MSF fights to stem emergencies across a nation in need
In the remote village of Bachuma, nestled 600 kilometers away from the bustling capital, Workagegnehu Yilma, the dedicated Deputy Coordinator of Médecins Sans Frontières (MSF) or commonly known as Doctors Without Borders, Ethiopia, finds himself immersed in the heart of the action.
Alongside the tireless MSF teams, he leads emergency responses to combat the menacing surge of malaria, measles, and Kala-azar (visceral leishmaniasis) outbreaks sprawling across multiple zones in the southern reaches of the country.
In an interview with The Reporter’s Ashenafi Endale, Workagegnehu shed light on the challenges MSF faces in leading this emergency response on the ground in neglected, hard-to-reach regions. He advocates for more support from other aid agencies, as MSF’s resources alone are not enough to address the magnitude of needs across southern Ethiopia. EXCERPTS:
The Reporter: In the newly formed south-western part of Ethiopia, MSF stands as the sole organization responding to the urgent call of various disease outbreaks. Why are other humanitarian organizations and the government largely absent in the in the area?
Workagegnehu Yilma: Over the past six weeks, MSF has been actively responding to outbreaks of measles and malaria in the southern regions of Ethiopia, with a particular focus on the west and south Omo zones within the newly formed South-Western Ethiopia regional state.
In the west Omo zone alone, we have deployed 25 MSF staff members and allocated over EUR 100,000.
Among the five big woredas and two city administrations in the west Omo zone, we are providing emergency response efforts in Gachit, Me’enit Goldiya, Gori Gesha, and Bachuma woredas.
We have also 21 mobile clinics in the west Omo zone alone and we are actively providing treatment and support for severely malnourished children across the affected zones.
Can you describe how you learned about the outbreak in this area and what made you identify an absence of emergency responses?
MSF utilizes different mechanisms to gather information about outbreaks and emergency responses during conflicts. We collect information from local communities, as well as local authorities such as health bureaus. In this specific case, we learned about the outbreak through social media.
One of MSF’s largest health projects is currently active in Jinka, South Omo zone, focusing on the outbreak of Kala-azar disease (visceral leishmaniasis). Consequently, our project team from the South Omo zone was also monitoring the adjacent west Omo zone.
The malaria and measles outbreaks occurred in the west Omo zone repeatedly and the latest one in September. Based on information from social media and our medical data, we decided to launch an emergency response in the west Omo zone.
We conducted on-ground evaluations and determined that MSF’s presence was highly needed in the area. As a result, MSF initiated the emergency response operation in the west Omo zone since mid-October.
What is the current trajectory showing for caseloads – are new infections still mounting or has the rate of new cases started to slow?
During the initial stages of our operation, the situation was incredibly dire. Cases of measles, malaria, and other illnesses were alarmingly high.
Malaria, in particular, affected almost everyone in the area, resulting in a significant number of deaths. However, since MSF initiated emergency responses, we have observed a decline in caseloads.
To ensure access to healthcare for those in remote areas or areas inaccessible by our vehicles, we have established mobile clinics. These clinics have proven to be successful in reducing the high mortality rate.
However, the conditions on the roads present significant challenges. Heavy rainfall and muddy terrain make travel difficult, and we often encounter obstacles such as crossing up to 10 rivers. These circumstances hinder our ability to reach those in critical need in a timely manner.
Moreover, the level of health awareness within the community is low. We have encountered resistance when attempting to provide incubation treatment for critical cases, as it is often associated with traditional beliefs and concepts.
Can such interventions address the health crisis permanently?
MSF has been involved in numerous emergency operations throughout Ethiopia, focusing on both man-made and natural disasters. One of our key operations involves conducting mass vaccination campaigns.
In Konso, Amaro special woreda, and Korem, we have successfully vaccinated over 60,000 children this year.
Currently, we are making preparations to launch a mass vaccination campaign in the west Omo zone as well. However, extensive preparations are required, including ensuring a cold chain for the vaccines, managing logistics, and securing necessary supplies from Addis Ababa.
The campaign is expected to span from four to six weeks, barring any delays caused by inclement weather, such as heavy rainfall.
With conflicts, droughts, disease outbreaks and large IDP populations persisting in many regions of Ethiopia, how substantial is this influx of humanitarian demands straining the MSF?
Currently, we are actively engaged in providing emergency responses across seven regional states in Ethiopia, as there is a pressing need for humanitarian assistance throughout the country. It is important to acknowledge that MSF cannot simultaneously reach every area in need.
