MSF-France Assessment of Senafe Sub Zoba, Zoba Debub, State of ...

MSF-France Assessment of Senafe Sub Zoba, Zoba Debub,
State of Eritrea
1. General Information
MSF-France started a Humanitarian Assistance program in Senafe Sub Zoba on the 27/2/2001.
With the support of the Ministry of Health (MOH) and the United Nations Mission for Ethiopia
and Eritrea (UNMEE), MSF-F was given a special access to this area prior to the formal
establishment of the Temporary Security Zone (TSZ).
The main objective of this rapid assessment is to have a small but reliable picture of the current
situation in Senafe Sub Zoba. This picture is of course influencing the nature of our operations in
the area but it will also be, we hope, a useful first-hand tool for the MOH and the other
international organization. Two separate assessments took place between the 14/03 and the 21/3.
A three-day assessment in Senafe Town where the first team visited randomly 37 households and
a three-day assessment of 7 villages and 1 IDP camp outside Senafe Town.
According to the population figures that we were able to get from the zone/ villages
representatives and from the food distribution lists, there is currently a population of
approximately 39 500 in Senafe Sub Zoba (80 000 prior to the last offensive). In addition to
MSF-F, there is only ICRC which is currently operational in the Sub Zoba (food distribution,
water & sanitation, support to health posts). Apart from the dispensary in Senafe Town, there is
only one other health post currently operational in the area (Rokoyto village). During Ethiopian
occupation, some volunteers were serving the populations (giving drugs, dressing, polio
immunization) in four locations (Senafe Town, Metera, Rokoyto, Tsaeda Korso & Zigfet). Prior
to the offensive of the 12/5/2000, 6 health posts were operational in the Sub Zoba; Senafe Town
(Caritas), Forto, Serha, Menekuseyto, Rokoyto and Golo. A 45 beds hospital was also
operational in Senafe Town. This hospital needs to be reconstruct completely since it was
destroyed by Ethiopian forces.
2. Senafe Town
The town of Senafe lies in a quite fertile valley and there is usually enough water for two crops
per year (maze, wheat, pulses and legumes). Prior to the war the town itself had been a booming
border town with a population of approximately 17,000. All the administrative buildings were
destroyed but most of the private houses were only looted (including doors, windows, etc.).
There is currently one water station which is functional (rehabilitated by the ICRC) and providing
enough water for the current population. The ICRC is planning to rehabilitate the second water
station in the coming weeks to assure sufficient quantities of safe & potable water for the whole
population of the town after the return of the displaced. The electricity was cut-down. The social
life in town is slowly but surely increasing in town every week. The market place is busy on
Wednesdays and Saturdays. Some shops are also open.
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3. Senafe Town/ Demographic Information
Senafe is divided into six zones, but includes in its administration three neighboring villages.
The reported current total population and number of households per zone, as well as number of
births and deaths over the last nine months are as follows:
Zone Total # Families # births Total # War related Under 5
Population
deaths deaths deaths
Zone 1 545 135 3 11 3 2
Zone 2 1294 283 2 9 1 3
Zone 3 1072 237 2 5 3 2
Zone 4 1278 276 1 4 0 0
Zone 5 1372 306 3 3 1 1
Zone 6 904 180 4 5 2 1
Zone 7 672 159 3 9 2 1
Matera 920 189 11 6 0 0
Tisha 332 65 0 20 17 2
Afoma 320 105 7 8 7 1
TOTAL 8709 1935 36 80 36 18
These population figures were provided by the zone representatives and are based on lists
prepared for the food distribution. Births and deaths are based solely on recollection because
there were no records kept after the administration left. Based on these grossly under-reported
figures, the Crude Mortality Rate (CMR) for the last 9 months would be approximately of 0.5 per
day per 10,000 population (according to WHO standards, a CMR above 1 death per day per
10 000 people indicates an emergency situation). 45% of the deaths were war-related (mostly
from Tisha residents who were caught in the crossfire because the town was located between the
two army positions), and 22% were deaths of children under 5 years of age.
4. Senafe Town/ Population Structure
A household sample survey of 37 households was done. Houses were randomly chosen, with an
average of 3-4 households per zone visited. The population breakdown by age and gender:
Adult males: 9.3%
Adult females: 25.5%
Children over 5 years of age: 50.6%
Children under 5 years of age: 19.6%
Elderly living alone 4% (8% of the households)
Most of the male and approximately half of the female population were over 50 years of age.
Most of the families live in their own house, with a minority living in rented homes, or in homes
which had been evacuated nine months ago by relatives. Houses are generally made of stone with
tin roofs and are equipped with a wood or kerosene stove, kitchen utensils and beds.
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5. Senafe Town/ Food Supply at Household Level
Even though the household food supply was occasionally under-reported, all the households were
found to have some food:
99% had wheat (an average of 4kg/person)
99.5% had oil (an average of 0.4 liters/person)
43% had sugar
The survey took place approximately three weeks after the ICRC food distribution and four
weeks after the ICRC wheat distribution. According to ICRC, their food distribution was
intended as a supplement to what the population had as a baseline and included 10.7kg of wheat,
1 liter of oil, 2 kg of pulse, 1 kg of sugar, 10.5 kg of tea, 0.25 kg of salt per person per month, and
soap. Food was distributed per family.
In zones 1-7 and in Tisha, none of the families visited owned any animals. However the
neighboring villages of Afoma and Matera have land for agriculture and animal rearing, and more
than 50% of the population in these two villages own oxen, goats, sheep and/or donkeys. Afoma
has four wells, but the water pumps were removed by the soldiers, and therefore now depend on
rain for their crops.
6. Senafe Town/ Health and Nutrition
The nutritional status of children under 5 years of age was assessed during the household survey.
Of the 40 children reported in the 37 families visited, 28 had a green MUAC (normal), and 5 had
a yellow MUAC but wt/ht over 80% (normal). Of the 7 children not checked, 4 were absent, and
3 were

