MSF-France Assessment of Senafe Sub Zoba, Zoba Debub, State of Eritrea
1. General Information MSF-France started a Humanitarian Assistance program in Senafe Sub Zoba on the 27/2/2001. With the support of the Ministry of Health (MOH) and the United Nations Mission for Ethiopia and Eritrea (UNMEE), MSF-F was given a special access to this area prior to the formal establishment of the Temporary Security Zone (TSZ). The main objective of this rapid assessment is to have a small but reliable picture of the current situation in Senafe Sub Zoba. This picture is of course influencing the nature of our operations in the area but it will also be, we hope, a useful first-hand tool for the MOH and the other international organization. Two separate assessments took place between the 14/03 and the 21/3. A three-day assessment in Senafe Town where the first team visited randomly 37 households and a three-day assessment of 7 villages and 1 IDP camp outside Senafe Town. According to the population figures that we were able to get from the zone/ villages representatives and from the food distribution lists, there is currently a population of approximately 39 500 in Senafe Sub Zoba (80 000 prior to the last offensive). In addition to MSF-F, there is only ICRC which is currently operational in the Sub Zoba (food distribution, water & sanitation, support to health posts). Apart from the dispensary in Senafe Town, there is only one other health post currently operational in the area (Rokoyto village). During Ethiopian occupation, some volunteers were serving the populations (giving drugs, dressing, polio immunization) in four locations (Senafe Town, Metera, Rokoyto, Tsaeda Korso & Zigfet). Prior to the offensive of the 12/5/2000, 6 health posts were operational in the Sub Zoba; Senafe Town (Caritas), Forto, Serha, Menekuseyto, Rokoyto and Golo. A 45 beds hospital was also operational in Senafe Town. This hospital needs to be reconstruct completely since it was destroyed by Ethiopian forces. 2. Senafe Town
The town of Senafe lies in a quite fertile valley and there is usually enough water for two crops per year (maze, wheat, pulses and legumes). Prior to the war the town itself had been a booming border town with a population of approximately 17,000. All the administrative buildings were destroyed but most of the private houses were only looted (including doors, windows, etc.). There is currently one water station which is functional (rehabilitated by the ICRC) and providing enough water for the current population. The ICRC is planning to rehabilitate the second water station in the coming weeks to assure sufficient quantities of safe & potable water for the whole population of the town after the return of the displaced. The electricity was cut-down. The social life in town is slowly but surely increasing in town every week. The market place is busy on Wednesdays and Saturdays. Some shops are also open.
3. Senafe Town/ Demographic Information
Senafe is divided into six zones, but includes in its administration three neighboring villages. The reported current total population and number of households per zone, as well as number of births and deaths over the last nine months are as follows: Zone
These population figures were provided by the zone representatives and are based on lists prepared for the food distribution. Births and deaths are based solely on recollection because there were no records kept after the administration left. Based on these grossly under-reported figures, the Crude Mortality Rate (CMR) for the last 9 months would be approximately of 0.5 per day per 10,000 population (according to WHO standards, a CMR above 1 death per day per 10 000 people indicates an emergency situation). 45% of the deaths were war-related (mostly from Tisha residents who were caught in the crossfire because the town was located between the two army positions), and 22% were deaths of children under 5 years of age. 4. Senafe Town/ Population Structure
A household sample survey of 37 households was done. Houses were randomly chosen, with an average of 3-4 households per zone visited. The population breakdown by age and gender: Adult males: 9.3% Adult females: 25.5% Children over 5 years of age: 50.6% Children under 5 years of age: 19.6% Elderly living alone 4% (8% of the households) Most of the male and approximately half of the female population were over 50 years of age. Most of the families live in their own house, with a minority living in rented homes, or in homes which had been evacuated nine months ago by relatives. Houses are generally made of stone with tin roofs and are equipped with a wood or kerosene stove, kitchen utensils and beds. 5. Senafe Town/ Food Supply at Household Level
Even though the household food supply was occasionally under-reported, all the households were found to have some food: 99% had wheat (an average of 4kg/person) 99.5% had oil (an average of 0.4 liters/person) 43% had sugar The survey took place approximately three weeks after the ICRC food distribution and four weeks after the ICRC wheat distribution. According to ICRC, their food distribution was intended as a supplement to what the population had as a baseline and included 10.7kg of wheat, 1 liter of oil, 2 kg of pulse, 1 kg of sugar, 10.5 kg of tea, 0.25 kg of salt per person per month, and soap. Food was distributed per family. In zones 1-7 and in Tisha, none of the families visited owned any animals. However the neighboring villages of Afoma and Matera have land for agriculture and animal rearing, and more than 50% of the population in these two villages own oxen, goats, sheep and/or donkeys. Afoma has four wells, but the water pumps were removed by the soldiers, and therefore now depend on rain for their crops. 6. Senafe Town/ Health and Nutrition
