Articles

“As heavy fighting continues to restrict humanitarian operations across parts of Tigray, people are facing an extremely dire humanitarian situation…Aid workers continue to receive reports of attacks on civilians and civilian infrastructure in Central, North Western and South Eastern zones, including house-to-house searches accompanied by indiscriminate, extrajudicial killings. Gender-based violence remains widespread…About 4.5 million people are currently in need of humanitarian assistance in Tigray.”

This report by the UN OCHA shows how vital it is that aid gets through to people now on the edge of starvation. Below is a selection from the report.

HIGHLIGHTS

The humanitarian situation in Tigray remains extremely concerning, with conflict continuing to drive displacements of people and reports of some villages completely emptied.
Following the transition to a flexible notification system for access, several organizations have deployed international staff to Tigray to support the scale up of the response.
Delivery of assistance is stepping up, with humanitarian partners reaching 0.9 million people with complete food baskets, almost 0.7 million with water, and 136,000 with shelter.
Despite some progress in accessible areas, many people remain in hard-to-reach areas due to insecurity, logistical and administrative hurdles, where assistance is needed.
Over the past week, a large influx of people has reached Shire from Western Tigray amid reports of grave human rights abuses. Those newly displaced arrived in critical conditions.

BACKGROUND

SITUATION OVERVIEW

As heavy fighting continues to restrict humanitarian operations across parts of Tigray, people are facing an extremely dire humanitarian situation. Clashes continue to be reported in Central, Eastern, North Western, South Eastern and Southern Zones, where social services have reportedly collapsed, according to partners on the ground. A vast majority of health centres have been vandalized, destroyed or burned, and many health personnel have not been paid and are reportedly being threatened by armed actors, further delaying their return to work. Ongoing looting of health facilities, including in Southern Tigray, is hindering the health response, as partners are discouraged from providing medical supplies. People with chronic diseases and pregnant women are particularly affected, as they are unable to access emergency medical services during curfew hours, causing preventable deaths and delivery complications. Universities across Tigray have reportedly been extensively looted, while at least two have been destroyed by fire or bombs.

Basic services, including communications, electricity and banking, remain disrupted across much of Tigray. Approximately 4.5 million people living in rural areas and major towns in North Western Zone have had no power or communications for more than four months. Lack of communications in most areas are adding significant challenges to the delivery and monitoring of life-saving assistance.

In Western Tigray, partners report that tens of thousands of people have been displaced from the area allegedly on ethnic grounds. Since November 2020, the Western Tigray Zone has been under de facto control of Amhara regional authorities, during which there have been reports of ethnically motivated violence and forced displacement. Since February, thousands of residents in Western Tigray have fled the Zone amid reports of extrajudicial killings, arbitrary detentions, and disappearances of people, particularly young men. As of 8 March, more than 45,000 people have been registered in Shire, with an influx of about 1,500 people every day. The newly displaced, who arrive in dire conditions, have reported that some people remain stranded on the way due to lack of transportation from Tekeze River to Shire and have very limited humanitarian assistance. In Shire, aid workers have started delivering some food, shelter, wash and health assistance, and stressed the very urgent need to provide additional relief to the new arrivals, particularly shelter and non-food items. Humanitarian access and response in Western Zone is currently only possible through Amhara Region.

Aid workers continue to receive reports of attacks on civilians and civilian infrastructure in Central, North Western and South Eastern zones, including house-to-house searches accompanied by indiscriminate, extrajudicial killings. Gender-based violence remains widespread, according to the latest Emergency Coordination Centre meeting on 5 March, and humanitarian actors are still unable to measure the full extent of the situation, particularly in rural areas due to limited access. With government social protection, security and judicial systems not functioning, survivors of human rights abuses are receiving inadequate assistance. International actors, including the World Bank, continue to underscore the importance of safeguarding the rights of all people in Ethiopia. Multiple human rights organizations published, on 9 March, a joint open letter to H.E. Ms. Linda Thomas-Greenfield, Permanent Representative of the US to the UN in New York, calling for a prioritization of the crisis in Tigray at the UN Security Council, including mobilizing an appropriate diplomatic response.

