IOM data shows a humanitarian meltdown in Tigray

The recent publication of data from Tigray by the IOM’s Displacement Tracking Matrix (DTM) shows that the children of Tigray have been left to starve to death without access to food or life-saving treatment. The resumption of the IDP hosting site and village assessments is a major achievement for IOM that will bring local communities in the region back onto the humanitarian grid. It is unclear if the decision-makers are even seeing the assessments, but the data itself is very clear. Conditions of life throughout Tigray are extremely bad and deteriorating. The people of Tigray are in a uniquely poor position to survive another week without food aid and nutrition support. 

WFP and USAID have struggled to speak clearly about the reality on the ground in Tigray, which could have serious consequences. Currently, funding for the food and nutrition response stands at 24% and 30%, respectively, and the most powerful aid agencies in the world have spent five months proving that they lack the institutional capacity to deliver wheat over a secure supply route. More funding for food could be a tough sell to risk-averse donors, but it will probably return when WFP and USAID get their collective act together. Funding for nutritional support could be much worse, which could threaten the lives of the most vulnerable children in Tigray, and across Ethiopia.  

During the suspension, the WFP and USAID were clear about the need for food in Tigray, but have been less than transparent about the need for treatment of acute malnutrition. There is no indication that WFP and USAID have informed donors about (a) the impact of their food suspension on child starvation in Tigray or (b) the sharp drop in the reach of lifesaving nutrition programs in the most disadvantaged areas.

Public facing messaging from the UN and WFP about child starvation in Tigray is alarmingly misleading and devoid of hard facts. Both WFP and USAID are on record stating that the food aid suspension would not affect nutrition assistance, which would continue to reach children in Tigray. As noted previously, life-saving interventions for children suffering from severe acute malnutrition declined substantially after the suspension. 

The collapse of the nutritional response makes the prior statements by WFP Head Cindy McCain and USAID Director Samantha Power dangerously false, but this has not been clarified on the record. The most recent UN-OCHA update used a year-on-year comparison to depict the nutrition response as improving from last year, while hiding the post-suspension cuts in service. When discussing the nutrition response in a press conference last week, UN Spokesman Stephane Dujarric told reporters how many organizations were involved in the nutritional response, without mentioning that far fewer starving children in Tigray were receiving care after the food suspension. In both cases, the statistics used give the impression of progress to conceal a more meaningful and lethal failure.

The IOM-DTM monitoring represents a rare step towards transparency and away from deliberate efforts that aid groups have taken to hide similar assessments made after the suspension of food aid in Tigray. These assessments reflect the level of monitoring that should be adopted by the food and nutrition cluster until the food suspension is lifted.

New Data

 After having been forced to suspend operations for two years due to fuel restrictions and other “logistical challenges,” IOM-DTM is once again monitoring the conditions of Tigrayans who are displaced and recently returned in areas that are not under military occupation by the Eritrean or Amhara regional forces. Despite these gaps, the depth of the data within the coverage area is unparalleled, which includes assessments of 1,606 locations in six zones of Tigray, where 3.7 million Tigrayans live in 887,855 households. 

IOM-DTM Assessment Coverage, by zone

IOM-DTM Assessment Coverage, by displacement status

Children are starving with no relief

Arguably, the most important finding in the IOM’s rich datasetis that the children of Tigray are facing severe acute malnutrition without access to live-saving treatment. Both datasets are worth exploring in detail, which include different question sets for villages and IDP hosting sites. At the village level, researchers want to know more about crops, livestock, and livelihoods; at IDP hosting sites the focus was on living conditions and services. However, one question is identical in both assessments: 

“What percentage of children under 5 that are affected by SAM have access health and nutrition services free of charge?” 

This is a critical question in any circumstance, because parents who cannot feed their children are generally not in any position to pay for medical care. However, given the current freeze on food aid, the life or death implications of this question have likely never been more significant. 

The combined finding is that nearly three million Tigrayans (80%) are living in communities where at least nine out of every 10 children who experience severe acute malnutrition must survive without any international relief. Treatment coverage for SAM only reached 75% of affected children in 16 of 1,606 sites. 

Of the 16 sites where more than 75% of children were able to access free treatment at the last stage of starvation, 14 were in a single district of the Southeast zone. Everywhere else needs nutritional aid and food. The enormity of the unmet need clearly demonstrates that targeted assistance should be replaced by a blanket approach. Particularly after five months without food aid, a baseline need for food and nutrition support should be assumed in every village or IDP hosting site in Tigray and agencies should be clear with donors and the public about the consequences of missing the target. 

