On 4 November, Ethiopia’s prime minister ordered military action against the Tigray People’s Liberation Front (TPLF) in the Tigray region, in northern Ethiopia, following an attack on a military base. The escalating conflict is already affecting hundreds of thousands of people, and it runs the risk of destabilizing other parts of the country and the region, with potentially catastrophic humanitarian consequences.
Sudan, which was already home to 1.1 million refugees and 1.9 million internally displaced persons before this crisis, is experiencing a major economic crisis while the new government is still settling in. The country's fragile health system is unable to meet the needs of all people and has been further weakened by the COVID-19 pandemic.
On 7 November, the first wave of people from Ethiopia started to arrive in Sudan. As of 25 November, UNHCR had registered 45,000 arrivals, but the number is likely higher, as many have not been registered. Currently, all these people enter Sudan through three locations: the main arrival point is Hamdayet, in Kassala state in eastern Sudan, which accounts for more than two-thirds of arrivals (68 percent). Almost a third (30 percent) enter Gedaref State in the south-east, while a very small number (just 2 percent) arrive in Sudan via a location further south in Blue Nile State.
MSF warns of the urgent need for all humanitarian actors present in the area to strengthen their activities to meet the most basic needs in terms of shelter, water, health and food. Otherwise, the health status of all these people will begin to deteriorate rapidly.
Médecins Sans Frontières provides a summary of what teams on the ground are seeing and shares some details about how we are responding in these two areas of eastern and south-eastern Sudan that are hosting the majority of Ethiopian refugees.
Teams from MSF are present at the crossing point in Hamdayet, where they are witnessing first-hand people crossing the river that separates Ethiopia from Sudan. Many people tell our teams that they fled their homes abruptly and quickly, without even being able to pack basic supplies for the journey. They left their belongings behind and had to walk for hours, and sometimes days, in a very harsh, arid environment before they reached Sudan.
Upon arrival in Sudan, the vast majority of refugees are located in a transit and border area of Hamdayet, where shelter, access to food, sanitation and clean drinking water continue to be significant issues. Most refugees in Hamdayet, specifically those without shelter, are having to sleep in the open – near the roads, under trees – and are staying in a market area in Hamdayet village. Some people are being hosted in homes and, so far, people living in border villages in Sudan have been very open and supportive towards their neighbours from Ethiopia.
We are also seeing people cross back to Ethiopia, either to help bring family members who stayed behind, or to collect their belongings. Some are going back to sell their assets and return to Sudan with money. A small number of the people arriving are originally from Eritrea, and they were previously displaced into Ethiopia, before now fleeing again to Sudan.
MSF is asking organisations working on family reunification to step forward to support those who have lost family members while fleeing. It is feared that many of those who return to look for them are putting their lives at risk.
The first MSF team arrived in Hamdayet on 16 November and three days later, we began running activities. As a first response to address the needs of the growing numbers of refugees, the MSF team working at this crossing point have started providing healthcare, health promotion messages, mental health activities, and screening the new arrivals for their nutrition status. We are also carrying out water and sanitation activities. Our teams in the clinic we set up are currently undertaking about 300 consultations per day; the highest number of illnesses being related to respiratory infections, malaria or diarrhoea. A small number of wounded refugees and some people who have experienced gender-based violence have been seen at the clinic and there are many people requiring continuing treatment for chronic conditions such as tuberculosis and others.
After screenings and registration by the UN, some people arriving in Hamdayet are being placed on buses and driven to Um Rakuba camp in Gedaref state, the only official operational camp in the area dedicated to arrivals from Ethiopia. Um Rakuba is a 7-8 hour drive from the border. The camp is meant to host 10,000 people; it already hosts more than 8,000 people. Discussions are ongoing about establishing an additional camp to host people as the number of refugees continues to increase.
Pressure is being exerted on refugees to leave the transit centres in Hamdayet for Um Rakuba. MSF reminds the authorities to provide adequate assistance to the refugees in the transit centres and not to use the lack of it as a means of pressure to force people to move to Um Rakuba, where sanitary conditions are extremely poor as well. MSF staff report that there are not enough latrines and that people are forced to defecate in the open.
In Um Rakuba camp, MSF teams provided 453 medical consultations between 19 and 23 November. The teams there are treating mostly diarrhoea and urinary tract infections. Two patients arrived with bullet wounds and were referred to Gedaref hospital for further treatment. Fifteen people with severe acute malnutrition, and 154 people with moderate malnutrition were identified and given nutritional supplements. Some people are showing symptoms of anxiety and insomnia due to the violence they saw or experienced in Ethiopia, and the conditions of their journeys to Sudan.
“On 3 or 4 November, I was working in the shop; suddenly I heard war sounds, very loud noises,” said a young Ethiopian man in his mid-30s who shared his story with MSF. “I don’t know why they are fighting, I saw many people dying, even old people, I know so many of them. I’m confused, I don’t know why they did this.”
“In Tigray, the people are hiding in the bush, young and old. The most difficult is that we have no money, nothing to cook, no one brought anything from their home,” he added. “We had to leave. I came with two pairs of trousers. Before the war started, electricity, the phone network, the banks, were all closed. I have money back there but not here.”
One major issue the team is facing in this area is the shortage of medications for non-communicable diseases and chronic illnesses. We are working with other organisations locally to secure needed supplies.
Our team has also identified many doctors among the arrivals from Ethiopia, who are staying in the camp as refugees. Since staff from humanitarian organisations are not allowed to stay overnight in the camp, we are working with these doctors to find a system that allows for 24-hour medical support.
In Khartoum, the MSF team is negotiating with authorities to facilitate the import of medical supplies and urgent visa processes for additional staff to come into the country for this emergency.
By 14 November, at the Ministry of Health medical facility that MSF supports in the Amhara region, teams had treated more than 260 war-wounded since hostilities began. A total of 18 people died in the hospital or on the way there.
"While UNHCR has registered more than 45,000 people who fled across the border into Sudan, reports we have accessed indicate that many more displaced people, in an increasingly vulnerable situation, remain trapped within the Tigray region. Médecins Sans Frontières has been present in Ethiopia for more than 30 years, but like other humanitarian organisations present in the area, we have so far failed to gain significant access to the Tigray area where fighting is concentrated. Millions of people living there may have been affected. Many of the people who fled to Sudan tell us that they have not heard back from the relatives who were left behind. They are traumatized by what they have seen, and extremely worried about their loved ones, doing everything they can to find them. We continue to call on all parties to the conflict to respect the lives of civilians and the medical infrastructure and to allow us unhindered access to all people in need of humanitarian and medical assistance. They must ensure that everyone can reach safe places, whether within the Tigray region or outside, as well as across the border in Sudan," explains Monica Camacho, MSF's regional representative.