With many areas of Tigray not having received vital assistance since the conflict started four months ago, the rising needs have vastly outstripped the preliminary response plan that was developed by the humanitarian community in the first weeks of the conflict. Now, partners are increasingly able to access hundreds of thousands of people in Tigray who are in desperate need, and to move more supplies and personnel into the region. The 2021 Humanitarian Needs Overview launched by the humanitarian community on 5 March estimates that about 4.5 million people are currently in need of humanitarian assistance in Tigray, of whom 3.5 million people are in accessible and partially accessible areas. The humanitarian community will continue to update this figure as more assessments become possible in the Region.

HIGH-LEVEL VISITS

About 40 diplomats, including the United States Ambassador to Ethiopia and members of the European Union, visited Mekelle on 10 March. Their visit follows the recent announcement by the US Agency for International Development (USAID) on the deployment of a Disaster Assistance Response Team to respond to growing humanitarian needs in the Region.

CROSS-BORDER IMPACT

Conflict along the border between Sudan and Ethiopia has significantly escalated over the past week, with direct confrontations between Sudanese Armed Forces and Ethiopian and Eritrean forces. The rising tensions over the disputed Fashaga area have gained broader geopolitical implications for the Horn of Africa region, including the Great Ethiopian Renaissance Dam in the Benishangul-Gumuz region.

Although the number of people arriving in East Sudan has drastically reduced in the past weeks, UNHCR reports that more than 61,880 people are currently seeking refuge in the Sudanese states of Gedaref and Kassala. Both Um Rakuba and Tunaybah camps in the Gedaref State have reached their maximum capacity, each slightly above 20,000 people. Relocations to the camps have stopped after more than 41,180 people were relocated to camps and settlements. More than 20,000 people remain in Hamdayet and Village 8 near the crossing points. UNHCR are working with local authorities and partners to adequately respond to the situation, as well as mobilizing resources to provide life-saving assistance services to the new arrivals.

HUMANITARIAN PREPAREDNESS AND RESPONSE

Following the recent transition from the previous clearance mechanism for international aid workers to a flexible notification system by email to the Ministry of Peace, a number of humanitarian organizations have begun using the new system and have deployed international staff to support the scale up of relief operations in Tigray. The National Disaster Risk Management Commission (NDRMC) and the Logistics Cluster also replaced the previous system on the movement of aid cargos with a similar notification mechanism. Partners are now able to move humanitarian commodities by informing NDRMC 48 hours ahead of any cargo movement into Tigray, without waiting for clearance.

Access to Eastern Tigray has improved over the past weeks as armed hostilities in the area largely subsided, and partners are operating in areas that were previously inaccessible. Movements along the main road between Alamata, Mekelle and Shire remains possible, while partners have reported issues with government clearances and insecurity along the road from Shire, Mae-Tseri, to Gondar. With stronger presence on the ground, there is an urgent need for humanitarian organizations to decentralize their capacity out of Mekelle through the main accessible axis from Adigrat, Adwa, Axum to Shire. Establishing a presence closer to the people is critical in order to reach more people in rural areas with the greatest humanitarian needs, as well as ensuring protection-by-presence.

Despite significant progress, partners estimate that 950,000 people who need urgent assistance remain in areas that are hard-to-reach by humanitarian organizations. The situation is particularly concerning in Central Zone, where about 460,000 people need critical humanitarian assistance. Very limited assistance and services are currently available to the people in hard-to-reach areas, while the overall operational environment is highly volatile and insecure for humanitarian operations.

Further, the humanitarian situation in Shire remains dire, according to a recent mission by the World Food Programme and Office for the Coordination of Humanitarian Affairs and partners on the ground. Thousands of displaced people lack adequate shelter and basic access to health, water, sanitation, and hygiene services, while food aid is also reportedly irregular and insufficient. With the sudden and ongoing influx of more than 45,000 people from the Western Tigray Zone to Shire Town, it became increasingly critical to scale up the multisectoral response to provide life-saving assistance to those in need.

