By 31 October 2020, Ethiopia was hosting more than 796,400 registered refugees and asylum seekers, according to UNHCR, the UN refugee agency. Most of them are from South Sudan, Somalia, Eritrea and Sudan. In addition, intercommunal violence has led to an internal displacement crisis, which at times has affected more than one million people.
We provide medical and mental healthcare to refugees, internally displaced people and their host communities, communities affected and displaced by natural disasters such as floods and droughts, as well as to Ethiopians deported from Gulf countries and returned from Lebanon.
Our activities in Ethiopia include treating malnourished children and people with neglected diseases such as kala azar, running mobile clinics for communities in remote locations and donating drugs and medical supplies.
The killing of our colleagues and the suspension of our activities
On 24 June 2021, 35-year-old María Hernández Matas, our emergency coordinator; 32-year-old Yohannes Halefom Reda, our assistant coordinator; and 31-year-old Tedros Gebremariam Gebremichael, our driver, were travelling in Tigray region when we lost contact with them. On 25 June, we received the devastating news that María, Tedros and Yohannes had been killed.
Since then, Médecins Sans Frontières (MSF) has been making every possible effort to understand what happened, by continuously engaging with the parties to the conflict. We have met, multiple times, with representatives of the government of Ethiopia, to ensure that their killings are investigated and that the findings are shared with us. We have made the same requests of the Tigray People’s Liberation Front.
The preliminary results of MSF’s own internal review – a standard practice following critical security incidents – established that on 24 June, María, Tedros and Yohannes were heading out to search for and collect people injured in areas affected by intense fighting. They had received prior information that there were wounded people in a village near where the incident took place. Just over an hour into the journey, their car stopped. Their bodies were later found not far from it, and their injuries showed that each had been shot multiple times at close range. This information confirmed that the attack was an intentional killing of three humanitarian aid workers, as all three of them were clearly recognisable as civilians and humanitarians at the time of the incident. The car, which bore the MSF logo and two MSF flags, had numerous bullet holes and had been set on fire.
Following the killing of our colleagues, MSF took the painful decision to suspend activities in parts of Tigray and Benishangul-Gumuz regions. In July, a government order obliged us to suspend activities in Amhara, Gambella and Somali regions, and other parts of Tigray, for three months. Although this suspension was lifted in October, it was not possible for us to restart activities in 2021, mainly due to the security situation and administrative obstacles.
In November, when a state of emergency was declared, we suspended activities in other places, including Guji, where we had been assisting displaced people and victims of violence, and Addis Ababa, where we had been offering medical and psychological care to returnees from Saudi Arabia, Lebanon and other countries. However, we continued some medical services in Afar, our water and sanitation programme in Southern Nations, Nationalities and People’s (SNNP) region, and made ad-hoc donations of medical supplies in Amhara, Gambella and Somali regions.
Violence and displacement
Ongoing fighting in several regions killed, injured and displaced thousands of people, while insecurity and administrative barriers continued to obstruct the delivery of humanitarian assistance almost everywhere in the country.
Between January and June 2021, before the brutal killing of our colleagues, our teams assisted communities in nine of Ethiopia’s 10 regions: Addis Ababa, Afar, Amhara, Benishangul-Gumuz, Gambella, Oromia, SNNP, Somali and Tigray.
Despite the pre-existing challenges that our teams had already been facing in northern Ethiopia, the most notable of which had been gaining sufficient access to areas most in need, we have been providing medical care and other assistance in Tigray to cover basic health needs for the most vulnerable people affected by conflict and violence across the region.
Soon after the conflict started in November 2020, we launched medical and humanitarian activities to address the urgent health needs in Amhara and Tigray regions (and in neighbouring Sudan for refugees). Early in 2021, in Tigray, we started to run mobile clinics, rehabilitate and support basic and specialist healthcare facilities to ensure lifesaving services were available, and establish alternative referral systems to restore access to specialist services. We supported five hospitals in collaboration with the Regional Health Bureau (RHB). Our teams also distributed emergency and essential medical supplies, and provided water and sanitation support to sites for internally displaced people in communities where the water system had been damaged.
In Amhara, and two other conflict-affected regions – Benishangul-Gumuz and SNNPR – we offered basic healthcare to people who had been displaced by fighting, and improved access to clean water and sanitation in the local communities. In addition, we supported the response to mass-casualty incidents and measles outbreaks in SNNPR. In Addis Ababa, we provided medical and mental health support to Ethiopian migrants deported from Saudi Arabia, Yemen and Lebanon.
We also worked in Guji zone, Oromia region, an area that otherwise has no access to healthcare services. MSF supported surgical and maternal care services, outpatient services and provided healthcare through extensive mobile clinics and community-based services to expand coverage in hard to reach areas.
In Gambella region, we offered medical care to South Sudanese refugees in three camps, as well as host communities, in partnership with the government and UNHCR, the UN refugee agency. Our mobile clinics serving pastoralist communities in Somali region continued to operate in 2021.
Until the suspension(s), MSF supported the RHBs and Ethiopian Public Health Institute in their emergency surveillance activities, which aim to cover most of the country and enable our teams to investigate and respond to health alerts promptly.