Starvation deaths and damage control in Tigray

Reports emerging from Tigray in recent weeks paint a grim picture. After suffering through two years of scorched earth military operations and occupations, involving widespread atrocities and siege warfare, families across the entire region of Tigray are struggling to survive. This should be a time of healing, recovery, and rebuilding. Instead, it’s a time of uncertainty, desperation, and starvation. 

For months, senior leadership at USAID and WFP have publicly ignored Tigray’s well documented descent into mass starvation, which was triggered by their controversial decision to suspend food assistance in March. Today, reports of starvation-related deaths come in from across the entire region, with multiple hotspots discovered in every accessible area of Tigray, including the Northwestern, Central, Eastern, Southeastern, and Southern zones. 

Surprisingly, there does not appear to be any systemic, ongoing tracking of starvation deaths across Tigray. The only rigorous mortality study in Tigray conducted since the aid suspension began, ended in July. In this assessment, Physicians from Tigray’s Health Bureau, the Tigray Health Research Institute, and Mekelle University investigated deaths from around 10% of the region. They determined that more than 1,300 people had died of starvation-related causes since the cessation of hostilities agreement. According to the preliminary findings, the monthly death rate increased sharply following the start of the suspension in March and was highest in the final month of coverage. In the months that followed, Tigray entered their traditional lean season and then experienced significant crop failure in November due to a lack of agricultural supplies and drought.

What is the US Congress being told?

The study was referenced by Representative Brad Sherman in last week’s hearing, “Ethiopia: Promise or Perils, The State of U.S. Policy”, which was held by the US House Foreign Affairs Subcommittee on Africa. This hearing was the first held on Ethiopia under the chairmanship of Republican John James of Colorado, who took the Abiy Ahmed  administration to task for the long and growing list of atrocities and crimes committed under its leadership. Chairman James concluded bluntly, “If I’m being honest, it’s increasingly difficult to see where the promise lies.”

Rep. Sherman is not technically on the subcommittee but was allowed at the end of the hearing to question Special Envoy Mike Hammer and USAID’s Deputy Assistant Administrator, Tyler Beckelman before a largely empty chamber. In response to a question about the impact and the resumption of food assistance, Beckelman tried to reassure the congressman that his agency was still saving lives in Ethiopia, arguing that:

“A lot of focus has been placed on the pause in food aid… Food aid is just one component of the overall suite of humanitarian activities we provide to the people of Ethiopia and things like nutritional feeding for malnourished children and [treatment] children under five continued throughout the period of the pause.” [House Foreign Affairs Hearing, 11/30/23, 1:17]

Beckelman is correct that lifesaving nutrition support is still being provided to children in Ethiopia. In the six months following the suspension of food aid in Tigray at the end of March, the number of children under five years old admitted for severe acute malnutrition (SAM) in Ethiopia declined only slightly. However, for the children of Tigray, which Rep. Sherman specifically mentioned, access to this nutrition aid has almost entirely evaporated.

To put it another way, a US congressman asked about starvation deaths in Tigray and the Deputy Assistant Administrator of USAID’s Africa Bureau responded with a very misleading statement that implied that the safety net for starving babies and toddlers in Tigray had not been pulled out from underneath them at the worst possible time. It is important that USAID defends the decision to suspend aid without making claims that obscure the true extent of the suffering of the Tigrayan people.  

What is Congress not being told?

The chart below illustrates the collapse of the international humanitarian effort to save the lives of Tigrayan children who are starving now after eight months of suspended food aid. It shows how many children under five years old were admitted each month for severe malnutrition in select regions of Ethiopia compared to the level of admissions when the aid suspension started in Tigray. Admission for treatment of SAM is the last line of defense against babies and toddlers starving to death. It is important to note that every month takes Tigray closer to the Agricultural lean season and further from the last time anyone received outside food assistance, resulting in an increased demand for SAM treatment. 

In every other region on this chart, nutritional services are still being provided, except Tigray. For Tigrayan children who have been displaced, treatment for SAM simply does not exist outside of a couple of cities in the Northwestern zone. As of June, an IOM assessment found that there were 140,993 children under five years old displaced in Tigray. According to the mid-upper arm circumference (MUAC) measurements from the most recent SMART+ nutrition survey collected in August, more than 35% of displaced children were suffering from either severe (5.7%) or moderate (30%) acute malnutrition. That means that in the displaced population alone, an estimated 50,000 babies and toddlers are starving, as of August. 

Over the two months following the SMART+ Survey, September and October, only 210 displaced children are reported to have received treatment for SAM according to the Nutrition Cluster’s SAM Management Update. The total number of children admitted with SAM breaks down to 207 in the Northwest Zone and 3 in the capital of Mekelle. None of the 31,000 babies in the Central zone, none of the 16,000 babies in the Eastern zone, none of the 11,000 babies in the Southern and Southeastern zones had access to treatment for SAM. The only kind of care available to displaced children was out-patient treatment, no displaced child received special (in-patient) care for SAM.

For comparison, in the two months prior to the food aid suspension (February and March) nearly 1,300 displaced children received treatment for severe malnutrition. Access to care for displaced children under five years old has fallen 84% as the aid suspension has dragged on. 

The reverse should have happened. If USAID and WFP were not prepared to surge nutrition assistance to meet an increased need, then pausing food aid should not have ever been considered. Not after two years of weaponized starvation. Not with the lean season approaching. Not with so many innocent lives hanging in the balance.

Damage Control or Controlling Damage

When people talk about “damage control,” the damage they are referring to is reputational. It is something that celebrities or corporations do when faced with a scandal. It’s never courageous, but often accepted. It can never be an acceptable practice for humanitarian organizations or governments when the people who they are meant to serve are dying for lack of the goods and services that they are meant to provide. Aid agencies and governments must take measures to control the damage caused to the people who are relying on them to survive.

The impact of the humanitarian suspension was entirely predictable. It should have been prevented, but it’s too late for that now. What Tigray needs now is for aid agencies and officials to get out of damage control and start controlling the damage that they have caused. Donors have become too willing to accept that major aid agencies operating in Tigray expend more effort in the former than the latter. 

The people of Tigray need donors to demand that aid agencies provide accurate data about conditions on the ground; adopt transparency about plans, decisions, and operations; and distribute assistance to people in need. Anything less than that constitutes a grave distortion of fundamental humanitarian principles which creates the conditions for a repeat of the total meltdown that we are witnessing right now in Tigray.