Médecins Sans Frontières (MSF) is witnessing alarming indications of a deadly and escalating nutrition crisis in Ethiopia’s Afar region, requiring an urgent scale up of the humanitarian response. In Afar, in the country’s northeast, hundreds of thousands of people have fled from recent conflict only to find themselves grappling alongside host communities with drought, hunger and a staggering lack of access to healthcare and clean water.

“What scares us most at this point is that we are only beginning to see the very tip of the iceberg, and already it is overwhelming,” said Raphael Veicht, MSF Emergency Coordinator in Addis Ababa, Ethiopia. “In Dupti Hospital, which is the only functional referral hospital in all of Afar region, we are seeing children arrive after incredibly long and difficult journeys.”

“Far too many of them are dying within 48 hours because they are too sick and too malnourished to have a fighting chance at survival,” said Veicht.

Since April, we have been increasing our support to Dupti hospital, which serves a population of more than 1.1 million people, including hundreds of thousands of displaced people. This year, the number of severely malnourished children admitted to the facility has already exceeded the previous year’s baseline by a factor of three to four. Patient mortality rates are staggeringly high, exceeding 20 per cent in some weeks. Thirty-five children have died in the last eight weeks alone, and more than two-thirds of those patients died within 48 hours of admission.  

“Clearly, many people in Afar cannot access the very minimum levels of healthcare, food and water necessary to sustain human life,” said Veicht. “This is due to a combination of recent conflict, displacement, a lack of access to healthcare, food and water scarcity, combined with an insufficient humanitarian response.”

“To even begin to get control of this, a major scale of humanitarian assistance is urgently needed for displaced people and vulnerable host communities,” said Veicht. “Food security, basic healthcare, nutrition and water need to be the key points of focus.”

Damaged, destroyed, abandoned or under-resourced, it is reported that only 20 per cent of health structures in Afar region are functional. At Dupti hospital, more than 80 per cent of malnourished children admitted for care have had no previous access to healthcare before arriving to the referral hospital. Patients tell our teams that they struggle to access healthcare, food, clean water or other basic needs, leading to increased levels of malnutrition and life-threatening illnesses.

“The site where we are staying is extremely harsh and uninhabitable,” said Asiya Salih Mohammed, who says many people from her community died in the conflict and that she was forced to travel by foot for over a month in search of safety.

Now, she has arrived in a displaced people’s site which lacks even the most basic services, including no medical centre, which is why she’s brought her one-year-old daughter to Dupti hospital.

“There is not enough food to eat, there is no drinking water,” said Mohammed. “The house in which we are staying has no roof, so we have no shade and we’re exposed to the sun.”

The impact of these conditions is apparent among the patients in Dupti hospital, where nearly two-thirds of malnourished children requiring hospitalisation come from displaced families, driving up admission rates. After MSF started our support for the 14-bed inpatient therapeutic feeding centre in Dupti hospital this April, the ward was quickly overwhelmed with two or more patients per bed.

Teams opened 14 additional beds in temporary structures, but these are also fully occupied and medical staff struggle to provide the level of care children need in this overcrowded facility. And recently, even the regular paediatric ward has become overwhelmed, with more than double the number of patients than beds.  

“In two days alone, we saw 41 children admitted to the paediatric ward with severe stomach infections because people are forced to drink from muddy puddles,” said Veicht.

MSF has recently agreed with the Ethiopian Ministry of Health to increase the hospital’s paediatric, in-patient feeding and emergency departments’ capacity. This includes the rapid construction of new buildings, and to support sanitation and the establishment of a reliable water source. In parallel, we plan to open five outpatient feeding programmes in the most critically needed areas, but far more is needed to stave off a looming crisis.

Hundreds of thousands of people are struggling to survive, not only in Afar but also other parts of Ethiopia. In Wardher, Somali region, rains have finally started falling, but people are still experiencing the compounded challenges of food and water insecurity linked to an extended period of drought.

MSF recently completed a measles vaccination campaign, reaching more than 7,000 children in 50 different locations. We have also implemented medical surveillance to quickly react to emergency medical needs. Communities across the region warn of catastrophic drought, which is killing off livestock and other vital lifelines for survival, while water, food and access to healthcare are often out of reach.

There are currently thousands of people suffering from the dire consequences of the ongoing nutritional crisis and who are in a desperate search for food and assistance, not only in Afar, but also across other parts of Ethiopia. The only response to a nutritional crisis is to make sure that people have access to food. But large numbers of people in Afar and other parts of Ethiopia, especially those displaced by conflict, also don’t have access to other essential means to sustain life, such as medical care and safe drinking water.

Without an urgent upscale of the humanitarian response in Afar, many people already living through the horrors of conflict, displacement and drought will be further pushed towards the brink of survival. In order to avoid further excess illness and deaths as a consequence of the ongoing nutritional crisis in Afar and other parts of Ethiopia, the humanitarian community must act with urgency.