In light of concerns that food aid is not reaching people in urgent need particularly in rural areas despite large amounts of assistance dispatched into and within the Region, the Food Cluster has established the Monitoring Working Group and held its first meeting on 5 March.In the past week, the Protection and Health clusters finalized the Joint Response Plan to Sexual and Gender-Based violence and Mental Health and Psychosocial Support needs in Tigray, and partners on the ground are working to operationalize the plan. The Protection Cluster is also working with the Education Cluster to develop a joint position on safe school reopening, particularly given alarming reports of threats to teachers and kidnappings of several students and the overall politicization of schooling by parties of the conflict.

Protection

Needs

Gross violations and abuses against civilians, such as forced displacement and returns, killings, abductions, sexual violence including against children, allegedly perpetrated by various parties to the conflict, and reported since the beginning of the conflict, continue to reach the Cluster partners.
Reports of sexual violence are widespread across the region. The Emergency Coordination Center noted on 5 March that there have been at least 417 self-reported cases of gender-based violence (GBV) from Mekelle, Wukro and Adigrat alone, simultaneously stressing that this is only “the tip of the iceberg”. While more than 110 rape survivors are currently seeking medical care in several medical institutions, according to the Protection Cluster, these incidences are believed to be greatly under-reported due to fear of stigma, discrimination and repercussion. Partners have also received reports that survivors of GBV who have reached out locally for community support were not able to access any services. Given the stigma and shame surrounding GBV, survivors in rural and remote areas are less likely to access local or mobile clinics as they are less confidential. Further, since many areas in Tigray remain inaccessible, it is difficult for GBV survivors to receive urgent and life-saving medical care, GBV case management or mental health and psychosocial support (MHPSS).
Women and children displaced are at heightened risk of abuse and exploitation, while recent assessments in collective centres for displaced people in Mekelle, Adigrat and Shire showed that the severe lack of infrastructure leaves women and children exposed to a range of abuse, including GBV. In general, many are sheltering in unfinished or damaged building and most centres do not include separate spaces or latrines for women and men, doors or even windows. At least 90 unaccompanied and separated children are living in these three centres that were assessed.
As of 18 February, 724 unaccompanied and separated children were registered by the Bureau of Labour and Social Affairs (BoLSA) and Protection partners in Mekelle, Adigrat and Axum towns. These children are at increased risk of violence and abuse, including GBV, child labour, trafficking and exploitation.
The Cluster is receiving concerning reports that many who have been displaced in western Tigray, including Adi Goshu, Humera and other locations near the Sudanese border, are now struggling to reach Shire. These groups are in urgent need of unimpeded access to safe areas, as well as related assistance and protection. Further, more than 45,000 people who have reached Shire from Western Tigray Zone are living in precarious conditions, mostly in the open air, as outlined in the Shelter section. Partners on the ground report that the pace and circumstances of displacement, together with humanitarian assistance, place these people at heightened protection risks.
Reports of exclusion from food assistance are increasing. The Protection Cluster is receiving reports on alleged exclusion of female-headed households from food assistance unless accompanied by a male family member. These reports have been shared with the Food Cluster.
Forced relocation of displaced people is also reported by protection actors on the ground. While advocacy by protection actors successfully halted the relocation of more than 30,000 people from Axum University to an unused prison in Shire, it is critical that these advocacy efforts continue in order to ensure that a suitable location is identified, that the displaced people are engaged and informed, and that the conditions for safe and dignified relocation are met.
There have been alarming reports of death-threats to teachers and kidnappings of several students by parties to the conflict to deter school re-opening. Focus group discussions and assessments in Mekelle suggested the instrumentalization of education by different parties of the conflict, giving rise to an urgent need to balance the right to education and the non-derogative right to life, as outlined in the section on Education reporting.
Overall, many people affected by the conflict in Tigray are traumatized and still face high protection risks, and are in need of urgent assistance, including mental health and psychological support. There is an immediate need for the Government to fulfil its responsibility to protect civilians, restore law and order, and bring perpetrators to account. Access to justice and protection of survivors and witnesses of violence are essential to ensure a favourable protection environment.

