In late 2022, a Médecins Sans Frontières (MSF) team in Southern Nations, Nationalities and People’s Region (SNNPR) of Ethiopia received an alert about an unusually high number of deaths in the south Omo Valley among an isolated group of people from the Mursi Tribe, living in what is now a national park.
The Mursi are a small tribe of approximately 7,000 people, among more than a dozen isolated indigenous groups in Ethiopia’s Lower Omo Valley – largely pastoralists, hunter gatherers, and flood-retreat cultivators. Visceral leishmaniasis, also known as kala azar, is affecting many of the Mursi and other indigenous peoples in the area.
“Patients come with a huge swelling of their spleen and liver, with fever, malnutrition and sometimes even bleeding because their bone marrow is affected,” says Hewot Melak, MSF doctor.
“[Kala azar] is also among the neglected tropical diseases that can cause a 95 per cent fatality [rate] if not treated. So, you can understand the urgency of finding these cases and putting them on treatment,” says Melak.
After receiving the alert about the deaths in Omo Valley, our teams have been responding to this acutely neglected disease, actively finding and treating 79 patients with visceral leishmaniasis in less than two months.
What our teams found after travelling to the South Omo Valley was shocking: an alarmingly high number of kala azar cases amongst this relatively small community with no access to healthcare. Our assessment team also found a high number of people suffering from severe acute malnutrition caused by kala azar – among both children and adults.
Kala azar is also among the neglected tropical diseases that can cause a 95 per cent fatality [rate] if not treated.Hewot Melak, MSF doctor
“We don’t know where it comes from but it kills a lot of people,” says Bicolshe, a community member in South Omo Valley. Another patient, an elderly man named Samakaoulu Kumuhuli Data, shared that he had lost two wives and five children because of the disease.
Kala azar is not only one of the most neglected tropical diseases but also one of deadliest. It is almost always fatal if untreated. The disease has spread to become endemic in many parts of Ethiopia, after first being documented in 1942. More than 3.2 million people across the country are at risk.
Providing life-saving treatment
In response, we started visiting the community to actively find kala azar cases and provide urgently needed healthcare services. For many people it was the first time they had seen a doctor, and most had never been vaccinated.
“This is the first time most most people here have visited a clinic,” says Tamirat Bantule, MSF doctor. “We have also found several malaria cases… and a lot of cases with nutritional anaemia. We are going to refer them back to the hospital.”
When a patient is identified with kala azar, they are referred to the Jinka hospital about 50 km away. Within a few weeks, the capacity of the hospital to treat kala azar was overwhelmed and our teams, alongside staff from the Ministry of Health, set up tents to provide additional space, eventually running a dedicated kala azar ward within the hospital. Despite the complex and painful diagnosis and treatment of the disease, almost all patients treated so far have recovered.
“I decided to take my son to the mobile clinic. The doctors referred us to the hospital here. He got treated. At first I thought he would die, but he made it,” says the mother of a young kala azar patient who was treated at Jinka hospital.
Malnutrition and other infections remain a concern
With a severe drought affecting large parts of Ethiopia for several years, kala azar is not the only life-threatening risk faced by the many indigenous groups struggling to survive in the South Omo Valley.
“People who are still alive will die because of hunger,” says Samakaoulu Kumuhuli Data during a mobile clinic visit. “There is nothing to eat except for wild leaves. This is what makes us worried.”
As well as kala azar and chronic hunger, our teams are concerned about possible measles and cholera outbreaks among the people who have missed out on routine vaccinations. We have extended case-finding activities and basic healthcare services to various parts of the South Omo Valley, while continuing to increase the capacity to diagnose and treat kala azar at the Jinka hospital.
MSF continues to remember our colleagues killed in 2021 and to call for accountability
On 24 June 2021 our colleagues María Hernández Matas, Tedros Gebremariam Gebremichael and Yohannes Halefom Reda were brutally and intentionally killed while clearly identified as humanitarian workers in Tigray. After extensive engagement with the Ethiopian authorities, we still do not have any credible answers as to what happened to our colleagues that day. MSF will keep pursuing accountability for this incident by using all possible means and avenues, with the hope this shall contribute also to improve the safety of humanitarian workers in Ethiopia.
MSF has been working in Ethiopia for 37 years, providing medical assistance to people affected by conflict, epidemics, disasters or with limited access to healthcare, in collaboration with Ethiopian authorities at local, regional and national levels. We have been providing kala azar care for more than 20 years, including our dedicated kala azar and snake bite project in Abdurafi, Amhara, and through emergency interventions. All our activities are guided by humanitarian principles: humanity, independence, neutrality and impartiality.