding) is for three months.

Amhara region – Casualty response from 5-14 November 2020

On the morning of 5 November 2020, wounded people started to arrive from Tigray. In the Amhara region, where OCA runs a Neglected Diseases project in Abdurafi, MSF supported the MoH Health Centre with triage, treatment of injuries, and coordination of ambulances to Abrehajira and Gondar hospitals. In total, our teams received 278 casualties, both combatants and civilians, with 18 deaths. As the frontline of the conflict moved east, no more wounded were received after mid-November, but we continue to monitor the situation, and mounting tensions along the border with Sudan.

Leterbrhan (pseudonym) lies with her five-year-old daughter in a small room where around 20 people sleep at the elementary school in Abi Adi, a town in central Tigray. Schools have become informal settlements for displaced people fleeing the conflict in this northern region of Ethiopia. 

Sudan

MSF teams continue healthcare provision, health promotion, mental health, nutrition screening, and water and sanitation activities. At the Hamdayet clinic, the main morbidities are respiratory tract infections and diarrhoea. Only a small number of wounded and sexual and gender based violence cases have been seen at the clinic.

Since November, MSF teams have been present in Gedaref and in Kassala states at the border with Ethiopia, responding to the influx of Ethiopian refugees. 

MSF is present at the border crossings and transit centers in Hamdayet, and Hashaba village. Nearly 14,000 refugees are located in the transit area and border of Hamdayet, where shelter, access to food, sanitation and clean drinking water remain an issue. Most refugees in Hamdayet, especially those without shelter, are living within the host community. Currently, the clinic of Hamdayet does about 300 consultations per day (host and refugee communities), with the main morbidities being respiratory infections and diarrhoea. Only a small number of wounded and SGBV cases have been seen at the clinic. 

In Hashaba camp, we do medical consultations, provide support for reproductive health care, and run health promotion activities. 

As of mid-February, around 20,000 refugees were moved to an official camp called Um Rakuba and another 20,000 refugees were relocated to a second permanent refugee camp in Al Tanedeba, Gedaref state. The conditions in the camps have improved compared to earlier stages. However, the needs of people remains high, especially with the rainy season.

The situation in Um Rakuba is relatively better than in Al Tanedeba that is built on “black soil”, where after the first strong wind in early May, destroyed 200 tents. A second storm on 7 June destroyed most of the remaining tents in the camp. Some refugees had managed to reinforce their tents in advance, but most lacked the material and funds to do so and are now sharing tents with others or in communal shelters.  

Administrators register newly arrived displaced people at Tsegay Berhe school, in the city of Adwa in central Tigray, northern Ethiopia. 
Administrators register newly arrived displaced people at Tsegay Berhe school, in the city of Adwa in central Tigray, northern Ethiopia. 
Igor Barbero

A flyer distributed in April warning of the risk of damage to tents and belongings during the rainy season, followed by the first storm in early May, created panic within the camp. Many refugees have expressed a wish to leave the camp citing their concerns about the rainy season. Each day, dozens of people leave, some are heading for Hamdayet, the crossing point between Sudan and Ethiopia, from where they return to the conflict area of Tigray, others are going to Hashaba in the state. However, most of the refugees are heading for Libya where they will risk their lives attempting to reach Europe.

In Um Rakuba, MSF runs a clinic where we offer medical consultations, screen people for signs of malnutrition, and help patients with non-communicable disease (like hypertension, diabetes, etc.). We also support reproductive health, for pregnant women and new mothers, and we provide mental health consultations. MSF sends a weekly mobile clinic to the Um Rakuba village to provide medical care to the Amhara group staying in the village. The most common health issues we treat here are bloody diarrhoea, urinary tract infections, and a limited number of malaria cases. MSF teams are in the process of building a field hospital with 30 beds and ten additional isolation beds for transmittable disease.  

MSF has been working in Al-Tanideba camp since December 2020. MSF medical staff run a clinic in the camp providing primary and secondary healthcare, inpatient care, vaccinations and malnutrition treatment and provide regular health checks for new arrivals. MSF water and sanitation teams have constructed latrines and an emergency water treatment plant for the refugees.   
 

A group of displaced people engage in a discussion at Abdimalaha school in the city of Adwa, in central Tigray. 2021
A group of displaced people engage in a discussion at Abdimalaha school in the city of Adwa, in central Tigray. 
Igor Barbero

MSF has been working in Ethiopia since 1984. For more than 30 years, MSF has responded to emergencies countrywide, including malnutrition, malaria, acute watery diarrhoea, refugees’ health needs and access to healthcare. In Ethiopia, we continue to fill gaps in healthcare and respond to emergencies in both the host population and the growing refugee and displaced communities, often in collaboration with government health institutions and other partners. 

MSF started working in Sudan in 1979. MSF teams run regular projects and ad-hoc emergency interventions to tackle specific needs as they arise throughout the country’s vast territory.