Response

The Protection Cluster, with 16 partners on the ground, is planning to assist nearly 410,000 people, including 263,000 with protection activities through monitoring aimed at identifying risk groups and referring cases through established and strengthen pathways for specialized services, 106,000 with prevention of GBV programmes, over 35,300 children with specific services for this group, and 4,565 people with housing, land and property activities. A protection actor to carry out monitoring activities has been identified, who will also ensure appropriate referral pathways for specialised provision of services.
The Protection Cluster has finalized its input to the Joint Protection-Health Response Plan to address the Sexual and Gender-Based Violence and Mental Health and Psychosocial Support (MHPSS) needs across Tigray. The plan includes the scale up of the response in several areas, including legal aid support, case management, MHPSS and enhanced health services. It further outlines additional activities to be implemented through other clusters including Camp Coordination and Camp Management, Emergency Shelter, WASH and Education.
In addition to conducting trainings to newly recruited staff who will contribute to the scale up of the response, the Cluster is also engaged in mobilising actors and resources to provide legal aid support and rehabilitate and establish safe shelters. Efforts to increase MHPSS support are underway with a strategy under development to engage actors across different clusters, as well as training relevant actors on psychological first aid and psychosocial support.
In the first week of March, Child Protection (CP) partners provided psychosocial support to 422 displaced children in Mekelle and its surrounding areas, such as Hadinet and Kisanet woredas.
Since the beginning of 2021, GBV partners have distributed a total of 23,722 dignity kits for women and girls of reproductive age across Amhara and Tigray regions. Importantly, 1,275 women and girls, including GBV survivors, have received psychosocial support and case management. In addition, over 5,000 displaced people have been reached with awareness-raising interventions, including as accompaniment to the provision of dignity kits to provide updates on service availability and key sexual and reproductive health and GBV messages. UNFPA has pre-positioned an additional 3,600 dignity kits in Afar Region for distribution to conflict-affected women and girls in woredas bordering Tigray.
The CP/GBV Areas of Responsibility has also consolidated a sectoral work plan to guide partners and humanitarian efforts in the coming five months. The plan is a living document that has also been consulted with the Ministry of Woman, Children and Youth and BoLSA. Its main areas of work revolve mainly around the prevention and response to SGBV and caring for survivors; on providing tracing and alternative care for unaccompanied and separated children; on MHPSS; and on awareness raising/community engagement and support. Ensuring adequate coordination and efficient mechanisms to prevent and respond to SEA is a priority throughout the response. Likewise, scaling up existing operational capacities, gaining access and raising the necessary resources is also urgent to implement these actions.
The Protection Cluster and the Food Cluster continue to work together to develop a joint plan to mitigate the risk of food exclusion and reported threats at distribution points.
Given the reported death-threats to teachers and kidnapping of students, the Protection Cluster continues to work closely with the Education Cluster to develop a common position to balance the right to education with the non-derogative right to life, and is engaging with other humanitarian partners for advocacy. The Cluster will also work with relevant partners to address protection risks associated with back-to-school plans and ensure the voluntary, safe, and dignified relocation of displaced people currently sheltering in schools.

Gaps

Despite the gradual scale-up, the Protection response remains insufficient compared to the scale of the needs and identified targets.
The network of local and regional government Protection services has been deeply disrupted by the conflict. Access to these services has been made much more difficult, and the situation is particularly concerning for displaced people across the Region.
The volatile security situation is hindering the response, particularly as partners remain reluctant to confirm their implementation locations.
The delayed programming for protection interventions is undermining the efforts to provide emergency protection services and mitigate the risk of further exacerbation of the protection needs.
Tens of thousands of people displaced from Western Tigray Zone continue to arrive in Shire Town, overwhelming the existing humanitarian capacity.

Logistics

Needs

While the Logistics Cluster has so far transported over 300 million tons of humanitarian cargo on behalf of its partners along the main routes into Tigray, primarily Gondar – Mai Tsebri – Shire routes, and from Kombolcha to Mekelle, secondary routes have yet to be serviced due to lack of requests from partners for delivering of cargo along these routes. Additional food operators are needed to complement ongoing efforts to deliver aid to areas that have not been reached for over three months.
The supply of commercial trucks is expected to be further limited during the agricultural season–March to September–, according to the Logistics Cluster Partners. Overall, increased capacity to mobilize humanitarian supplies and personnel, particularly to rural areas of Tigray, is needed to allow partners to scale up the response.

