By Duke Burbridge
According to reports shared with Tghat Media, food distribution has restarted in some areas of Tigray. The total number of people who are targeted to receive food assistance has been reduced, but the cut does not appear to be as severe as first feared. Even with this positive development, the distribution targets are not being met, possibly due to the temporary suspension of the Relief Society of Tigray (REST) as a USAID food distributor. REST was previously the primary partner for food distribution for the USAID-funded Joint Emergency Operation (JEOP). It is unclear who could replace REST capacity if the suspension becomes permanent.
The combined target of the World Food Programme (WFP) and JEOP for the current food distribution cycle in Tigray is 3.2 million people (outside of the Western zone.) While this is less than the previous caseload of 5.2 million, it is much better than initial reports of a possible 80% reduction by Tigrayan Interim President Getachew Reda in December. The target for December (970,100) did indeed reflect an 81% reduction, but the new January target is much higher due to reassessments of IDP returns and drought-affected woredas.
The problem is that, by January 21, the major food agencies, WFP and JEOP, had only reached a fraction (14%) of their “January Cycle” target. Also note in the picture of the Wheat Flour above, the expiration date is February. As Goyteom described from the scene in Shire, the flour was found to be of bad quality and may have already gone bad.
If distribution can scale up to actually reach 3.2 million people targeted in a normal six-week cycle, the number of people receiving aid in Tigray would be very close to where it was this time last year (see chart below). However, due to the damage already done through nine months of suspended aid and the drought; if the targets are not met, people will continue to die.
The WFP began distribution for the current cycle in the Northwestern Zone in mid-January. As of January 21, additional food distribution began in Mekelle, the Southern Zone, and the major towns of the Northwestern zone including Shire, Sheraro, and Endabaguna. The JEOP has also begun dispatching food for the current cycle to several areas, and distribution has begun in at least two woredas in the Central zone. With the dispatch of food to the areas of greatest concern well underway, the report from the week ending January 28 should show a major improvement in distribution, but that remains to be seen.
It is difficult to see how the JEOP will meet their target without their primary distribution partner. As the map in this update from January of last year shows, REST was responsible for food distribution in most of the Central, Eastern, and Southeastern zones; as well as half of the Southern zone.
USAID claims that the suspension is a result of a technical issue with the external auditing of REST. Reports from sources that I have spoken to in Tigray with intimate knowledge of the situation speculate that the decision to remove REST from the food distribution cycle was made not by the food cluster, but by senior USAID officials. This could prove to be a catastrophic decision made by individuals who have demonstrated highly questionable judgment when it comes to the humanitarian response in Tigray.
Child starvation continues to go untreated in Tigray
New food distribution is sorely needed in Tigray, in part, because nutritional support for children at the last stage of starvation remains inaccessible for most of the population. New data out from the nutrition cluster appears to show a very muted response to the rising threat of famine in Tigray. While the number of children admitted into care for severe acute malnutrition ticked slightly up, the level remained less than 20% of what it was when food distribution was at its highest point in Tigray. For perspective, fewer children were admitted for severe acute malnutrition (SAM) in the last five months of 2023 combined than were admitted in the final month of food distribution.
Treatment for SAM for children under five years old has a single objective: to stop a baby from starving to death. This is usually done on an outpatient basis with therapeutic food or baby formula (~95%), but also includes specialized care at a health facility. The target set by the UNICEF-led Nutrition Cluster for 2023 in Tigray was 136K, but only 64K were admitted.
There are a lot of programs intended to stop child starvation. Everything from food distribution to agricultural development, even vocational and education programs are geared directly or indirectly towards stopping children from starving. Nutrition support for babies at the final stage of starvation is the “last stand” intervention.
Babies who need treatment for SAM often die if they do not get it. They do not always die directly from starvation, but usually from something that their bodies could not survive in such a weakened state. For a starving child, almost any disease or infection can be fatal.
A closer look at the data from November and December shows a shift in resources from the Northwestern and Southern zones to the areas in the Central, Eastern, and Southeastern zones that were hit hardest by the drought. However, without additional capacity to treat SAM in children, there is cause for concern. In December, admissions for SAM were lower in every zone of Tigray than before the food aid suspension and the drought. Even a clear shift towards Central and Eastern zones, far fewer children are receiving SAM treatment than (a) the number who received it when food was being distributed and (b) the number who were expected to need it from estimates made at the beginning of the year.
The chart below shows the number of children admitted into treatment for SAM in Tigray during the last month that food distribution was available (March), as well as the number of admissions from November and December. It also shows the target, which was estimated at the beginning of the year.
