Since the civil began in mid-December last year, 69,456 South Sudanese refugees have entered Ethiopia’s Gambela Region.
Two thirds of the arrivals have been children, many of whom are unaccompanied, according to a March inter-agency report on South Sudanese refugees coordinated by UNHCR. The report anticipates that 140,000 refugees will enter Ethiopia in the coming months.
“They are arriving on foot, over difficult and remote terrain, in a deteriorating nutritional status, and are traumatized and exhausted by travel and continuous conflict in their home country,” the report stated.
Food shortages in South Sudan mean that many of the refugees, especially children, are severely malnourished and ill when they reach the transit centres at one of seven entry points. The largest, Pagak, transfers on average more than 1,000 people a day to two camps across Gambela Region.
Data from the UN Refugee Agency (UNHCR) indicate that there could be an average of 1,000 new arrivals each day to Ethiopia.
“The condition of women and children who are crossing over is quite critical at the moment," said Adem Shifa of the International Organization for Migration (IOM). He was conducting medical screening tests for refugees before relocating them to various camps when IRIN spoke to him in March.
"A majority of them are malnourished and are also infected with various diarrhoeal diseases. We can also spot some measles cases and other respiratory-related health problems," he said. "Most of the children need food here at the entry points, not after their relocation to other camps," he added.
Yodit Mekasha, a medical expert at Kule refugee camp near the Pagak border entry point echoed this view and said that while 1,500 children have been assisted medically at the camp, it is sometimes too late to do anything. “Some of them reach here when they are already weak and [it is] difficult to treat them. We have seen six children passing away a few weeks ago due to that.”
Temporary health posts have been set up at entry points which has helped reduce the number of people who arrive at camps critically ill. The World Food Programme (WFP) has also set up food rationing centres at entry points to Gambela Region to aid the severely malnourished entering Ethiopia.
"So their condition as they cross over at the first level of registration is improving as a result of that," said Purnima Kashyap, acting country director for WFP Ethiopia.
But, she warned: “The challenge is that the people who are coming in now have been staying amidst the forest or in the interior without any food to eat, and that brings people to the camp in a much more critical condition than the people who came a month and half ago."
"Those who came in January and February were in a much better condition than the ones that are coming in now," she added.
Rainy season only a month away
The start of the rains at the end of April means that camps in South Sudan and across the border in Gambela are likely to face problems.
Gambela is the “least developed region of Ethiopia and lacking most services and infrastructure”, according to an Assessment Capacities Project (ACAPS) briefing note on population displacement in Gambela.
While there are potential new camp locations, “they need to be developed from scratch.”
On the South Sudanese side of the border, the rains will probably lead to greater food shortages and less accessibility. "When the rain starts in May, South Sudan won't be accessible. Even if we tried, it would be very expensive to provide food at that time... even using airdrops," said Ayalew Awoke, deputy director of Ethiopia's Administration for Refugee and Returnee Affairs (ARRA). More people will then be likely to come to Ethiopia, Kenya or Uganda.
"We see malnutrition is going up since there is no food assistance inside South Sudan," he said. “It [food rationing in camps] has become a pull factor as they [camps] are the only place where they can get food."
The war will also affect future food supplies, according to WFP. "The challenge is the rainy season is coming now and if people are not able to plant at this time, then they will not have a harvest," WFP’s Kashyap told IRIN.
Three-quarters of all adults arriving are women, according to the ACAPS report. This, believes Lam Chuol Nynok, an official of Payam town (in South Sudan adjacent to the Ethiopian border), is because the “majority of men… remain inside [South Sudan] to protect their plot of land, and some are also participating in the ongoing fighting."
However, he told IRIN, should they be unable to plant crops, many of these men could flee to neighbouring Ethiopia due to lack of food, not just conflict.
The ACAPS briefing notes that “basic services at entry points and in the refugee camps are overstretched due to the recent population increases.” The report argues that quickly relocating the refugees who are at entry points or transit camps, and increasing camp capacity, is crucial to getting rapid aid to these populations.
"We are pulling out resources from our existing programmes to be able to deal with the situations for South Sudan," said Kashyap. Various UN agencies and the Ethiopian government are currently helping over 500,000 refugees from Somalia, Eritrea and other neighbouring countries.
The UN is appealing for US$102.5 million by way of a response to the needs of the estimated 140,000 South Sudanese refugees who could be arriving in Ethiopia over the next few months.
"We might actually end up having 200,000-250,000 towards the end of the year and even more than that depending on what's happening inside South Sudan,” said UNHCR Country Director for Ethiopia Moses Okello. “Efforts are going on to settle the problem, but it doesn't seem to be working yet.”