Key medical figures:
- 203,250 outpatient consultations
- 1,400 patients began TB treatment
- 2,160 births assisted
Despite significant economic progress in the country, medical care remains beyond reach for many Ethiopians, particularly in remote and conflict-affected areas.
Tens of thousands of refugees are also in need of health services. By the end of 2012, an estimated 170,000 Somali refugees had arrived in the southern and eastern parts of Ethiopia, escaping conflict and the effects of 2011’s severe drought. People fleeing violence in Sudan and South Sudan have entered Ethiopia from the west. Médecins Sans Frontières (MSF) continued to provide medical assistance to refugees and communities around the camps, as well as to other people without access to health services, throughout the year.
Refugees are medically screened and receive measles vaccinations upon arrival at the reception site at the southern border town of Dolo Ado in Liben zone, Somali region. Further medical care, including outpatient consultations, surgery, ante- and postnatal services, vaccinations and treatment for tuberculosis (TB), is available at the MSF-supported health centre.
For part of 2012, MSF also ran basic healthcare and nutrition programmes in five refugee camps in Liben zone. Approximately 30,000 children per month were screened for malnutrition. Children were also diagnosed and treated for pertussis (whooping cough), kala azar and diarrhoeal diseases. Staff handed activities over to the Ethiopian authorities.
To assist the many refugees with symptoms of mental distress, MSF carried out 1,090 individual counselling consultations and more than 400 follow-up sessions. Outreach teams conducted 14,840 education sessions to raise awareness of the psychological suffering among the refugees and suggest ways to strengthen resilience in their communities.
In the far west of Ethiopia, MSF supported the Regional Health Bureau to meet the increased needs for basic and specialist medical care following the arrival of refugees from South Sudan. Staff carried out more than 60,000 consultations at Mattar health centre and at mobile clinics, which are run by car or boat, depending on the season.
When Ethiopian authorities transferred 12,000 Sudanese refugees from the Ad-Damazin camp, near the Sudan–Ethiopia border, 80 kilometres east to Bambasi, in Benishangul-Gumuz region, roughly one out of four children was found to be malnourished. MSF teams treated 500 people for malnutrition, immunised 3,500 children against measles and distributed food rations to 4,000 people. MSF has been providing emergency healthcare to Sudanese refugees in Benishangul-Gumuz since 2011, but direct access to camps has proven difficult to obtain and MSF continues to negotiate with the authorities.
In March, a mobile medical team conducted consultations in and around the border town of Moyale for Kenyans fleeing intercommunal clashes. MSF also supported health facilities with additional medical staff, drug donations and training in management of common illnesses. The programme was closed in May, when most of the refugees had returned to Kenya and it was clear that local authorities could manage the basic needs of those remaining.
Basic and specialist health services in Somali region
The provision of healthcare in Somali region is limited, owing to lack of development, a dearth of trained medical personnel and conflict between government forces and armed anti-government groups. MSF runs a health clinic in West Imey and another in East Imey, providing basic and maternal healthcare, an inpatient clinic, treatment for TB and kala azar, as well as mobile clinics. With health services for the largely nomadic population now more firmly established, activities will be handed over to the Regional Health Bureau in early 2013.
In an area known as Ogaden, in the northeast of Somali region, MSF continues to assist at the hospital in the town of Degehabur with emergency obstetric care, antenatal consultations, treatment for malnutrition, and medical and psychological care for victims of violence. MSF staff also support Wardher hospital, particularly in treatment for TB and malnutrition, reproductive healthcare – including assistance for victims of sexual violence – and vaccinations. Another team works in Danod health centre. Since January 2011, MSF has conducted mobile clinics in Ogaden, providing basic healtcare, but these activities were limited in the second part of the year due to security restrictions imposed by authorities.
Sidama mother and child healthcare
Responding to a lack of access to healthcare in parts of Sidama, a zone in the Southern Nations, Nationalities and Peoples Region (SNNPR), MSF opened a programme in 2010 focused on the health of mothers and children under five years of age. Activities include ante- and postnatal consultations, a 24-hour emergency service, medical and psychological care for victims of violence, surgery and treatment for obstetric fistula and referrals. Obstetric fistulas are injuries to the birth canal, and are most often a result of prolonged, obstructed labour. They cause incontinence, which can lead to social stigma.
A maternity waiting home was also opened to accommodate women with obstetric complications so that they have rapid access to skilled emergency care. More than 50,000 women and 34,000 children received care in the Sidama programme in 2012. The team is also training Ministry of Health staff.
Decentralising care for TB
TB is the second-most common cause of death in Ethiopia, after malaria. There are indications that cases of drug-resistant TB (DR-TB) – which requires two years of gruelling treatment that can cause severe side effects – are on the rise.
MSF is assisting the federal Bureau of Health in the launch of a decentralised DR-TB treatment model in the eastern city of Dire Dawa, which will offer care on an outpatient basis. MSF has provided medical advice, donated specialised diagnostic equipment and designed modifications for the hospital as well as patients’ homes. These refurbishments will significantly reduce the risk of patients passing on the disease to family members and allow them to live at home during their treatment.
Kala azar and HIV
Kala azar, or visceral leishmaniasis, is a parasitic disease transmitted by the bite of a sandfly, which is almost always fatal if not treated. It receives very little attention from the medical community, however. In Abdurafi, Amhara region, MSF works with the Ministry of Health to treat patients with kala azar, including those co-infected with HIV. MSF pays particular attention to groups most vulnerable to these diseases, such as migrants and sex workers.
Badoo, 40 years old
I gave birth seven days ago to a baby girl. I delivered my baby in the bush where I live as I have done with all my previous babies. I have ten children. A traditional birth attendant delivered my baby but soon after I became very sick. I had a very high fever and was shaking uncontrollably. I felt like all the energy was leaving my body. I had been cut very badly and became infected after the birth; I found it painful to pass urine and the pain made me want to be sick and I almost fainted. I told my family that I felt very unwell and I needed help.
My family put me on a donkey cart and it took two hours to get here. The road isn’t good but it’s sandy so I was able to cope with the journey even though it was very hot and exhausting. I have been in the hospital two days and the staff check my blood pressure. They have given me medicine and have put me on an oxygen machine. The doctor says I look better now and I feel like I’m getting a little more energy in my body.
I feel like now I am here in the hospital I will be OK. I was in a lot of pain but every day that I’m here I feel a little bit better. I have to breathe with an oxygen mask because I’m still weak. If I had stayed in the bush and not come to hospital I don’t know what would have happened to me.
No. staff end 2012: 1,564
Year MSF first worked in the country: 1984