Tigray violence scatters people across two countries

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.


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 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 4.5 million people are in need of assistance.[1]

Current situation


In Tigray, hundreds of thousands of people have fled their homes but remain in the region – some have been displaced several times – but the exact number of displaced people in across Tigray is not known. They are trying to find shelter where they can; since the beginning of March, our teams have witnessed a massive influx of new arrivals in the towns of Shire, Adwa, Axum, Adigrat and Abyi Adi. The number of different sites where people are staying have multiplied by five in both Shire and Axum over recent weeks, while there are now more than 117,000 people in Adwa alone. Although people are still arriving, the numbers more recently have slowed.

Most have fled with few possessions; many just with their clothes on their backs. Conditions across most sites are very bad, and is at breaking point for the displaced and people in host communities alike. Shelter, hygiene services, clean water and especially food are all in short supply. More international assistance has arrived over the past month, but the humanitarian response has been slow and huge gaps remain; it generally does not reach people outside the major towns, where people are known to still be hiding.   

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.

Worryingly, there are increasing reports of violence against civilians, including extra-judicial killings and sexual violence, witnessed not only by our own staff, but also by organisations such as Amnesty International[2] and Human Rights Watch[3]. Clashes continue to be reported in Central, Eastern, North Western, South Eastern and Southern Zones.[4]


As of 13 April, more than 62,500 people have crossed to Sudan as refugees.[5] Though the number of new arrivals has significantly decreased over the past few weeks, because of challenges that refugees are facing to cross the heavy militarised border, there are still new people arriving every day.

Nearly 14,000 refugees are located in the transit and border area of Hamdayet where shelter, access to food, sanitation and clean drinking water continues to be an issue.  Most refugees in Hamdayet, especially the ones without shelter, are living throughout the village within the host community. Our teams are present at the border crossings and transit centres in Hamdayet and Hashaba village.

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

Three months on and MSF is still worried about the very limited services in the permanent camps, which are located in a very remote part of Sudan, and where many of the humanitarian needs – including shelter, water and food – are not being met. All humanitarian organisations need to step up their responses immediately to meet people’s needs.

We are particularly worried about the forthcoming rainy season and the situation in Al-Tanideba; the camp site is built on notorious black cotton soil, which doesn’t absorb water. This, in combination with the rains, could spell disaster for people living in tents, especially if the area floods. Permanent latrines and water networks (to replace water trucking) must be up and running as a matter of urgency.

MSF response


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 several 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, including at some of the sites for displaced people in both areas.
  • In Adwa, we are supporting Don Bosco hospital and two health centres with essential supplies, including medicines.
  • In Axum, we are supporting the hospital and two 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, following an upgrade of capacity and services, including emergency and observation rooms and an inpatient department. We’re currently rehabilitating the hospital.
  • Also in Abyi Addi, we conduct mobile clinics in the area and refer patients to the health centre.

North West Tigray

  • In Shire, we are supporting the hospital’s paediatric and intensive therapeutic feeding wards (the latter for malnourished children) and have given donations of goods to several health centres in the town.  
  • We are providing tens of thousands of displaced people in Shire with water and sanitation and relief items, such as cooking and hygiene kits.
  • Our teams provide medical and mental healthcare via mobile clinics located at 14 displaced people’s sites in Shire.
  • In the town of Sheraro, we are providing support to Sheraro health centre, which now provides services to admitted patients, and facilitate emergency referrals to Shire hospital.  
  • MSF also started providing support to 3 locations for displaced people in Sheraro.
  • Across both Sheraro and Shire, three mobile clinic teams regularly visit seven locations around Shire, and four locations around Sheraro, providing medical care as health posts are not functioning.

Western Tigray

  • In Humera, Adi Goshu, Dansha, Adi Remets and in the border area, we are conducting mobile clinics for people left behind without necessary protection and assistance. We also provide donations and support to health facilities in these areas.
  • Our teams are providing support to Humera hospital.
  • On the border with western Tigray, in Abdurafi (Midre Genet), Amhara region, we continue to support the remaining displaced people in town, and run a health centre to treat snake bites and kala azar.

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.



  • 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.


  • 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.
[1] Source: OCHA, 2021 Humanitarian Needs Overview, 15 March, 2021
[4] Source: OCHA, Ethiopia
[5] Source: OCHA, Ethiopia