There were significant improvements in Ethiopia’s main health indicators in 2015, but unstable weather patterns causing drought and floods meant that vulnerable groups struggled to access the services they needed.
MSF and the national authorities have been working together to increase capacity, respond to outbreaks of disease and fill gaps in basic and emergency healthcare for the fast-growing population, which includes a large number of refugees.
Between 2014 and 2015, more than 220,000 South Sudanese refugees, mostly women and children, arrived in Gambella, where infrastructure and services are limited. Until May, MSF managed a clinic providing comprehensive services inside Leitchuor refugee camp and ran mobile clinics to the Burbiey and Matar transit sites. Leitchuor and Nip-Nip camps had been set up in an area prone to flooding and consequently were completely inundated during the rainy season, forcing the relocation of more than 40,000 refugees to Jewi, a newly established camp 18 kilometres from Gambella town. MSF reduced activities in Leitchuor and now runs the main health centre in Jewi, providing medical consultations, emergency and maternity services, and outreach activities. Teams conducted over 19,600 outpatient consultations over the course of the year.
MSF’s Itang health centre, near Kule and Tierkidi camps, was damaged in the 2014 floods and was therefore temporarily relocated. It returned to its original site in February, with a 55-bed capacity and provided outpatient and 24-hour inpatient services. Over 200,000 outpatient consultations were carried out, 70,000 patients were treated for malaria, and mobile clinics travelled to the Pagak and Pamdong refugee sites. As hospital capacity increased in the camps, the project was closed in July. From December 2015 to January 2016, however, MSF conducted a meningitis vaccination campaign that reached 29,196 people in Kule and 29,317 people in Tierkidi.
In November, MSF teams started providing basic and specialist healthcare, including treatment for malnutrition, tuberculosis (TB) and HIV, at the Pugnido camps near Gambella. A network of community health workers was established to help monitor disease outbreaks and to refer people for medical care. There had been more than 9,700 outpatient consultations by December.
The third round of a vaccination campaign in Gambella targeting refugee children aged between six and 59 months was completed in February with 13,862 children vaccinated against pneumococcal disease and 3,376 vaccinated against diphtheria, whopping cough, tetanus and hepatitis B.
MSF provides medical and nutritional support to Somali refugees at Dolo Ado reception centre and Buramino and Hiloweyn refugee camps. People living in the woreda (district), the five refugee camps, and Somalis crossing the border with medical needs make use of these services. At Buramino and Hiloweyn camps, over 2,800 children received supplementary nutrition and 1,300 antenatal consultations were carried out.
MSF has been working with the Regional Health Bureau (RHB) to improve services at Dolo Ado health centre. In 2015, the team started providing TB treatment and a blood bank was set up. Over 1,800 patients were seen in the emergency room and 1,000 patients were admitted for care. People commonly presented with lower respiratory tract infections and gastric disorders.
In Jerar zone, located in an area of low-intensity conflict, MSF supported the hospital as well as health centres, and mobile clinics in up to 23 outreach locations in Degehabur, Birqod, Ararso and Yocale woredas, mainly through capacity-building activities in collaboration with the RHB. At the end of the year MSF scaled down outreach to streamline services and increase quality. A second base and supported health centre was scaled up in Yocaale woreda, with full 24/7 medical support. In Degehabur hospital, MSF runs specialist services including lifesaving and emergency obstetric care, an inpatient department, an emergency room and emergency TB referral. In 2015, a maternal waiting room was constructed, and the therapeutic feeding centre and TB ward were handed over to the hospital. Teams continue to provide nutritional support to acutely malnourished children and vulnerable people in Jerar. Some 76 community health workers conduct regular surveillance activities in Degehabur and 26 locations outside the city. MSF also offers logistical support for vaccination campaigns implemented by the RHB.
Fik woreda in Nogob zone is another area affected by protracted conflict, and a team has been strengthening capacity at Fik hospital, providing medical and nutritional support, in collaboration with the RHB.
In Wardher zone, MSF focuses on mother and child health, offering reproductive healthcare and paediatric services, treatment for malnutrition and care for victims of sexual violence. Basic healthcare is also available at Yucub health centre and through mobile clinics. In 2015, MSF carried out more than 22,400 outpatient and 2,700 antenatal consultations, and admitted 1,000 patients for care. Nearly 1,000 people of all ages were admitted to the therapeutic feeding programme.
Siti zone in northern Somali region has been heavily affected by drought, leading to very high malnutrition rates. An assessment in November in Hadigala, Erer and Afdem woredas found malnutrition rates of up to 14 per cent among the nomadic population and MSF began an emergency intervention in December.
Northeast Ethiopia has been badly affected by drought and regional authorities also granted MSF approval to begin an emergency nutritional intervention in October in Gewane woreda and in Bidu, north Afar in December.
Southern Nations, Nationalities and People’s Region (SNNPR)
MSF started an emergency preparedness project to carry out epidemiological surveillance, develop local contacts, gain knowledge and build capacity to respond to crises in SNNPR. Together with the RHB, six zones were identified for training and 112 health ministry staff were trained on epidemiological surveillance in 2015.
Treating kala azar
Kala azar (visceral leishmaniasis), a parasitic disease transmitted by sandflies, is endemic in Ethiopia and is almost always fatal without treatment. Since 2003, MSF has been running a project in Abdurafi, providing free diagnosis, treatment and referrals for the local population and migrant workers, resulting in a reduction in the incidence of kala azar and deaths from the disease. More than 2,500 people were screened for kala azar in 2015 and 325 patients suffering from the disease were treated. Additionally, 249 patients in Abdurafi received nutritional support for severe acute malnutrition and 325 patients were treated for snakebite.
Mental health in Tigray
In February, MSF opened a project focusing on mental healthcare for Eritrean refugees at camps in Tigray region. Outpatient psychosocial and psychiatric services are available at Shimelba and Hitsats camp clinics, complemented by community-based care in Hitsats camp. A psychiatric care centre was opened in Shimelba for inpatient treatment. Over 600 individual mental health consultations were completed, and community education and awareness activities are being implemented to reduce stigma and ensure that those in need make use of the services available.
No. staff in 2015: 1,610 | Expenditure: €26.6 million | Year MSF first worked in the country: 1984 | msf.org/ethiopia