For instance, in the west Omo zone, we are responding to measles and malaria outbreaks, but there are other critical gaps in healthcare provision, particularly concerning the health of children and mothers. Malnutrition rates are alarmingly high in the area, yet MSF remains the sole humanitarian agency, both local and international, operating in this region.
While our emergency intervention in the west Omo zone may continue for approximately eight weeks, we cannot sustain long-term operations in one location due to the pressing needs in other areas and resource limitations.
Therefore, we urgently appeal to humanitarian organizations and the international community to extend their reach to these underserved areas and provide the necessary assistance.
What is causing the outbreaks in the southern regions of Ethiopia? Why is the government struggling to effectively tackle this problem and why aren’t other humanitarian organizations stepping in to provide assistance?
There are health provision gaps across the country, and resource issues contribute to the challenge. Some areas are inaccessible due to their remoteness and the absence of proper infrastructure.
Are there security challenges that arise when operating in remote areas and conflict zones?
Not that much. MSF is a well-accepted organization across Ethiopia, particularly in the west Omo zone.
We have not faced security issues in this area, except for logistical challenges. We work closely with local health bureaus and administrators, ensuring that our operations are conducted with recognition and cooperation from the authorities. This are MSF’s principles and values.
In addition to emergency responses, what other operations does MSF undertake?
MSF specializes in providing emergency services during disasters and saving lives. In addition to our emergency response work, we also engage in long-term projects. For example, in Abdulrafi, we have been running a project focused on Kalazar for 15 years. Similarly, in the Somali region, we have ongoing projects that focus on primary health services.
We are present wherever there are emergency disasters such as cholera outbreaks, measles, malaria, and others. Jinka is another location where we have a long-term project dedicated to addressing Kalazar disease.
After providing emergency services in a particular area, MSF moves on to other locations. How does it ensure that the government or other organizations maintain the progress achieved and take measures to prevent the recurrence of the same problems?
MSF’s priority is saving lives. The malaria and measles outbreaks in southern Ethiopia have claimed the lives of many children and mothers. That is why we are preparing to launch a mass vaccination campaign in addition to our ongoing emergency responses through mobile clinics.
Once our operations in the area are completed, which may take several months, we will engage in discussions with the Ministry of Health to develop our exit strategy.
Our departure from the area does not mean abandonment. Six months after leaving, we will send medical teams to collect data and conduct assessments. Based on these evaluations and our available resources, we may decide to re-intervene if necessary.
We also actively advocate for the involvement of other international humanitarian organizations to continue the work and provide ongoing support in the area.
You mentioned that there are no international humanitarian organizations present in this specific region of the country. Due to the war in northern Ethiopia lasting for two years, the Ethiopian government has accused and cautioned international humanitarian organizations for allegedly supporting the Tigrayan forces. Do you believe the decline in the presence of international organizations is connected to these accusations?
This community in West Omo has never witnessed the presence of any humanitarian organization in their lifetime until MSF arrived. I believe this is primarily due to the remote nature of the area. Additionally, because this part of the country is abundant in greenery and fertility, people may not have anticipated the occurrence of complex diseases and health challenges.
It is also worth noting that the South-Western Ethiopia regional state is a newly formed regional state. Moving forward, I hope to see the involvement of both local and international NGOs in this region and extend their support to the community.
Do you actively participate in the government’s planning and policy-making process, or do you primarily intervene in areas where you identify gaps and needs?
It can go both ways. We work closely with the Ministry of Health and have a high level of collaboration. Sometimes, we express our interest to the government to intervene where we identify gaps. At other times, the government itself calls us to intervene in specific areas.
The job of MSF headquarters in Addis Ababa is to liaison with the government and local authorities. We maintain communication with all health bureaus across Ethiopia, and they inform us whenever there is an emergency. We also hold health cluster meetings with federal and regional health institutions.
There is a platform where all humanitarian organizations in Ethiopia and all health institutions frequently share data. MSF intervenes based on this data.
In your opinion, what strategies or approaches do you think Ethiopia can employ to effectively manage the substantial humanitarian emergency service needs despite limited resources on the supply side?
The humanitarian need in Ethiopia is currently very high, with limited access in conflict-affected parts of the country. There are areas where government health institutions are unable to reach, such as the Oromia region, where difficulties have arisen.
