Gambella, Ethiopia - “My only joy is my child, I don’t have anything else in life,” says Nyabel Jock, a 19-year-old South Sudanese refugee, during her regular pregnancy check-up at the Jewi Health Centre, Jewi Refugee Camp, Gambella, Ethiopia. 

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 displacing 1.5 million people. She arrived at the camp with nothing but the clothes on her back. 

“I left home under very difficult circumstances and things at the camp have not been rosy either. As a refugee it is hard to get a job. You have to depend on donors for everything, including putting food on the table or your personal hygiene needs,”  she says.

Today, the Jewi Refugee Camp hosts 61,971 of the 349,542[1] refugees scattered across eight sites and settlements in Gambella. Over the last year, 11,000 South Sudanese refugees have newly-arrived in the region, 55 percent are women and girls.  

With no long-term solution in sight, and recently-announced cuts to food rations, the plight of refugees is  worsening by the day. Nyabel is weary; it is not safe for her to return home and without an income she is struggling to live on her food ration. She feels caught between a rock and a hard place.

Women bearing the brunt of Gambella’s forgotten crisis

Gambella’s health and social systems are creaking under ever-increasing needs - the region hosts the largest number of refugees in the country, equal in number to the host population.  In Jewi Refugee camp the only health centre serves more than 60,000 refugees, significantly lower than the recommended national standard of three. 

“Women with a pregnancy complication often walk over 6 kms to reach services and when they do, the consequences can be fatal,” says Bezabih Fentahun, Health Coordinator at the Agency for Refugees and Returnees Affairs (ARRA). 

A lack of infrastructure, skilled personnel and referral mechanisms for emergency obstetric care are adversely impacting the delivery of maternal and newborn health services. Asnake Getachew, a midwife on the maternity ward at Jewi Refugee Camp, says maternal and newborn deaths are all too common. She has witnessed three women and two newborns die this year. “They were in need of a blood transfusion and the ambulance was not available,” she explains.

Afework Solomon, a midwife working alongside Asnake, says that there are on average five to six deliveries per day, but the ward only has six midwives and one ambulance donated by UNFPA, the UN sexual and reproductive health agency.  “We don’t do surgery here so If we have two cases needing referrals at the same time, one will have to wait,”  she adds.

Increasing maternal and reproductive health services 

In 2021, UNFPA has distributed Emergency Reproductive Health Kits to health facilities in Gambella. The kits, which include medical equipment, supplies, medicines and solar panels, support the provision of sexual and reproductive health services, including maternal and newborn health care, to 104,894 refugees and host communities. Health staff, including midwives, have also attended training to build their capacity to deliver quality care, including managing pregnancy-related complications. UNFPA has also donated an ambulance to support emergency referrals. 

“The ultrasound from UNFPA and the medical supplies have allowed us to identify many complications on time and save many women’s lives,” says Asnake. 

To support survivors of violence, and women and girls at risk, a One-Stop Centre, providing comprehensive health and psychosocial care and a toll-free hotline have also been established in Gambella, while Women and Girls’ Friendly Spaces are being used as hubs to build women and girls’ agency to protect their right to live free from violence.

Day by day, however, new refugees arrive amid increasing food insecurity as drought grips the region, and much more needs to be done to uphold the rights of women and girls, including their right to a safe and dignified birth and to live free from violence.

The UNFPA Humanitarian Response appeal of nearly $14 million will strengthen the health systems capacity to delivery sexual and reproductive health services, including gender-based violence and response, in Gambella and a further sevenregions affected by multiple crises in Ethiopia through the end of 2022. To date, only 24 percent of this appeal has been funded.

Despite her dire situation, Nyabel holds on to hope: “I trust to be able to come back to my country with my son one day, reunite with my family and start over a new life”.