weekly activity reports. During the last nine months, the

In terms of water and sanitation, the population is going directly to the river to fetch water. There is
a spring down in the country side. The water points in town were destroyed. There is clearly
problems in terms of sanitation/ hygiene among the population, particularly when you look at the
condition of the children. During Ethiopian occupation, the population got 4 food rations and since
Ethiopians withdraw, they are receiving the monthly food ration from the ICRC in Tsaeda Korso
(one time already). The school was also destroyed.
10. Tsaeda Korso Village
There is currently approx. 450 people living in this village which is located few kilometers north
of Serha village on the main road between Senafe Town and Zalambesa. The population
configuration is quite the same as in Serha. This village is intact except for the 5 water pumps
which were destroyed. The population is currently going to Serha to fetch water from the river.
The ICRC monthly food distribution for 68 villages is currently done in this village (one time
already). Like for Serha, the population reported 4 food distributions during Ethiopian
occupation. The school is close. Prior to the last offensive, the population was going to Forto
health post (managed by the MOH).
During Ethiopian occupation, a health post was functioning and supported by the ICRC in this
location. The building which was used at that time is still intact. Consultation room, dressing
room and pharmacy were operational. Emergency cases were transferred to Adi Grat. This
health post closed when the Ethiopian forces withdraw from the area (19/02/2001) and now, the
population is coming to Senafe Town for health services. Polio vaccination was also done during
Ethiopian occupation. Three people over 50 years of age died in the past ten months in the area
(chronicle disease cases). But the nutritional & health status of this population seems stable and
no specific morbidity pattern was reported to us. The main issue now is access to health services
(like for Serha village) since the population have to walk to Senafe Town to get medical care
(more then two hours of walk). Here also, problems seems to be more related to the water &
sanitation situation (access to safe & potable water, hygiene conditions).
11. Forto Village
This village is located few kilometers north of Tsaeda Korso village on the main road between
Senafe Town and Zalambessa. The distance between Forto and Tsaeda Korso is of approx.
10 kilometers. The population of the village and surroundings if of approx. 500 people. An
MOH health post was operational in this village prior to the last offensive. The structure needs
rehabilitation work (roof, windows, doors) but the structure is intact. Same situation for the
school, which is close. Private houses are also intact.
The humanitarian picture (food, health, nutrition, sanitation/ hygiene) is the same as the one
described for Tsaeda Korso village. In terms of access to safe & potable water, the population is
fetching water from a well in the village, but this well needs rehabilitation work as soon as
possible since it is open & not protected (animals are going there, the distribution area is very
dirty, etc.). A