Response

The Logistics Cluster is increasing its capacity and has now established six storage capacities and common transport from Addis Ababa, Adama, Kombulcha, Semera, Gondar, and Mekelle.
Further, a 4,000 square metre facility with a 1,600 square metre warehouse has been established in Mekelle and is operational as of this week. In the coming month, the Cluster will be working to identify common storage for partners in Shire.
In the reporting period (3 to 10 March), the Logistics Cluster facilitated the transport of 259 MT of cargo by eight commercial trucks along the Kombolcha-Kombo-Mekelle route.
In addition to facilitating a delivery of 75 MT of wheat flour to Mekelle for a partner, the Cluster also facilitated two deliveries of 2.326 MT each to Mekelle and Alamata for two partners. WFP is increasing its fleet size from the current 23 trucks to over 100 fleet trucks by late March to support WFP and Logistics Cluster operations.
The Cluster currently supports 31 partners in the Tigray response and is on standby to facilitate access to a dedicated WFP fleet to support the humanitarian community, should commercial transport become unavailable.

Gaps

Ongoing insecurity is the main challenge of the response.

Source: MSF

Press Release15 March 2021

Violence in Ethiopia’s Tigray region has extended to attacks on health facilities, with barely one in 10 functioning.
Of the 106 health facilities MSF teams visited, one in five had been or was occupied by armed soldiers; one facility is being used as an army base.
The damaged, looted facilities and resulting lack of medical staff means people in the region have very little access to healthcare.
MSF urges all armed groups in the area to respect medical facilities and for services to be restored as soon as possible.

ADDIS ABABA – Health facilities across Ethiopia’s Tigray region have been looted, vandalised and destroyed in a deliberate and widespread attack on healthcare, according to teams from Médecins Sans Frontières (MSF). Of 106 health facilities visited by MSF teams between mid-December 2020 and early March 2021, nearly 70% had been looted, and more than 30% had been damaged; just 13% were functioning normally.

In some health facilities across Tigray, the looting of health facilities continues, according to MSF teams. While some looting may have been opportunistic, health facilities in most areas appear to have been deliberately vandalised to make them non-functional. In many health centres, such as in Debre Abay and May Kuhli in North-West Tigray, teams found destroyed equipment, smashed doors and windows, and medicine and patient files scattered across floors.

In Adwa hospital in central Tigray, medical equipment, including ultrasound machines and monitors, had been deliberately smashed. In the same region, the health facility in Semema was reportedly looted twice by soldiers before being set on fire, while the health centre in Sebeya was hit by rockets, destroying the delivery room.

MSF teams recently visited 106 medical facilities across Tigray region, Ethiopia. Of the facilities visited:

30 %

HAD BEEN DAMAGED

73 %

HAD BEEN LOOTED

87 %

WERE NO LONGER FUNCTIONING OR FULLY FUNCTIONING

Hospitals occupied by soldiers

Every fifth health facility visited by MSF teams was occupied by soldiers. In some instances, this was temporary; in others the armed occupation continues. In Mugulat in east Tigray, Eritrean soldiers are still using the health facility as their base. The hospital in Abiy Addi in central Tigray, which serves a population of half a million, was occupied by Ethiopian forces until early March.

“The army used Abiy Addi hospital as a military base and to stabilise their injured soldiers,” says Kate Nolan, MSF emergency coordinator. “During that time, it was not accessible to the general population.”

“They had to go to the town’s health centre, which was not equipped to provide secondary medical care – they can’t do blood transfusions, for example, or treat gunshot wounds,” says Nolan.

Health facilities and health staff need to be protected during a conflict, in accordance with international humanitarian law. This is clearly not happening in Tigray.OLIVER BEHN, MSF GENERAL DIRECTOR

Ambulances seized

Few health facilities in Tigray now have ambulances, as most have been seized by armed groups. In and around the city of Adigrat in east Tigray, for example, some 20 ambulances were taken from the hospital and nearby health centres.