Adigrat: 570 dead of starvation and 26000 IDPs God knows where in Adigrat 

Last June, Catholic Bishop Tesfasellassie Medhin of Adigrat in northern eastern Tigray pleaded with the world for the lives of his people, but no one listened. Denouncing the aid suspension, he said:

“I want to call upon the decision-makers to consider our shared humanity and beg them not pronounce a death sentence upon those trying to survive in the wake of the terrible armed conflict…”

However, by June, the decision to sacrifice the lives of the innocent civilians of Adigrat was long made. The decision-makers that Bishop Medhin hoped to persuade already knew that the food aid suspension was a death sentence. The WFP and USAID had chosen to deprioritize the lives of everyone he hoped to save. 

The cost of the decision to suspend food aid indefinitely is being paid, as always, with the lives of Tigrayan civilians. Local authorities in Adigrat last week reported that more than 570 people have died of starvation related deaths since the food aid suspension, but the totality is likely even worse than what can be presently recorded. According to data published in August by the IOM-DTM, assessments were performed at Adigrat’s ten IDP hosting sites a week before the Bishop issued his statement. 

Researchers found a population on the brink of collapse. IOM researchers were told that nearly 26,000 IDPs (30%) set out from six of Adigrat’s hosting sites in a desperate search for food. Some intended to reach nearby villages, while others tried to return to their homes. According to camp administrators, the cause of the mass departure was food scarcity, which remained a critical need for more than 61,000 IDPs who stayed hosted in the city, which includes 6,139 children under five years old.

The lack of food is clearly due to the suspension of aid by the WFP and USAID. Each of the hosting sites assessed by IOM-DTM in Adigrat reported that food was the highest-priority need and none reported any food distribution in the previous three months. The aid suspension has become the primary driver of food scarcity for Adigrat’s IDP population and cause of desperate and dangerous returns. According to dashboard updates from the food and nutrition clusters, May was the first month of 2023 when all the following things were true in Adigrat:

1. No displaced households received food rations from UN partners.
2. No displaced children under five years old were treated for SAM.
3. No IDPs received supplemental food for moderate acute malnutrition.
4. No displaced pregnant or lactating women received treated for acute malnutrition 

Adigrat: Admission and Treatment for Acute Malnutrition for Displaced Children and PLW 

It is likely that more people have left hosting sites in Adigrat since assessments were conducted, because there has been almost no resumption of life-saving services to the displaced population. In June and July, distribution of food rations and nutritional supplies to treat acute malnutrition in children and pregnant and lactating women, and moderate malnutrition appears to have remained paused and only a small number (11) of displaced children under five years old were admitted for treatment of SAM. 

The number of displaced children who needed treatment for malnutrition was likely in the thousands. If the malnutrition rate from WFP’s February 2023 Emergency Food Insecurity Assessment is used to estimate the current number of displaced children in Adigrat who require treatment for acute malnutrition would be 1,811. The impact of the March food aid suspension has not been measured in Adigrat but has been shown elsewhere in Tigray to have caused malnutrition rates to double and triple.

When Bishop Medhin issued his appeal, the decision-makers at WFP and USAID knew that people had starved to death in Adigrat and elsewhere in Tigray, they knew that 26,000 people had left IDP camps in a desperate search for food for their families, and they knew that people continued to starve to death every day throughout Tigray. Senior leadership at WFP and USAID knew that the aid that they had suspended meant the difference between life and death for thousands of children. Saving the lives of these innocent civilians was not a priority.

USAID and WFP must take some responsibility for the IDP families who were forced to abandon their hosting sights in Adigrat and elsewhere in Tigray. The people in Adigrat are genocide survivors who protected their city for two and a half years from two Eritrean invasions into Tigray. After years of brutal genocide, the cause of death for the people of Adigrat who are dying today is the inability of the world’s most powerful country and multilateral body to deliver food to them through an unobstructed supply route after a four-month shutdown. 

TG379: One of 643 IDP sites in Tigray 

Looking through the IOM-DTM data from Tigray, the enormity of the suffering is staggering, but even a single datapoint can be heartbreaking. There are 113 displaced children under five years old registered to a gas station in Mekelle, most of them have never seen their homes. The WFP is supposed to be distributing food to this site, but they stopped months ago. If the children registered here slip into severe acute malnutrition, it is unlikely that they will receive treatment.