12. Rokoyto Village
The humanitarian situation in this village is the most positive one that we were able to see outside
of Senafe Town. A health post serving 40 surrounding villages is operational with one health
assistant (between 10 and 30 consultations per day), a water distribution point was rehabilitated
by the ICRC and is providing sufficient water to the whole population of the agglomeration and
for the animals. The private houses are intact and good number of goats & cattle were seen in the
area. People are also cultivating. This village is at approximately 45 minutes of drive west from
Forto village. The current population of the village is of approx. 600 people and 3000 people
were living here prior to the last offensive. For the food distribution situation, the same pattern as
described above during Ethiopian occupation and since the withdrawal. But the population is
complaining that the ICRC food distribution is not enough (no milk, no DMK). The school was
looted but the structure is intact.
The morbidity patterns are the one for a normal health post (malaria, pneumonia, eye disease,
anemia, respiratory infection, diarrhea, gastritis, abdominal pain, etc.). No specific morbidity
patterns that we can link with a potential epidemic. Again here, polio vaccination was done
during Ethiopian occupation. During Ethiopian occupation, 3 deaths were reported by the health
assistant; 2 tuberculosis cases and 1 malaria case (all >50 years old). There is no sign of
malnutrition among the

ack in the Sub Zoba, a quick decision will have to be taken about this caseload. If the village of
origin is falling inside the TSZ, the best option is a fast return there. If it is not falling inside the
TSZ, the best option is to resettle this displaced population to a less remote area near Senafe
Town where they will have easier access to health services, humanitarian assistance, etc.
14. Menekuseyto Village
This village is located at the extreme south of the Sub Zoba, very close to the southern boundary
of the TSZ, at approximately 25 kilometers from Senafe Town. The current population is of
approx. 300 people and prior to the last offensive, 800 people were living here. It is the only
village where we were not able to find any counterpart. The population is still living in fear and
we can presume, according to some individual interviews, that there is still an Ethiopian presence
in the area (or so called Eritrean opposition). The population is cultivating and there is a good
number of cattle/ goats in the area.
The population is mostly a mix of children, women and elderly people. The health post is intact
but closed one year ago. Small scale rehabilitation work needs to be done, mostly for the water
supply (windows, doors, roof and even material inside the structure were not looted). During
Ethiopian occupation, a priest was giving basic drugs to the population which had otherwise
access to the health post of Zigfet (operational during Ethiopian occupation). The 50 years old TB cases and 2

the population is quite the same as what was seen in the other villages that we visited. Diarrhea
cases are most probably linked to the problem of access to safe & potable water. A well located
in the town was destroyed, so now the population is going directly to the river to fetch water.
17. Conclusions
The general health and nutritional status of the population in Senafe Sub Zoba remained stable
during the last nine months. The mortality patterns reflect the direct effect of war more than a
change in morbidity patterns. The current health needs are those typical of the age groups
remaining behind, and the psychological consequences of war. One of the main problem is about
easy access to health services since there is currently only one health posts operational for the
whole Sub Zoba outside of Senafe Town. The second one is about access to safe and potable
water and sanitation.
The current fragile but stable situation in terms of health & nutritional status of the population
can potentially be disturb by the return of the displaced populations. Population figures will
double and the pressure in terms of access to water, food and health services can potentially be
problematic if no rapid humanitarian response is organize prior to the return from the camps.
An additional information is about the health post of Golo village (approximately 20 kilometers
north of Senafe Town, few kilometers north of the TSZ), which was operated by the MOH prior
to the last offensive. This health post was closed when the MOH withdraw in May 2000. The
structure was looted but intact with a need for rehabilitation work (doors, windows, roof). The
population of that area (approx. 750 people in Golo village and ten surrounding villages) is
currently coming to Senafe Town for health services.
There will be a need for Measles vaccine campaign, as this was not done along with Polio. To
make it easier, MSF-F will do the campaign before the IDP’s return to Senafe.
The nutritional status has remained stable, and so far there seems to be no indication for
development of targeted supplementary feeding programs in the town of Senafe.
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