The nutritional status of children under 5 years of age was assessed during the household survey. Of the 40 children reported in the 37 families visited, 28 had a green MUAC (normal), and 5 had a yellow MUAC but wt/ht over 80% (normal). Of the 7 children not checked, 4 were absent, and 3 were <6months of age. This findings are supported by the screening done in our dispensary, where the number of moderately (wt/ht <80%) and severely malnourished (wt/ht <70%) children has been relatively low. For the whole sub-zone of Senafe of 176 children under five seen in consultation, more than 50% have been screened for malnutrition, 5 have been found to have moderate malnutrition, and 4 (including one child from the town of Senafe) ware found to have severe malnutrition. The incidence of severe malnutrition would be about 4% in this very biased group of children. In the survey, at least 10% of the households were composed of only people over 50 years of age, whereas in 10% of the households women were taking care of both their children and their parents. In at least 4 households, there were people with mental disorders, including severe depression/social withdrawal requiring total care. Five children < 5 yrs of age had current illnesses including cough, fever, vomiting/diarrhea and one partially treated TB patient. Of 53 children born in those households in the last 5 years, 8 had died, and 50% of these deaths had taken place in the last 9 months (diarrhea x 3, fever x 1). After the MOH evacuation, Senafe received health services provided by an informally trained health worker who had been an employee of the Caritas dispensary prior to the last offensive. His only support came from ICRC in the form of donated basic drugs (paracetamol, chloroquine, some basic antibiotics etc.) and transport of patients to Adigrat Hospital when very patients were very ill. Unfortunately no records were kept of these medical activities during the last 9 months. For disease patterns documented after the opening of the MSF-F dispensary, please see our
weekly activity reports. During the last nine months, the <5 population was immunized against Polio on two different occasions, however there was no campaign against Measles. 7. Senafe Town/ Non-Food Items
On the average, the reported monthly expenditures in non-food items per family included: 135 nakfa in wood 27 nakfa in kerosene 37 nakfa (3 nakfa/person) in water (obtained mostly through general population pumps, occasionally through running water within the house, or wells) More than 95% of the families use wood as primary source of fuel, and 50% of the households use kerosene when available. There is a shortage of currency, although some manage to trade their wheat, oil, etc for other non-item foods. Among the NFI most consistently reported as needed were clothes and shoes. 8. Senafe Town/ Security Issues
Although none of the households visited had experienced thefts, or even heard of such incidents in their neighborhoods, more than 90% reported fear of theft as the number one security issue, and voiced concern over the absence of local police authorities and the administration. 9. Serha Village The village of Serha is located south of Senafe Town, the last village before the southern boundary of the TSZ on the main road between Senafe Town & Zalambesa. The population of the village was of approx. 800 before the last offensive and currently of approx. 394 (150 <5 children). The population is mostly a mix of elderly people & young children. It is one of the only village in Senafe Sub Zoba which was totally destroyed during and after the last offensive (private houses in concrete & public buildings, including the health post which was operated by the MOH prior to the last offensive). The remaining population of the village resettled in the country side few kilometers west from the destroyed village. The Ethiopian forces positions/trenches are at a maximum of 5km south from the inhabitants households and the population is reporting acts of harassment (stealing of goats, threats, thefts). The population of that area is certainly living in fear and is complaining about the absence of basic security conditions. During the war, the population was living in Tisha camp (near Senafe Town). During Ethiopian occupation, they came back to Serha and were able to get health services in Tsaeda Korso. Since the Ethiopians withdraw few weeks ago, they need to go to Senafe Town to get health services from the MSF-F dispensary. Health status of the populations is not alarming, same as nutrition status of the <5 population. Since the population came back in the area (nine months ago), three deaths were reported (epilepsy, heart problem and TB case). 12 babies were born in the area in the past nine months. Polio vaccination was done in Tsaeda Korso during Ethiopian occupation. We did spontaneous MUAC screening during our visit and among a very small sample of 15 children screened, 9 were normal, 4 were at risk of malnutrition and 2 were possibly moderate malnutrition cases (we did only MUAC screening).