More than a hundred displaced families are registered to TG379, mostly from Irob and Western Tigray where they were hunted by the genocidal Eritrean soldiers and Fano militia, which continue to illegally occupy the two regions. For these families, there is no option to go back until the brutal occupation is over. Of the 755 people registered here, most (420) arrived in the past year and the rest arrived two years ago. There are 113 children under the age of five living here and 15 senior citizens. For most, this is just the latest of several forced migrations. 

There are two pieces of good news from this site. First, the displaced families are not living on the grounds of the gas station. Most are living in the homes of host families, and some can pay rent. Still, overcrowding is a problem with up to half of people not being able to sleep without touching another family member. Most have no bedding. Despite the challenges, living conditions here are comparatively better than other IDP sites in Tigray. The second positive feature is that TG379 was one of a handful of sites in the capital where food was distributed (to <50% of households) when the aid suspension was temporarily lifted for a week in April. After four months, this food is gone, and the delivery is irrelevant to survival.

Respondents from these sites did not mention shelter was a primary need, but food, health care, and bedding were seen as most critical. Of the 117 households, less than 25% have access to beds to sleep in, basic cooking sets, or hygiene kits (basin, jerry can, soap.) It is notable that researchers were also told that less than 25% of households at this site have received any of these items in the past year. There is a nearby market that sells this kind of thing, but few can afford it. 

Only around half of the families at this site have enough drinking water. There are two accessible water sources at TG379, but only one is functional and families rely primarily on water trucks. There are no reported challenges accessing water distribution sites and the line is generally less than 15 minutes, but there is not enough water for everyone or containers to hold it. The situation is similar with latrines. There are 17 latrines for IDPs to use, but only 12 are functional. The latrines have locks and IDPs report feeling physically safe using them, but there are too few, they are not accessible to persons with disabilities, and they are unclean. There is also no soap for washing. In these conditions it is impossible to prevent the spread of disease.

As might be expected from the conditions of sanitation, diarrhea was cited as the most prevalent health condition, followed by acute malnutrition. Health facilities are available, but without drugs or equipment to treat people and cost is prohibitive. Every traditionally vulnerable demographic group was found to be facing additional obstacles accessing healthcare. Children at this site are being actively monitored for malnutrition, but there is no outpatient treatment available for severe acute malnutrition (SAM). Less than 10% of IDPs under the age of five who are suffering from SAM receive treatment. A mobile nutrition unit visited this site in mid-April, which probably saved lives. It is unknown if any services have been available since April. This is, of course, unlikely due to recent cutbacks in the child nutrition program. 

It is impossible to learn from a site assessment what life is like for the people of TG379, but basic survival appears to be a full-time endeavor. There is no safety net to catch these families if they slip, and the lack of food, water, medicine, nutritional support, and sanitation creates an environment where a single mistake or misfortune can become an existential threat. Basic staples of survival and common non-food items distributed by humanitarian agencies around the world everyday could make the difference between life and death for anyone at this site, but aid is stopped. The people registered to this site have survived three years of genocide and are still a step away from collapse ten months after the Pretoria Agreement was signed. The only solution for this site is for the families living in TG379, or in Adigrat, or in IDP hosting sites anywhere Tigray to be able to return to their homes, but this would require the end of multiple illegal military occupations. 

There are indications at every level that the failure to deliver aid is driving human suffering in Tigray and will continue to kill more people every day until the suspension is lifted. The smoldering humanitarian meltdown is not what WFP or USAID described to congress or donors. The food aid suspension should have never been allowed to drag on this long and should have ended the day that relief agencies could no longer maintain a baseline of nutritional support for children in Tigray. Nothing is worth one more needless death in Tigray. 

The WFP and USAID should be focused on setting ambitious targets for aid distribution and meeting them. It has been five months since food aid was halted in Tigray and agencies have largely stopped providing care for Tigrayan children at the last stage of starvation. The continuation of the aid suspension for another week should be a non-starter. Sadly, it seems inevitable.

The suspension should be lifted, but if it continues, WFP and USAID must be held to their intentions. If they are allowed to continue to block food and nutritional support from reaching starving children in Tigray in order to fix the food distribution system, the operation that restarts should be state of the art. Out of respect for the lives lost during development and implementation, it has to work. After aid restarts, any new failure to reach vulnerable communities in Tigray with life-saving aid should trigger high-level resignations rather than more excuses.