According to remote sensing methods presented in a recent, unpublished December report from USAID and REACH, the harvest does not appear to have been much better in the Northwest compared to the other zones and actually appears to have been worse in 2023 than the previous year. The drop in admission capacity in the Northwest zone means that the number of children who were receiving treatment in December was more than 20 times lower than the number receiving treatment in March. The slight increase in admissions in the Eastern and Central zones only brings them to 13% and 28% respectively, of the target.
The bottom line is that the current level of capacity to treat SAM cannot be divided to address the impending famine in Tigray. It must be increased.
Malnutrition in the Displaced Population
Displacement is another major consideration for the nutrition response. According to the IOM-DTM’s latest published assessments, there were 950,000 people displaced in 667 hosting sites in Tigray in August. More than 121,000 of the displaced population are children under the age of five. The most recent SMART+ Nutrition Assessment found that the malnutrition rate for displaced children under five years old was at least 33.6%.
The true number of malnourished children is almost certainly higher than this because the middle upper arm circumference (MUAC) measurement is only one of two ways to determine severe malnutrition. Using a weight-for-height scoring system, 26.4% of displaced children were found to be malnourished. The report only shows the combined malnutrition data on a regional level and does not break down the zones and displaced population. However, if the regional trend holds for the displaced population, the combined malnutrition rate could be as high as 50%.
If the MUAC malnutrition rate is used, it would mean that 40,903 displaced children under five years old were malnourished in August, of which 6,939 were at severe malnutrition. The largest number of displaced, malnourished children was in the Northwestern Zone, with the Central zone and Mekelle close behind.
While the nutrition cluster does not include SAM admission targets specifically for displaced children; the IOM-DTM and SMART+ Surveys would have rendered any previous estimations moot anyway. The last column of the table above is the real target. As the chart below shows, admissions did not come anywhere close to meeting the need.
As of August, the need for SAM admissions of displaced children was at least 6,939, if the additional 34,000 displaced children who were facing moderate malnutrition were receiving therapeutic food or formula. However, fewer than 1,400 displaced children were treated for moderate malnutrition in August. Of the 40,903 displaced children found to be starving in August, only 5% received any form of treatment.
By examining the total number of displaced children admitted for malnutrition more closely, it appears that displaced children in Mekelle and the Southern zone are likely being treated in the neighboring Southeastern zone. In the Central and Northwestern zone access to treatment was extremely low. The combined number of children who needed admission for SAM in the Northwestern and Central zone was 4,003. In December, only 45 displaced children were admitted for treatment.
Where is the response?
In a previous article, I mentioned the testimony of USAID Deputy Assistant Administrator Tyler Beckelman before the Africa Subcommittee of the US House Committee on Foreign Affairs. More than an hour into the recording Representative Brad Sherman asks Beckelman directly if we are going to be sending in enough food for “all the very people of northern Ethiopia.” Beckelman said: “We are going to do our best on this.”
Congressman Sherman interrupted to ask if USAID had “sufficient funds and trucks and logistics to get the job done.” Beckelman responded: “We are confident in the logistics chain. We are confident in our partners’ ability to deliver. And… um… with the very generous support of congress, we greatly appreciate, we think we are in a good place to continue to make a difference in the lives of the Ethiopian people.”
Why was USAID’s answer not “no, we don’t have enough resources”? The US Congress is the body responsible for making sure that USAID has the resources to stop the famine in Tigray. The congressman asked the USAID representative a direct question about whether or not USAID had what they needed to stop babies from starving to death and the response was absurd: they think that they are in a good place to continue to make a difference in the lives of the Ethiopian people.
At the time of that hearing, USAID already knew about the destruction of Tigray’s food system. By November, they knew about the drought and about the mass starvation that had been happening during their suspension of food aid. In November the nutrition response only reached 2% of displaced children believed to be at the last stage of starvation and was only reaching 20% overall of a target set before Tigray experienced such horrible shocks to the food system. By November 30, USAID would have also known that the amount of nutrition supplies and food being sent into Tigray in December was entirely insufficient to address the growing threat of famine.
As the largest provider of humanitarian aid, USAID decisionmakers know that they are in a place to “make a difference” in the lives of starving Tigrayans. At the beginning of 2023, the food provided by USAID made a difference in cutting severe food insecurity in half in Tigray. At the beginning of 2024, USAID made a difference in whether or not Tigray was prepared for the drought.
All of the international donors to Ethiopia had a year to prepare Tigray for the worst. USAID and WFP paused food assistance for eight months to build a logistics pipeline into Tigray capable of distributing a large volume of food aid with a minimal risk of diversion or waste.
This should be the moment of truth for USAID in Ethiopia. Unfortunately, the commitment of international donors to the truth in Tigray is as questionable as their commitment to stopping the famine.