Later, MSF teams saw some of these vehicles being used by soldiers near the Eritrean border, to transport goods. As a result, the referral system in Tigray for transporting sick patients is almost non-existent. Patients travel long distances, sometimes walking for days, to reach essential health services.

Many health facilities have few – or no – remaining staff. Some have fled in fear; others no longer come to work because they have not been paid in months.

Devastating impact on people

“The attacks on Tigray’s health facilities are having a devastating impact on people,” says Oliver Behn, MSF general director. “Health facilities and health staff need to be protected during a conflict, in accordance with international humanitarian law. This is clearly not happening in Tigray.”

Before the conflict began in November 2020, Tigray had one of the best health systems in Ethiopia, with health posts in villages, health centres and hospitals in towns, and a functioning referral system with ambulances transporting sick patients to hospital. This health system has now almost completely collapsed.

ATTACKS ON MEDICAL FACILITIES IN TIGRAY

MSF staff conducting mobile clinics in rural areas of Tigray hear of women who have died in childbirth, because they were unable to get to a hospital due to the lack of ambulances, rampant insecurity on the roads and a night-time curfew. Meanwhile, many women are giving birth in unhygienic conditions in informal displacement camps.

In the past four months, few pregnant women have received antenatal or postnatal care, and children have gone unvaccinated, raising the risk of future outbreaks of infectious diseases. Patients with chronic diseases such as diabetes, hypertension and HIV, as well as psychiatric patients, are going without lifesaving drugs. Victims of sexual violence are often unable to get medical and psychological care.

“The health system needs to be restored as soon as possible,” says Behn. “Health facilities need to be rehabilitated and receive more supplies and ambulances, and staff need to receive salaries and the opportunity to work in a safe environment. Most importantly, all armed groups in this conflict need to respect and protect health facilities and medical staff.”

MSF teams are rehabilitating a number of health facilities across the region and providing them with drugs and other medical supplies, as well as providing hands-on medical support in emergency rooms, maternity wards and outpatient departments. MSF teams are also running mobile clinics in rural towns and villages where the health system is not functioning, and in informal sites where displaced people are staying. However, there are still rural areas in Tigray that neither MSF, nor any other organisation, has been able to reach; MSF can only assume that people living in these areas are also without access to healthcare.

The health system in rural areas has collapsed

While the situation for displaced people in Shire is difficult, it is far worse for people living in areas outside of Tigray’s main towns.

Birhane* has walked over two hours from his village to get medical care. He says that the health centre that served his farming community of 2,500 people has been closed since November, and that all six staff have left.

“We are suffering from a lack of medical care. We don’t have any medication; the village’s two ambulances were taken,” says Birhane. “Many people are sick. Three pregnant women have died during childbirth in the past three months.”

“There is no food in the village. Our fields have been looted,” he continues. “Some of our women have been raped. We stayed for two months in the forest and we are still scared.”

Since the end of January, MSF is sending mobile medical teams to provide patients in villages and towns north, east and southeast of Shire with basic health care. We are also supporting some health facilities with medical supplies and just opened a base in the northwestern town of Sheraro, from where we are supporting the town’s rural catchment area.

Most of the health facilities our teams have visited are not functional. Many were vandalised and looted, and, in most facilities, the staff has left. Most people have not received any medical care since November.

Berhe*, a health professional working with MSF, says that the region used to have a well-functioning health system before the fighting started. Villages had health posts and there were health centres in smaller towns and hospitals in bigger towns. There were health extension workers visiting communities and a referral system with ambulances.

“Now, the health system is completely destroyed,” says Berhe. “When we visit rural areas, mothers say: ‘My child is three months old. He has not been vaccinated yet.’”

“Maternal and child health is very difficult now,” Berhe continues. “During one of our mobile clinics, we heard that a delivering mother died because she could not get assistance from health professionals. In the rural areas there are no health structures, no ambulances.”

As access to towns and villages along the main roads in northern Tigray is getting easier, we are now trying to reach people who are living in the bush, says Juniper Gordon.

“These are the people who really cannot access any kind of healthcare,” says Gordon. “We try to get there and give a bare minimum of healthcare and see their condition. We hear of people who have been in the bush for months and still don’t feel safe enough to go to the clinic.”