UNICEF has dispatched 22 trucks into Tigray (15 for Mekelle and seven for Mai Tsebri) inclusive of prepositioned critical life-saving supplies for all prioritized sectors. In collaboration with our partners, a total of 65,433 vulnerable groups including refugees have received access to water in Tigray. 22,099 Internally Displaced Persons (IDPs) have been reached with WASH Non-Food Items (NFIs) while 19,506 have received medical consultations including through the distribution of Emergency Drug Kits (EDKs). A total of 2,392 women and adolescent girls have so far received dignity kits. In addition, 2,700 under-5 (U5) children and pregnant and lactating women (PLWs) have been provided with high energy biscuits to avert the consequences of malnutrition. These actions cover both Tigray and Amhara regions.
The prolonged disruption of schooling, leading to 1.3 million out of school children (OOSS) and other social services, as a result of COVID-19 pandemic and conflict in the regions concerned, has had a dire impact on children’s well-being. In several rural areas of Tigray and in Mekelle, the salaries of civil servants have not been paid for two months (due to displacement and absence of bank services) including for 657 health workers in Mekelle displaced from other zones. This is having a critical impact on the resumption of the necessary health services.
Humanitarian missions and reports from partners in the field point out a dire humanitarian situation with poor access to essential services and limited livelihoods. Access to food, shelter, protection, including from gender-based violence (GBV), restoration of health, nutrition and WASH systems are the most urgent needs identified.
UNICEF delivered nearly 8,000 cartons of Ready-to-Use-TherapeuticFood (RUTF) enough to meet 8,000 children’s nutrition needs for three months. This is about half of the need for Quarter (Q) 1 of 2021. 192 cartons of F-100 and F-75 each have also been delivered for inpatient management.
Situation Overview and Humanitarian Needs
Ethiopia is currently facing a severe humanitarian crisis as a result of the conflict in Tigray, with massive internal displacement, as well as refugee outflow into neighboring countries, predominantly into Sudan.
There are at least 222,413 IDPs1 within the region of Tigray, while another 63,600 people have been displaced into and within Amhara2 and Afar regions (of these at least 39,025 are in Amhara according to the UNICEF field office in the region). According to UNCHR, as of 12 January 2021, around 57,500 people have crossed the border into Sudan, mainly from Tigray.
While the situation in Mekelle seems to have stabilized, conflict is still taking place mainly on the outskirts of the city, and in the northern and central parts of Tigray and around Shire; more efforts are required to ensure that protection is an integral part of the response. Similarly, two of the four refugee camps in the region (Hitsats and Shimelba) are still not accessible, with Shimelba reportedly empty and Hitsat facing military confrontations, along with major destruction of infrastructure inside the camps. Humanitarian partners acknowledge the gradual resumption of basic services in some urban areas of Tigray, such as Mekelle and some towns in Alamata, including telecommunication, electricity and banking services. However, the rest of the region is still facing a dire humanitarian situation and the response is largely inadequate.
The Emergency Coordination Centre (ECC) operating in Tigray for instance recently highlighted that more than 4.5 million people in the region need emergency food assistance. The operating environment thus still remains highly volatile, whereby the protection of civilians impacted by the conflict remains a critical humanitarian concern, together with the safety of humanitarian workers3 . Hence the need to ensure unconditional and sustained access for humanitarian actors and for affected civilians to goods and services through life-saving humanitarian aid.
UNICEF’s response plan builds not only on its own capacity, but also on its partners’ capacity to deliver considering the high likelihood of a persistent restricted movement of staff and access to vulnerable communities. In support of this, UNICEF is collaborating with the Ministry of Health (MoH) and other partners in an initial mapping of the status of essential services to assess how many hospitals and primary health care facilities (PHCs), Outpatient Therapeutic Feeding Programs (OTPs) and Stabilization Centres (SCs) are operational. A similar effort is being undertaken for protection, WASH and education services, in coordination with the respective clusters and Bureaus. For instance,
UNICEF is currently mapping the 919 Community-based Management of Acute Malnutrition (CMAM) sites in the region, including 81 Inpatient SCs to support last mile distribution of RUTF and anthropometric equipment as well as routine drugs in facilities that are functional; UNICEF is also advocating for the re-opening of those centers that are still not functional or not accessible. However, the mapping of facilities is hampered by lack of communications and access in a large number of cases.
Based on the data available from the initial assessments4 , the humanitarian consequences observed are dire across the region and the situation is deteriorating in particular around Shire, in the North-West and several border areas with Eritrea. It is reported that the areas affected by the conflict have shown quite significant damages and looting of civilian infrastructure and supplies, seriously jeopardizing the delivery of the essential social services5 . As in any conflict or military operations, women and children are among the most vulnerable. Family separations, psychosocial distress and prolonged disruption of schooling (around 1.3 million children remain out of school) and other social services as a result of COVID-19 pandemic, and now the conflict, have had and continue to have a major impact on children’s well-being.
Overall, protection of civilians is a key characteristic of this conflict, but as far as child protection is concerned, there are reports of sexual and GBV, abductions, risk of child recruitment and exploitation of children for different purposes. As usual, collecting data on those elements is very difficult, but we are committed to work with partners around it. The very limited case management and referrals are a particular concern, in particular for unaccompanied and separated children (UASC). There are for instance reports of about 300 UASC among refugee children in Sudan.
Malnutrition is of particular concern: all clinics visited by UNICEF partners in Shire region show malnutrition as a leading cause of morbidity along with diarrheal disease, respiratory tract infections and skin infections. It is worth noting that in the pre-crisis period, Tigray already had wasting and stunting levels worse than the national average (respectively 9.2 per cent versus 7.2 per cent and 30 per cent versus 21 per cent). In the period January to August 2020, UNICEF and the nutrition cluster recorded an increase of 34 per cent admissions of severely acutely malnourished (SAM) children due to COVID-19 and locusts as compared to the same period in 2019 in the Tigray region. The current gaps in food distributions and the rise in food prices on the market are reportedly having an impact on children. Initial screenings from partners in Shire showed up to 10 per cent SAM and up to 34 percent Global Acute Malnutrition (GAM) levels. To prevent the gap in supplies, UNICEF has managed to deliver into Tigray around 8,000 of RUTF cartons so far and new shipments will be organized soon.
There are reports that vaccines are unavailable and that all immunization activities have been interrupted. There is a need for essential medicines, ambulances, vehicles and trucks to distribute the supplies needed. Almost all the health centres, except those around Mekelle (in total around 250) are reportedly inaccessible at this time. A total of 12 hospitals are providing essential PHC services, including nutrition. So far, only one hospital has received nutrition and health supplies in Mekelle, which has a target population of 65,593.
UNICEF visited the Mekelle Water Utility Office and verified that in spite of resumed operations, all sub-cities in Mekelle still experience shortages of potable water as they are unable to operate at optimum capacity due to damages on the various parts of the water supply system. Limited access to potable water and inadequate sanitation facilities across the region, as well as absence of fuel may also increase water borne diseases, while there are also concerns of a pronounced spread of COVID-19, in the absence of a working surveillance and treatment system.