In terms of water and sanitation, the population is going directly to the river to fetch water. There is a spring down in the country side. The water points in town were destroyed. There is clearly problems in terms of sanitation/ hygiene among the population, particularly when you look at the condition of the children. During Ethiopian occupation, the population got 4 food rations and since Ethiopians withdraw, they are receiving the monthly food ration from the ICRC in Tsaeda Korso (one time already). The school was also destroyed. 10. Tsaeda Korso Village There is currently approx. 450 people living in this village which is located few kilometers north of Serha village on the main road between Senafe Town and Zalambesa. The population configuration is quite the same as in Serha. This village is intact except for the 5 water pumps which were destroyed. The population is currently going to Serha to fetch water from the river. The ICRC monthly food distribution for 68 villages is currently done in this village (one time already). Like for Serha, the population reported 4 food distributions during Ethiopian occupation. The school is close. Prior to the last offensive, the population was going to Forto health post (managed by the MOH). During Ethiopian occupation, a health post was functioning and supported by the ICRC in this location. The building which was used at that time is still intact. Consultation room, dressing room and pharmacy were operational. Emergency cases were transferred to Adi Grat. This health post closed when the Ethiopian forces withdraw from the area (19/02/2001) and now, the population is coming to Senafe Town for health services. Polio vaccination was also done during Ethiopian occupation. Three people over 50 years of age died in the past ten months in the area (chronicle disease cases). But the nutritional & health status of this population seems stable and no specific morbidity pattern was reported to us. The main issue now is access to health services (like for Serha village) since the population have to walk to Senafe Town to get medical care (more then two hours of walk). Here also, problems seems to be more related to the water & sanitation situation (access to safe & potable water, hygiene conditions). 11. Forto Village This village is located few kilometers north of Tsaeda Korso village on the main road between Senafe Town and Zalambessa. The distance between Forto and Tsaeda Korso is of approx. 10 kilometers. The population of the village and surroundings if of approx. 500 people. An MOH health post was operational in this village prior to the last offensive. The structure needs rehabilitation work (roof, windows, doors) but the structure is intact. Same situation for the school, which is close. Private houses are also intact. The humanitarian picture (food, health, nutrition, sanitation/ hygiene) is the same as the one described for Tsaeda Korso village. In terms of access to safe & potable water, the population is fetching water from a well in the village, but this well needs rehabilitation work as soon as possible since it is open & not protected (animals are going there, the distribution area is very dirty, etc.). A <5 children died in this village two weeks before the assessment (diarrhea case, the only death reported) and we can expect more health problems linked to the water situation in the coming weeks, more particularly when the displaced population will come back from the camps. 12. Rokoyto Village The humanitarian situation in this village is the most positive one that we were able to see outside of Senafe Town. A health post serving 40 surrounding villages is operational with one health assistant (between 10 and 30 consultations per day), a water distribution point was rehabilitated by the ICRC and is providing sufficient water to the whole population of the agglomeration and for the animals. The private houses are intact and good number of goats & cattle were seen in the area. People are also cultivating. This village is at approximately 45 minutes of drive west from Forto village. The current population of the village is of approx. 600 people and 3000 people were living here prior to the last offensive. For the food distribution situation, the same pattern as described above during Ethiopian occupation and since the withdrawal. But the population is complaining that the ICRC food distribution is not enough (no milk, no DMK). The school was looted but the structure is intact. The morbidity patterns are the one for a normal health post (malaria, pneumonia, eye disease, anemia, respiratory infection, diarrhea, gastritis, abdominal pain, etc.). No specific morbidity patterns that we can link with a potential epidemic. Again here, polio vaccination was done during Ethiopian occupation. During Ethiopian occupation, 3 deaths were reported by the health assistant; 2 tuberculosis cases and 1 malaria case (all >50 years old). There is no sign of malnutrition among the <5 population but here again, sanitation/hygiene seems a problem when we look at the condition of the children. According to the statistics of the health assistant, there is a significant number of tuberculosis cases in this area. 13. Rokoyto Displaced Camp Approximately 15 kilometers east from Rokoyto village, a population of 350 people are living in a camp under tents. The population of this camp is coming from Ambesete Geleba village (extreme south-center of the Sub Zoba, between Zalambesa & Serha). It is difficult to say for the moment if their village of origin is falling inside or outside the Temporary Security Zone (TSZ). This caseload was displaced from Ambesete Geleba to this camp in 1998. During the last offensive, the healthiest people from this camp were able to move to Harena camp. The population left behind in the camp is mostly a mix of elderly people, women and young children. The global picture is preoccupying in terms of living condition. The tents are old, the camp is located in a remote area, the non food items seen in the tents (jerry cans, blankets, cooking sets) are in limited number and old (most probably distributed in 1998). In addition to that, the population is fetching water directly from the river near the camp (quality is questionable). They are going to Rokoyto for heath services and they are included in the food distribution of the ICRC in Rokoyto. Because we are mostly talking about mix of elderly and young children, the health status of this population is more fragile. Three people died in this camp during Ethiopian occupation (all cases of tuberculosis) and we saw few other cases of TB among the population. Malaria seems also a problem which can increase in the coming weeks. All children screened for malnutrition (MUAC) were normal. The population don’t want to move from this camp until the return of the civilian administration in the area. For the moment, they are requesting assistance to improve their living condition. Their only wish is to go back to Ambesete Gelaba. When the civilian administration will come