The number of refugees from Sudan accumulating on the Ethiopian border is rising, leading to a cholera outbreak. MSF is providing humanitarian responses in these areas.
Throughout the country, there are humanitarian gaps, particularly in the healthcare sector. However, MSF’s emergency response capacity is limited, and we prioritize critical cases based on their magnitude.
A few months ago, we launched an emergency intervention program in Somalia, highlighting the widespread need.
Currently, we have regular projects in seven regional states, but this year alone, we have also initiated emergency response programs in seven additional areas. We would be happy if we could address all the emergency needs in Ethiopia, but we are facing human resource shortages. Importing medicines, medical equipment, and vehicles for emergency logistics is a complex and time-consuming process, presenting significant challenges.
Has the government’s criticism of foreign NGOs and humanitarian agencies as being politicized, leading to their downsizing of operations in Ethiopia, had any impact on MSF’s activities in the country?
MSF adheres to global principles of neutrality, non-discrimination, and impartiality, which are core values of our organization. We never form political alliances or provide support to any armed groups. These principles guide our operations in Tigray as well.
It is possible that the approach of other humanitarian organizations in Tigray during the conflict might be perceived as impartial given the challenging context at the time.
In situations of conflict, emergency needs often arise, and it is inevitable for humanitarian organizations to be involved. Governments may sometimes place blame on humanitarian organizations, but despite any challenges or criticisms, MSF has continued its intervention in Tigray, providing assistance.
Can you provide an update on the investigation reports regarding the killing of two MSF staff members in Tigray during the conflict?
I am unable to disclose this information at my level, as the case is being handled by individuals above me.
MSF has established a presence in Ethiopia for over thirty years. However, do you believe that MSF has become a household name in the country? Furthermore, does MSF adhere to a principle of not discussing its operations?
MSF is well-known in certain areas, while in others, our presence may be less established. For instance, we had several projects in the previous SNNPR, making us well-known in that region.
We are also recognized in regions such as Somali, Gambela, Tigray, Sidama, and others. However, in the newly formed Southwestern Ethiopia regional state, MSF is present for the first time, which means our presence and recognition may be relatively new in that area.
Do you believe the humanitarian crises in Ethiopia, primarily caused by issues such as poor governance, political instability, corruption, and systemic failures within the government, can be effectively resolved solely through the emergency response efforts of organizations like MSF? To what degree does MSF exert pressure on the government to address and resolve the underlying root causes of these crises?
In some cases, there are scenarios where we work on the root causes. Sometimes we identify gaps and ask the government how they intend or plan to solve them. As long as the root causes can be resolved by MSF, we go for it.
For instance, we will soon supply donations to Bachuma Primary Hospital in the West Omo zone. The hospital has no supplies due to budget shortages, so we cover the gaps left by the government. Especially the women’s delivery rooms of this hospital have no proper facilities.
However, for root causes that take longer time and can only be solved by the government structure, we recommend them to the government. We share our reports and urge them to resolve the root causes. But we cannot aggressively push the government to address the root causes. We only analyze the problems on the ground, assess the damage, and urge the government to take preventive measures.
Who are the individuals or entities behind MSF?
MSF was founded by journalists and medical doctors. It does not accept financial support from governments or local and international organizations. MSF’s funding comes from nearly seven million donors worldwide. In Europe, we conduct fundraising programs.
The government does not dictate where we should operate or abandon certain areas. We intervene wherever we deem the need to be a priority. The government has granted us consent to operate anywhere.
Are the majority of the seven million donors comprised of businesses or individuals?
Our funding largely comes from individuals and private companies. Well-known private firms like IKEA and Barcelona Football Club, as well as iconic individuals worldwide, contribute to MSF.
Ordinary individuals also make contributions. For instance, I personally contribute five dollars to MSF every month, and I have been doing so for the past 10 years.
In which locations or regions does MSF have a presence?
MSF runs emergency responses in approximately 70 countries across Africa, Asia, Europe, and the Middle East. We address various chronic diseases such as HIV, malaria, cholera, and other areas of need.
Any last words?
In the West Omo region, we have successfully managed to save numerous lives and witnessed a significant need for assistance.
My message is that local and international humanitarian organizations should join us in our efforts. Their interventions are crucial at this point, as there is a wide range of needs, from addressing gaps in children’s and mothers’ health to tackling major humanitarian crises. Humanitarian organizations can, simply put, provide training to public health service providers on how to respond to emergency situations.