Nutrition support for Tigrayan children cut for third straight month

Each week takes Tigray deeper into their agricultural lean season and into the suspension of food aid by the WFP and USAID. Every family in Tigray survived a genocide and they are once again being systematically starved in their homes. Since March 2023, food distribution has been stopped and since then there have been no publicly released assessments of conditions being faced by Tigrayan families or operational updates on progress made to restore aid.

After food aid was paused in Tigray, WFP and USAID both informed policymakers and donors that nutritional support for children would not be affected by the suspension. This program is a critical last line of defense against childhood starvation that has never been more urgently needed in Tigray than it is today. However, while the food suspension continues to drive childhood malnutrition in its fourth month, the number of Tigrayan children being treated for severe acute malnutrition (SAM) has continued to decline, and children who are already starving continue to die.

(All data used for the charts in this article provided by the Ethiopia Nutrition Cluster Dashboard)

Failure to meet the increased need for this treatment is measured in child mortality, stunted growth and development, and lifetimes of health problems. The impact is being felt across Tigray right now, where children in the cities, displacement hosting sites, and rural communities are starving to death. There is an open supply route into Tigray for food and nutrition aid, but it remains largely dormant while international aid organizations struggle to restart aid.

Conditions in Adwa

According to a recent food assessment in the Adwa woreda, three of every 10 children under two years old are experiencing severe acute malnutrition. As an aid worker in Adwa town told TGHAT recently, people are not dying in medical facilities right now because  no treatment is available to the thousands of children in need. This claim is supported by data from the nutrition cluster. According to the SAM management dashboard, only 547 children under five years old have been admitted for SAM in the four months since the food aid suspension and only 73 of them into special (in-patient) care in Adwa and the surrounding district. 

For context, the combined pre-war and newly displaced population of this area can be estimated at around 400,000 people and the number of children admitted for SAM treatment for the month prior to the suspension was 1,856. Now, with food aid cut to the entire region, fewer than a third of that number are receiving treatment for SAM. 

Months of neglect

The children of Adwa are certainly and sadly not starving alone. In a gripping account for the Addis Standard, journalist Mihret Gebrekritos brought to light the story of a displaced mother in Abi Addi town who gave birth to triplets only to lose two of them to malnutrition. This is sadly only the most recent report of starvation deaths in Abi Addi, where the international humanitarian response has almost entirely collapsed. According to the nutrition cluster, only 27 children were admitted for SAM in the past two months in Abi Addi, an alarmingly low number of an estimated 54,000 displaced Tigrayans being hosted in the area. The most recently released IOM-DTM site assessment reported that there were 6,677 children under five years old living in twelve displacement camps in Abi Addi. The child malnutrition rate from the WFP’s February Emergency Food Assessment would suggest that nearly 2,000 displaced children in Abi Addi required treatment for malnutrition, of whom UN partners were only able to reach about 1%.  

The response is even weaker still in Endabaguna, where at least 36,000 people were displaced in March by ethnic cleansing in camps at the hands of Eritrean soldiers and Fano militias along the Amhara border. A multi-sectoral assessment was performed in April (covered here) which found that there were at least 20,000 displaced children in Endabaguna and they were suffering from acute malnutrition at a rate that exceeded the threshold for famine (30% GAM). The assessment mentioned delivering and distributing nutritional supplies, which can be observed in the data on the chart below. Also apparent in the chart are the next three months of complete neglect which followed. The UN-OCHA-led team assessed the situation in Endabaguna, counted, screened, and found the people there to be starving and in desperate need of better living conditions, medical access, access to clean water and sanitation. UN-OCHA never published the assessment and never delivered the humanitarian aid that the people in Endabaguna needed to survive. They are out of supplies in Endabaguna. In the past two months, medical centers could only admit 10 children into care for SAM. 

Also, in Samre and Seharti, where some of the earliest reports of starvation deaths emerged after the suspension, the number of admissions for SAM has also dropped significantly in the past two months. According to another UN-OCHA-led assessment of food insecurity in the Southeastern Zone from April, none of the people in Seharti or Samre who desperately needed food assistance had received it so far this year. The assessment teams also reported starvation-related deaths in both districts and malnutrition rates among children were found to be much higher in April than two months earlier in the WFP’s February assessment. Again, like in Endabaguna, UN-OCHA never published the assessment of the Southeastern Zone, and the people being assessed were not provided with life-saving aid. While the number of children being admitted for SAM in Seharti and Samre is much higher in these woredas than in Endabaguna or Adi Abi, the population is also about doubled. 

The systems set up to keep malnourished children alive are failing all over Tigray when they are most needed. The lack of response from WFP and USAID to this new lethal development suggests that these agencies do not have a very good handle on the situation. The controversial decision to halt food assistance and the failure to restart within a reasonable timeframe is having life-or-death consequences in Tigray, yet the decision-makers appear to be immune from scrutiny or pressure.  

Silence and Inaction

The WFP and USAID have not announced that nutrition aid has been cut, nor have they made any public appeal for additional funding or support for the program. But most importantly, they do not appear to have registered the need to accelerate the resumption of service. Last week, WFP began a trial program to test new “enhanced control measures” in food distribution, but as reported by AP, this was limited in scope and only used food provided by an alternate donor. As Tigray’s humanitarian commissioner noted, the program was not humanitarian in the traditional sense as it offered food in exchange for work performed.

Once nutrition assistance was cut, the level of risk of child mortality resulting from the food aid suspension would have increased dramatically. At that moment, the reasons for continuing to freeze food assistance should have been reevaluated against the potential impact of this new development. During this reevaluation “do no harm” should be understood to protect starving children rather than donors. The bottom line is that the plan that WFP and USAID had in mind for Tigray when children were still able to receive treatment for SAM should have changed when the capacity to provide this treatment in Tigray was lost. 

There is no indication that WFP or USAID reconsidered the aid suspension or that policymakers were informed that children would no longer receive nutrition support. If either organization was still communicating to Congress or donor states that the nutrition program in Tigray was still active after it had largely collapsed, it would represent a serious omission. But due to the complete lack of transparency in this process, it is not even clear that critical information is reaching those responsible for oversight and decision-making. 

There has been a glaring and inexplicable lack of transparency, accountability, and urgency from the senior officials who hold so many innocent lives in their hands. A course correction in Tigray would have to start with transparency to introduce at least a threat of accountability which, in turn, is the only thing that will create urgency at the highest levels. As has been the case for most of the past three years, the price of silence and inaction is being exclusively paid by the most vulnerable in Tigray. It is important that those who are making decisions feel that at least their reputation or credibility is at stake. Senior leadership at WFP and USAID cannot fix the humanitarian response in Ethiopia without breaking their own code of silence and culture of impunity. 

At present, the only urgency lies with medical workers, humanitarians, and parents of starving children in Tigray, who are all cut off from supplies. There is urgency on the local level, because accountability is undeniably present in the faces of every child who suffers the slow torture of starvation and their parents. Senior leadership at USAID and WFP must not be allowed to quarantine themselves, policymakers, or the general public from the urgency of Tigray.