Ethiopia: Bringing the water system back to life in Tigray

When Doctors Without Borders (MSF) teams were able to return to Tigray in November 2022, the region was emerging from a devastating two-year civil war. The war caused significant damage to infrastructure, whether due to lack of maintenance, intentional destruction, or the fighting. Health facilities were hardly functioning.

Among MSF’s first priorities was rehabilitating health facilities’ water systems and re-establishing a functioning waste management system. In Shire’s Suhul hospital, for instance, the team managed to get safe water flowing again and built latrines, showers, and areas for washing. They also installed incinerators to ensure safe disposal of sharp, soft, and organic medical waste such as needles, syringes, soiled dressings and body parts. Most crucially, the team cleared a mountain of rubbish containing hazardous medical waste close to the facility.

Another critical goal was to bring safe water into people’s homes as a bulwark against the spread of waterborne diseases, including acute watery diarrhoea, skin and eye diseases, and those caused by parasites. The biggest fear was that the lack of access to clean water might trigger a cholera outbreak.

The medical consequences of not having access to water and sanitation:

Between December 2022 and March 2023, several assessments were done in northwest and central Tigray and showed that only 34% of water hand pumps were still functioning among 2000 surveyed across 14 districts. It was critical to repair the unusable pumps before the rainy season, when water sources can become contaminated from open-air defecation, increasing the risk of cholera outbreaks.

When water hand pumps aren’t functioning, people will use water from lakes and rivers, which is often unsafe. “At one stage, towards the end of March, almost one in four ambulatory patients we were seeing in Tigray were suffering from preventable waterborne diseases,” says Samreen Hussain, MSF medical coordinator in Ethiopia.

At the end of April, several cases of acute watery diarrhoea were recorded in Derso, a small village south of Sheraro, after a ten-year-old boy died on his way to a rural health facility. “The conditions in the village were very poor,” says Daniel Shmondi, an MSF water and sanitation supervisor who was among the team assessing the situation in the area. “There were no wells and people were using water from the river for all purposes. Open air defecation was common practice near homes.”

In response, the team distributed water purification tablets to 120 households and checked whether other people in the village had become sick. They found that two siblings of the boy who died had severe diarrhoea, and they were then admitted to an isolation centre that MSF helped set up in Sheraro to prepare for a possible cholera outbreak. This also triggered a response at Suhul Hospital, the referral facility for the region, which is two-hour drive away.

The hospital rehabilitated its cholera treatment centre and trained staff to strengthen their ability to respond during outbreaks.

Early in the morning, Adisalem loads his camel with the spare parts he will need to repair a hand pump in Ademeyti, a village at the border with Eritrea. “In this area most people have not returned yet,” he says. “Many are still living in camps or with hosts in the community.”

Persisting insecurity has also slowed down recovery from the war. Water infrastructure in Tigray underwent costly repairs several times, only to be looted or intentionally destroyed again.

Aid organisations have been hesitant to carry out new big interventions. Pumps for the water treatment plant that provides safe water to the city of Sheraro took six months to be replaced. During that time, the city survived thanks to deliveries made by truck or donkeys. In addition, MSF provided up to 1.4 million litres of safe water for six displacement camps daily.

Where water utility technicians are unavailable, MSF technicians carry out the rehabilitation directly while training new staff hired by the water administration. The objective is to act as a catalyst in re-activating the pre-existing public hand pump repair system. As recovery continues, more resources and efforts will still be required to increase the availability of safe water and improve overall sanitation and hygiene conditions in parts of Tigray.

MSF has been working in Ethiopia for 37 years, providing medical assistance to people affected by conflict, epidemics, disasters or with limited access to healthcare, in collaboration with Ethiopian authorities at local, regional and national levels. Currently, we are working in seven regions in Afar, Amhara, Gambella, Oromia, SNNP, Somali Region, Tigray. We have been providing kala azar care for more than 20 years, including our dedicated kala azar and snakebite projecte in Abdurafi, Amhara, and through emergency interventions. All our activities are guided by humanitarian principles humanity, independence, neutrality and impartiality.

About Doctors Without Borders (MSF)

Doctors Without Borders (MSF) is a global network of principled medical and other professionals who specialise in medical humanitarian work, driven by our common humanity and guided by medical ethics. We strive to bring emergency medical care to people caught in conflicts, crises, and disasters in more than 70 countries worldwide.

In South Africa, the organisation is recognised as one of the pioneers of providing Antiretroviral Treatment (ART) in the public sector and started the first HIV programmes in South Africa in 1999. Until today, the focus of MSF’s interventions in the country has primarily been on developing new testing and treatment strategies for HIV/AIDS and TB in Eshowe (Kwa-Zulu Natal) and Khayelitsha (Western Cape).

In Tshwane, we run a migration project, and we offer medical and psychosocial care to migrants, refugees, and asylum seekers, who struggle to access public health services under South Africa’s increasingly restrictive.

Previously we offered free, high-quality, confidential medical care to survivors of SGBV in Rustenburg.

To learn more about our work in South Africa, please visit this page on our website (www.msf.org.za). To support MSF’s work: