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Ethiopia :: Further into the mire The plight of Ethiopia is well-known: recurrent conflicts, chronic drought and some of the worst health indicators in the world. Even within the country, the gap between the haves and have-nots is considerable. After three years of uncertainty following the fall of the dictator Mengistu, in 1994 a new constitution divided Ethiopia into ethnic regions. The country has since been dominated by ethnic Tigreans and Oromians. South-eastern Ethiopia, which is populated by Somalis, has been largely disregarded. The figures speak for themselves; approximately one in ten children die at birth; only 7% of births are assisted by a health professional; the incidence of Tuberculosis is estimated to be up to five times the internationally-accepted epidemic level… David Curtis has just returned from 5 months as head of mission for Médecins Sans Frontières (MSF) in Ethiopia, where MSF is bringing assistance to this neglected ‘Somali Region.’ “Ethiopia seems like two distinct countries,” he observes. “You have the highlanders and then you have the Somali Region. The difference is so marked that when you cross into the Somali Region accompanied by highlanders , they often say, ‘now, we’re leaving Ethiopia.’” The Somali Region, in turn, is also divided. The population is split into three groups: agro-pastoralists who cultivate land near water sources and own livestock; pastoralists, nomads who graze their animals wherever pasture can be found; and those who live in the urban centres. Contained within these three groups is a seemingly impenetrable labyrinth of clans and sub-clans, all with their own particular histories, loyalties and traits. But the failure of the last three rains, from early 2003 onward, has gone some way to uniting the Somali region through even greater misery. “The last year and a half has been especially difficult,” Curtis recalls. “Figures are hard to verify but there are estimates that 50% of livestock died in 2003. Fortunately, the ‘small rains,’ which come around November, have been good this year and the desert has come to life.” The rains are a lifeline for the people of the region and water is a precious commodity. In response to the frequent droughts, for three years MSF has been running a water and sanitation project (watsan) which has translated into the construction of numerous wells. But even for the well-equipped 36-strong MSF watsan team, finding water is no easy task. As Curtis explains, “the underground water in the region is very hard to access. And even when it can be found without having to dig through metres of rock, it is often full of salt and therefore undrinkable.” Hunger, too, is constant. The droughts that occurred in 1999 and 2001 were especially severe. “We set up therapeutic feeding centres at times of emergency, but the need for food assistance is perpetual. What would be a crisis elsewhere is the daily reality in the Somali Region.” Providing assistance to pastoralists who are always on the move also challenges the traditional way of treating malnutrition. As such, Médecins Sans Frontières is adapting its approach in order to suit the nomadic way of life. The level of healthcare in the region is also appalling. “Outside the main urban centres, healthcare is extremely limited,” continues Curtis. “Even where structures exist they are just an empty shell. No drugs, no staff, nothing. The people have just been left to fend totally for themselves.” No wonder then that the need for humanitarian assistance is high. But Curtis sees a worrying trend that may well impact on the possibility for aid workers to provide such assistance. “The war on terror has come to the Horn of Africa,” he explains. United States forces are based in Djibouti and conduct operations not only in Somalia itself, but also in Ethiopia, Kenya and the Ethiopian Somali Region. The neglect of the Somali Region and the porosity of the border with neighbouring Somalia means that it is seen as a possible haven for extremism and this has brought its own problems. “The US policy is at once information gathering and what has become known as ‘hearts and minds’ operations,” Curtis continues. “More and more we have seen US civilian/military forces conducting activities in the region, undertaking non-military activities such as the construction of bridges, rehabilitation of hospitals and even carrying out medical and veterinary consultations. The idea seems to be to win the ideological battle.” The consequences of this are of serious concern for MSF. “When military and humanitarian groups are doing similar work it is hard for people, especially those who aren’t in regular contact with us, to differentiate between them,” explains Curtis. “Yet the objectives of the two are utterly dissimilar; humanitarian agencies aid the population without taking sides and based on need, while the US military serve their own political and military objectives alone. The two are incompatible. Humanitarian work is by nature a civilian and apolitical action. One of our fears is that the extremists and others opposed to the US in the region will identify MSF and other genuine humanitarian organisations as co-operating with their enemy. Humanitarian workers then become targets, just as the world has seen in Iraq and Afghanistan, and the civilians caught in-between the opposing forces are the ones to suffer. Being reliant on one or other of the warring parties for aid is no substitute for independent and neutral assistance.” Despite this, the US military in the Somali Region seem oblivious to the problem. “The military have worn civilian clothes and they have tried to become a partner within the humanitarian community, with their representatives attending humanitarian meetings. They have also used the same medical structures as MSF,” explains Curtis. A justification for the presence of the US military is that they increase the level of security. “But this has hardly been the case elsewhere,” continues Curtis, “and we have no reason to believe that the Somali region will buck the trend. As much violence is attracted as is avoided, if not more. Greater insecurity is the last thing that this stricken population need.” The actions of the US military constitute a potential threat to the aid provided by neutral and independent humanitarian organisations in the region. Blighted by poverty, disease, and drought, the people require an increase in assistance based on need, not short-term quick-impact projects for the benefit of information gathering. “Neglect of the Somali region needs to end, but the current spotlight on the region risks dragging the population further into, rather than out of, the mire, ” concludes Curtis. In addition to assisting with water and sanitation needs, Médecins Sans Frontières is also running a Tuberculosis project in 6 of the 9 districts of the Somali region and a primary healthcare programme in Cherati.
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