When MSF expanded medical activities in the Liben refugee camps in southern Ethiopia in May last year, an average of 300 refugees were crossing the border every day, with peaks of daily influxes of up to 1500. Years of civil war in Somalia, compounded by a drought that hit the Horn of Africa early last year, caused widespread malnutrition while aid agencies could extend little assistance inside Somalia itself. The refugees that were crossing the border to Ethiopia had sometimes walked for weeks in search of safety and assistance.Médecins Sans Frontières (MSF) has handed over one of its largest projects for Somali refugees in Ethiopia. The number of refugees crossing the border has significantly gone down since the large humanitarian crisis of 2011. MSF initiated the project in the Hiloweyn camp, one of the five refugee camps near to the border between Ethiopia and Somalia, in August 2011, at the height of the crisis.

“I am a farmer in Somalia, and had to flee because of drought and hunger. Our cattle died, and there was no rain,” said one refugee who fled to Somalia in June last year. “Sometimes my children were without food for many days, they were so hungry and suffered a lot. There was also a lot of violence in our town. We left everything we had and travelled with many other people. All the children on a donkey cart. The men and women were walking. The journey took twenty-one days. We had only little food and water, I saw people die along the way. One of my children almost passed away during the journey. She was very malnourished.”

At the onset of the crisis, MSF quickly set up a medical screening at the border, as well as an outpatient health post and therapeutic feeding centre in the transit camp that housed the newcomers. “At the height of the crisis, we were doing around 130 new admissions in the therapeutic feeding clinic per day,” recalled Karline Kleijer, who managed MSF programmes in Liben at the time. “I think all together we can be proud of what we achieved. It wasn’t easy. There was a big emergency in an area with a very sensitive security situation. There were big teams in Liben working and living close together and under a lot of pressure. Taking all that into account it is amazing what has been achieved!”

The majority of the incoming refugee population in July and August 2011 suffered from malnutrition and opportunistic infections. In the Hiloweyn camp alone, MSF treated over 50,000 outpatients, nearly 10,000 children and young adults for malnutrition, and 1000 in-patient admissions between then and May this year.

MSF constructed emergency medical facilities in the newly opened Hiloweyn and Bur Amino refugee camps, to provide the infrastructure for medical activities in an unforgiving environment.  MSF also expanded the infrastructure of the Dolo Ado Health Center with new surgical, post-operation, and maternity wards, including a new laboratory to serve the local host population and act as a referral center for refugees.  MSF handed over the infrastructure and most programs in Hiloweyn refugee camp to the Ethiopian refugee agency ARRA in May 2012.

MSF continues to work in all five camps in Liben with stabilization centers for severely malnourished children with medical complications. In addition, MSF provides primary and secondary health care in the newest camp, Bur Amino, where an average of two thousand new refugees are settled per month.  MSF also works in partnership with the Ethiopian Ministry of Health to provide emergency surgical care and stabilisation in the Dolo Ado health center.

MSF has been working in Somalia continuously since 1991. MSF relies solely on private charitable donations for its work in Somalia and does not accept any government funding.

In the period from May to December 2011, MSF was running 22 projects in many different parts of Somalia and in refugee camps for Somalis in Ethiopia and Kenya. In this period, covering the height of the crisis, the medical organisation treated over 78,500 patients for severe malnutrition and over 30,000 for moderate malnutrition, over 7,200 patients for measles and vaccinated over 255,000 persons against disease in the Horn of Africa. MSF assisted in over 6,000 deliveries and provided over 537,500 out-patient consultations.

The war in Somalia is now going into its 21st year. After the drought and the enormous crisis of last year, people survive and live from hand to mouth, and are still highly vulnerable to infections, disease and malnourishment.

Inside Somalia, MSF will not step up its activities or open up new projects until its two colleagues - Montserrat Serra and Blanca Thiebaut, abducted in Dadaab and held in Somalia since October 2011 - are reunited with their families.