Before fighting broke out in late 2020, the Tigray region in northern Ethiopia was home to around 5.5 million people, according to UN estimates. This included more than 100,000 internally displaced people and 96,000 refugees, who were already dependent on food assistance.

Since early November 2020, the terrible violence across Tigray has forced people to leave their homes – some becoming displaced again having been displaced already – for precarious living situations within Tigray, and over the border in Sudan.

Background

In September 2020, local group the Tigray People’s Liberation Front (TPLF) – which dominated Ethiopia’s government until their removal from Prime Minister Abiy Ahmed’s party in 2019 – held regional elections in the Tigray region, northern Ethiopia. Elections in Tigray were held despite the constitutional postponement of the national elections due to the COVID-19 pandemic.

As a result, tensions between the TPLF and the national government escalated, and eventually resulted in a full-blown conflict, following an alleged attack on a major Ethiopian Army base. On 4 November 2020, Ethiopia’s Prime Minister ordered military action against the TPLF, with fighting breaking out across the region.

The conflict has now led to hundreds of thousands of people being displaced; some within Tigray, finding shelter where they can in host communities. Others have made the journey over the border to Sudan, where they are now refugees. An estimated 1.3 million people are in need of assistance. [Source: OCHA]

Current situation

Ethiopia

In Tigray, people who have fled their homes across the region are now trying to find shelter where they can elsewhere. Tens of thousands of people have arrived in Shire, a large town in the zone of North West Tigray.

Most have fled with few possessions; many just with their clothes on their backs. In Shire, the majority stay with the host community, but 20,000 people live in informal sites. They sleep in cramped and often unhygienic conditions in the classrooms of several schools, as well as on the campus of Shire University.

Shelter, clean water and food are all in short supply. A 6.30pm curfew has been imposed on the town, making movements to seek medical care after these hours very difficult.

Access to healthcare is also very limited. Our teams in Tigray have documented evidence of widespread, targeted attacks on healthcare facilities across the region; of 106 facilities assessed between mid-December and early March, 87 per cent were no longer functioning or fully functioning.

Looting of facilities is widespread and most staff have left. The once well-functioning healthcare system in Tigray has almost completely collapsed.

Sudan

As of mid-February 2021, more than 60,000 refugees have been registered by the UN in Sudan; however, MSF teams estimate that some 10,000 to 12,000 refugees are still scattered in and around the border town of Hamdayet.

Here, people are supposed to be relocated to refugee camps within 72 hours, but some have been there for months. Humanitarian assistance in the border town remains substandard; refugees are living in unhygienic and appalling conditions, where their basic needs – food, water, sanitation, shelter – are being barely met. This situation is taking a toll on people, severely affecting their physical and mental health.

From Hamdayet, people are being slowly relocated to Um Rakuba and Al-Tanideba, the two permanent camps in Gedaref state, southern Sudan.

As of mid-February, around 20,000 refugees have been moved to Um Rakuba and more than 17,000 refugees have been relocated to Al-Tanideba. The conditions in the camps are quite poor.

MSF response

Ethiopia

Eastern Tigray

• MSF is supporting the hospital in Adigrat, which had partially stopped functioning. Our medical teams are running the hospital’s emergency room, as well as the medical, surgical, paediatric and maternity wards. They are also providing outpatient care for children under five.
• We have started a programme providing mental health consultations and activities
• MSF is supporting seven health centres in the area, where we run mobile clinics; our teams are also trying to reach more health centres in rural areas.

Central Tigray

• In the towns of Adwa and Axum, we are providing some of the displaced and local people with basic healthcare.
• In Adwa, we are supporting Don Bosco hospital and four health centres with essential supplies, including medicines.
• In Axum, we are supporting the hospital and four health centres with essential supplies, including medicines and food for patients.
• In the town of Abyi Addi, west of Mekele, a team is supporting the health centre with medical assistance.

North West zone and western Tigray

• In Shire, we are supporting the hospital and have given donations of goods to several health centres in the town.
• We are providing an estimated 30,000 displaced people in Shire with water and sanitation and relief items, such as cooking and hygiene kits.
• Our teams provide medical care via mobile clinics located at three displaced people’s sites in Shire, where people live in a university and two school buildings.
• In the town of Sheraro, we are providing support to Sheraro health centre and facilitate emergency referrals to Shire hospital.
• MSF is supporting health centres in over 10 locations in villages in the areas around Shire and Shiraro.
• In the towns of Mai Kadra, Humera and Abdurafi, MSF provided support to some health centres and has been assisting around 2,000 internally displaced people by providing medical services, supplying water, sanitation and hygiene products, and constructing emergency latrines after the fighting started.

Southern Tigray

• MSF teams ran mobile clinics and restarted some services at health centres in the towns of Hiwane and Adi Keyih, alongside staff from the Ministry of Health, until mid-January.

Sudan

Hamdayet

• At the border crossing in Hamdayet, our teams provide medical care, health promotion, mental health consultations, nutrition screening and water and sanitation services to people who have crossed the border.

Hashaba camp

• At the camp in Hashaba, we provide medical consultations, including support for reproductive health and health promotion activities.

Um Rakuba

• MSF runs a clinic where we offer medical consultations, screen people for signs of malnutrition, and help patients with non-communicable diseases, such as diabetes. We also support reproductive health, for pregnant women and new mothers, and provide mental health consultations.
• We run a mobile clinic on weekly basis in Um Rakuba village to provide medical care to the Amhara group who are staying in the village. The most dominant health issues treated by MSF are bloody diarrhoea, urinary tract infections as well as some cases of malaria.
• MSF teams are in the process of building a field hospital with 30 beds and 10 additional isolation beds for transmissible diseases.

Al-Tanideba

• We screen arrivals at the reception area of the camp for their health needs, providing treatment as needed.
• We are providing water and sanitation, basic healthcare, vaccinations, malnutrition screening and are supporting maternity services.
• MSF is currently building an inpatient clinic, which will have a ward each for women, men and children. The clinic will treat severely malnourished children and a maternity department.
• Medical services provided in the camp are for both refugees and the host community.