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MSF in Ethiopia, 2012
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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 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. Doctors Without Borders/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 programs 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 diarrheal 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 counseling 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-
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.
Sidama Mother and Child Health Care
Responding to a lack of access to healthcare in parts of Sidama, a zone in the Southern Nations, Nationalities and Peoples Region (SNN PR), 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 program in 2012. The team is also training Ministry of Health staff.
Decentralizing 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 grueling treatment that can cause severe side effects – are on the rise. MSF is assisting the federal Bureau of Health in the launch of a decentralized 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 specialized 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, and 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.
At the end of 2012 MSF had 1,564 staff in Ethiopia. MSF has been working in the country since 1984.