back in the Sub Zoba, a quick decision will have to be taken about this caseload. If the village of origin is falling inside the TSZ, the best option is a fast return there. If it is not falling inside the TSZ, the best option is to resettle this displaced population to a less remote area near Senafe Town where they will have easier access to health services, humanitarian assistance, etc. 14. Menekuseyto Village This village is located at the extreme south of the Sub Zoba, very close to the southern boundary of the TSZ, at approximately 25 kilometers from Senafe Town. The current population is of approx. 300 people and prior to the last offensive, 800 people were living here. It is the only village where we were not able to find any counterpart. The population is still living in fear and we can presume, according to some individual interviews, that there is still an Ethiopian presence in the area (or so called Eritrean opposition). The population is cultivating and there is a good number of cattle/ goats in the area. The population is mostly a mix of children, women and elderly people. The health post is intact but closed one year ago. Small scale rehabilitation work needs to be done, mostly for the water supply (windows, doors, roof and even material inside the structure were not looted). During Ethiopian occupation, a priest was giving basic drugs to the population which had otherwise access to the health post of Zigfet (operational during Ethiopian occupation). The <5 population was immunized against Polio in Zigfet. Same situation here in terms of health status or nutritional status of the population as described above for the other villages. We are talking about normal morbidity patterns, no signs of a potential alarming situation. Four deaths were reported during Ethiopian occupation (2 >50 years old TB cases and 2 <1 month old children who did not survive after birth). The main problem is access to health services. The village is at five hours of walk from Senafe Town and a good number of people needs to be treated for chronicle disease (TB, diabetes, etc.). It must be a priority to open soon a health post in this area. Another problem is again access to safe & potable water. The population is going directly to the river, with the animals, to fetch water. In terms of food distribution, the same situation here as described above for the period of Ethiopian occupation & after withdrawal. The school is intact but close. 15. Zigfet Village This village is located at approximately 15 kilometers south of Senafe Town on the way to Menekuseyto, with a current population of approx. 280 people (500 prior to the last offensive). The land is fertile, people are cultivating and there is a good number of cattle/ goats. Population composition is a mix of children, women and elderly. Food distribution pattern is the same here as what was described above from the period of Ethiopian occupation and after the withdrawal. A health post managed by a Christian congregation prior to the last offensive was supported by the ICRC during Ethiopian occupation, providing basic health services (pharmacy, dressing, consultations, polio immunization). This health post is intact and can be used immediately. It is close since Ethiopian withdrawal and the population is currently walking 3 hours to get health services in Senafe Town dispensary. The school is also close but intact. With the exception of significant number of diarrhea cases among the <5 population, the health and nutritional status of
the population is quite the same as what was seen in the other villages that we visited. Diarrhea cases are most probably linked to the problem of access to safe & potable water. A well located in the town was destroyed, so now the population is going directly to the river to fetch water. 17. Conclusions
The general health and nutritional status of the population in Senafe Sub Zoba remained stable during the last nine months. The mortality patterns reflect the direct effect of war more than a change in morbidity patterns. The current health needs are those typical of the age groups remaining behind, and the psychological consequences of war. One of the main problem is about easy access to health services since there is currently only one health posts operational for the whole Sub Zoba outside of Senafe Town. The second one is about access to safe and potable water and sanitation. The current fragile but stable situation in terms of health & nutritional status of the population can potentially be disturb by the return of the displaced populations. Population figures will double and the pressure in terms of access to water, food and health services can potentially be problematic if no rapid humanitarian response is organize prior to the return from the camps. An additional information is about the health post of Golo village (approximately 20 kilometers north of Senafe Town, few kilometers north of the TSZ), which was operated by the MOH prior to the last offensive. This health post was closed when the MOH withdraw in May 2000. The structure was looted but intact with a need for rehabilitation work (doors, windows, roof). The population of that area (approx. 750 people in Golo village and ten surrounding villages) is currently coming to Senafe Town for health services. There will be a need for Measles vaccine campaign, as this was not done along with Polio. To make it easier, MSF-F will do the campaign before the IDP’s return to Senafe. The nutritional status has remained stable, and so far there seems to be no indication for development of targeted supplementary feeding programs in the town of Senafe.
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