Shortage of water is a daily reality in Doolo Zone, a vast and sparsely populated arid area in the most eastern part of Ethiopia’s Somali Region. MSF assists the most vulnerable among the predominantly pastoralist communities in remote areas and to communities displaced by years of drought and tensions recurrently erupting over access to water.

Pastoralist life means moving from place to place, searching for water and pasture to feed the livestock. With no access to resilient water sources unaffected by the arid climate, every aspect of life depends on the seasonal rains usually expected in April and collected in ponds called ‘berkit’, providing water for both humans and their animals. The rains also bring pasture to feed the livestock, who in return provide milk and meat.

Failing rainy seasons over the past years caused prolonged and persistent droughts. Affected pastoralist families began traveling long distances in search of water, food and grazing grounds. Unstable and unreliable food and water sources, unhygienic living conditions in cramped sites for displaced people near villages and towns in combination with the poor coverage of health services, led not only to tensions, but resulted in disease outbreaks, malnutrition, and loss of lives and livestock. During the devastating drought in 2017, 75% of livestock were lost, further reducing the communities’ capacity to cope and many depend on humanitarian assistance.

In this isolated region, even under normal circumstances it is near impossible to get timely emergency care. The existing health care system does not cater to pastoralists, who are continuously on the move. Distances to health care are overwhelming and can be life threatening. People have to move for hours on foot. Only few functioning ambulances currently serve a population of 300,000 dispatched over a zone without paved roads. The poorest and most vulnerable are unable to access timely care.

MSF established a more dynamic surveillance and response system to reach the most vulnerable and hard to access moving communities and to provide them with a safety net in times of emergency, while medical teams provide flexible primary health care services through 17 mobile clinics. They follow the moving pastoral communities to locations where no health posts exist, and does referrals to the hospital in Wardher town from isolated areas.

MSF’s so-called ‘tea teams’, made up of a public health officer and health education supervisors from the communities, maintain close relations to influential local contacts and their communities in strategic remote locations. Their meetings, focus group discussions and health education session help enhance MSF’s knowledge of the populations’ health needs, health seeking behaviour and pastoralist movement patterns. They aim to enable MSF to respond timely and rapidly to any epidemic even in remote places. Through outreach activities and health education, MSF aims also to improve health-seeking behaviours, knowledge and awareness among the most vulnerable populations.

In Doolo Zone, Somali Region, MSF runs between 15 and 20 mobile clinics, which offer outpatient medical services, to remote and pastoralist communities, and supports referrals from isolated areas. MSF also runs 30+ surveillance locations in remote areas for early disease outbreak detection and timely response to emergencies.

Since 2007, MSF has been working with regional counterparts in Wardher hospital and health centres in Danod and Lehel-Yucub and handed over these activities to local partner in 2018. MSF has been supporting outpatient and inpatient services, water and sanitation activities and emergency referrals. Teams maintained and ran isolation wards during disease outbreaks, assisted deliveries and provided antenatal care, treatment for tuberculosis and for severe acute malnutrition in children under five.