A girl carries a jerry can of water back to her shelter in Al-Tanideba camp. In both Al-Tanideba and Umm Rakouba, latrines are scarce or unusable, which has led to widespread open defecation in the camps. As a result, cases of hepatitis E have emerged. © MSF/Dalila Mahdawi
A tap stand sits in a pool of muddy water. © MSF/Dalila Mahdawi
Hepatitis E is a contagious virus that causes liver disease. It noticeably yellows the eyes and skin, causes fatigue and dark urine, and can lead to acute liver failure and death. It is particularly dangerous for pregnant women, for whom the risk of death is about 25 percent. Some of the patients treated by Doctors Without Borders for hepatitis E have arrived comatose.
As with other diseases like typhoid, dysentery and cholera, the hepatitis E virus thrives in environments with poor water and sanitation conditions.
Since day one, the humanitarian response has been two steps behind the needs of people here. Early warnings about inadequate sanitation, hygiene and shelter were not heeded, and latrine and tap stand building has been far too slow. As a result we now have widespread open defecation in the camps. Tigray refugees are paying the price of poor international coordination with their health.Emergency Coordinator François Zamparini
Tigray refugees in Al Tanideba camp fill their jerry cans up at a tap stand.
Heavy wind and storms have destroyed many of the camp’s latrines, spreading contaminated water throughout the camp. Open defecation is widespread. Some latrines are located right next to water points, increasing the potential risk of contamination. Besides an increase in toilets and handwashing stands, refugees need more help to safely store their water and food. © MSF/Dalila Mahdawi
In both Al-Tanideba and Umm Rakouba, latrines are scarce or unusable. In Umm Rakouba, there are only 175 latrines for 20,000 people, while in Al-Tanideba many latrines have been destroyed by heavy rain and wind. Together the two camps host about 40,000 people.
Work is underway to build new latrines, but with the onset of the rainy season many won’t be ready for several months. Some latrines are located right next to water points, increasing the potential risk of contamination. This week, heavy rainfall flooded many parts of Al-Tanideba, making the situation even more acute. Humanitarian actors must urgently increase the quantity and quality of latrines, particularly as the rainy season is likely to increase the spread of other waterborne diseases.
Because food distributions have been erratic, many refugees have also resorted to selling their soap provisions in order to buy food. Mehrut lives in Al-Tanideba with her five children. She has this to say.
The toilets have been a problem since we arrived. They are never cleaned or maintained and we do not feel comfortable using them.Mehrut, refugee living in Al-Tanideba
One of the water tanks at MSF’s water treatment plant in Al Tanideba camp. Doctors Without Borders is treating water as an emergency measure to ensure refugees have clean water. © MSF/Dalila Mahdawi
In response to the growing number of cases, Doctors Without Borders has raised chlorine levels in the water it provides, and taken measures to protect and disinfect boreholes under its management from dirty surface water. Doctors Without Borders has also increased health education and outreach in the camps. This has included a jerry can cleaning campaign to ensure refugees can safely store their water. Doctors Without Borders is also following up with pregnant women, providing them with additional soap as a preventative measure.
The spread of hepatitis E could have been avoided if the basic infrastructure had been in place on time. Instead there has been a collective failure to provide dignified and safe services to a relatively small number of refugees.Project Coordinator Sergio Scor
The exterior of the emergency department at the Doctors Without Borders medical facility in Umm Rakouba camp for Tigray refugees © MSF/Dalila Mahdawi
Doctors Without Borders has been working in Umm Rakouba and Al-Tanideba camps since November and December 2020, respectively. In both camps, Doctors Without Borders medical staff run clinics providing primary and secondary healthcare, outpatients and inpatient care, including a maternity, mental health services, vaccinations for children under 18 months and malnutrition treatment. Doctors Without Borders is also supporting with water and sanitation, and operating an emergency water treatment plant to provide clean drinking water to refugees, chlorinates water and provides big bladders to store it in. Doctors Without Borders also works in Hamdayet and Al-Hashaba/Village 8 transit centres. Doctors Without Borders services are available to both Tigray refugees and local Sudanese communities.
