“My only joy is my child, I don’t have anything else in life,” said Nyabel Jock, a 19-year-old refugee from South Sudan, during her regular pregnancy check-up at the Jewi Health Centre in the Jewi Refugee Camp in Gambella.
Nyabel fled to Ethiopia more than five years ago from Nasir in the Upper Nile state of South Sudan, after conflict broke out in 2013 and displaced some 1.5 million people. She arrived at the camp with little more than the clothes on her back.
“I left home under very difficult circumstances, and things at the camp haven’t been easy either. As a refugee it’s hard to get a job. You have to depend on donors for everything, including putting food on the table or being able to meet your personal hygiene needs,” she said.
Today, the Jewi Refugee Camp hosts nearly 62,000 of the 350,000 refugees who are scattered across eight sites and settlements in Gambella. Over the last year, 11,000 South Sudanese refugees have arrived in the region, more than half of whom are women and girls.
UNFPA is distributing emergency reproductive health kits to facilities in Gambella, reaching more than 100,000 refugees and people in host communities so far in 2021. The kits include medical equipment, supplies, medicine and solar panels to support sexual and reproductive health services, including maternal and newborn health care. Health staff, including midwives, have also attended training sessions to build their capacity to deliver quality care, including managing pregnancy-related complications.
“The ultrasound machine and medical supplies provided by UNFPA have allowed us to identify a host of complications on time, saving many women’s lives,” said Asnake Getachew, a midwife on the maternity ward at the camp.
When giving birth is life-threatening
Women with pregnancy complications often have to walk over 6 kilometres to reach the nearest health service, and the consequences of doing so can be fatal
Gambella’s health and social systems are creaking under ever-increasing needs: the region hosts more than 370,000 refugees from South Sudan alone, the highest in the country and equal in number to the host population. In the Jewi camp, the only health centre serves more than 60,000 refugees – six times the recommended maximum of 10,000 people per health centre.
“Women with pregnancy complications often have to walk over 6 kilometres to reach the nearest health service, and the consequences of doing so can be fatal,” said Bezabih Fentahun, Health Coordinator at the Administration for Refugees and Returnees Affairs, which coordinates refugee assistance interventions in Ethiopia.
A lack of infrastructure, skilled personnel or referral mechanisms for emergency obstetric care are hampering maternal and newborn health services in Gambella. Asnake said maternal and newborn deaths are all too common; she has witnessed three women and two newborns die already this year. “They needed blood transfusions but there was no ambulance available,” she explained.
Afework Solomon, a midwife working alongside Asnake, said that there are on average five to six deliveries per day, but the ward only has six midwives and one ambulance, donated by UNFPA. “We don’t perform surgery here, so if we have two cases needing referrals at the same time, one will have to wait,” she said.
Persevering to protect women and girls
To support survivors of violence and women and girls at risk, UNFPA also supports a One-Stop Centre in Gambella that provides a comprehensive health and psychosocial care and a toll-free hotline, while Women and Girls Safe Spaces offer shelter and advice.
Yet new refugees continue to arrive daily. Food insecurity is rising as ethnic conflict and drought grip the region and cyclical floods destroy crops and homes. Much more needs to be done to uphold the rights of Gambella’s women and girls, including their right to safe and dignified birth and to live free from violence.
With no long-term solution in sight and cuts to food rations recently announced, the plight of refugees in Ethiopia is worsening by the day. Nyabel is weary and faces an impossible situation: it’s not safe for her to return home, but without an income, she is struggling to survive.
The UNFPA Humanitarian Response Plan for Ethiopia 2021-2022 is urgently calling for nearly $14 million to ensure sexual and reproductive health care for millions of women and girls in the country, including protection from gender-based violence and support for survivors. The response plan covers eight regions affected by multiple crises and with scarce or no access to essential health services. To date, only 24 per cent of the appeal has been funded, leaving millions of lives at risk.
Nyabel said she is holding on to hope: “I trust I will be able to return to my country with my son one day, reunite with my family and start over a new life”.
