Thousands of people have shuttled backwards and forwards between the Gedeo and Guji areas of southern Ethiopia over the past 15 months, following an outbreak of ethnic violence in April 2018 and repeated efforts by the authorities to relocate them.
The camps where they were staying have now been closed, but many people are unable to return to their homes, and remain displaced either in host communities or in their areas of origin. The majority are surviving in difficult conditions with little humanitarian assistance, struggling to protect their children from malnutrition and other diseases.
Over the past 15 months, Desalegn, his wife and their five children have lived in a dozen different places. After their own home in West Guji was burnt to the ground, they sought shelter with a neighbour. When the neighbour asked them to leave, they went to stay with Desalegn's in-laws, but it was not long before they had to move on again.
They went to a site for displaced people, then a ruined building, then a school, never staying more than a few days in each. Finally they decided to leave West Guji, in Ethiopia's Oromia region, for Gedeo in the Southern Nations, Nationalities and People´s Region (SNNPR), where Desalegn's ancestral family came from. Once there, they continued to move from place to place, trying to find somewhere suitable to settle.
Massive displacement crisis
Desalegn and his family's long walk took place between April and August 2018, five months in which an outbreak of ethnic violence in southern Ethiopia saw hundreds of thousands of people forced from their homes. At the peak of the crisis, as many as one million people were displaced, according to official figures.
In August last year, Desalegn decided to return home to Kercha woreda (district), where he had previously managed a fruit and vegetable farm, and where the family had had a comfortable life. "We had everything: oranges, limes, avocados, false banana and mangos," says Desalegn. "We also produced a lot of coffee every year and I sold my products in the market."
Desalegn built a shelter in the ruins of his farm, but soon after it was completed it too was burnt down. The family left once again for Gedeo, where they currently live in a small wooden hut rented from a relative in Banko Gotiti kebele (administrative ward or neighbourhood). After a year of almost continuous displacement, they are relieved to have found somewhere to settle for now, though their existence is hand to mouth.
"We pay a rent of 100 Ethiopian Birr (US$3.40) per month for this house," says Desalegn. "We are not getting any [humanitarian] assistance these days. Sometimes I manage to get a job as a day labourer, but what I earn isn't enough to sustain the whole family. We don't have enough food to go around."
Malnutrition in southern Ethiopia
High malnutrition rates
Desalegn's children, aged from one to 11, are all healthy for the moment. But for many others, it is a different story. Malnutrition rates have been high since the crisis began. Between July and December 2018, MSF treated more than 6,000 malnourished children in the frame of a wider emergency intervention.
When our teams arrived again in Gedeo in April 2019 following a huge deterioration of the humanitarian situation, their assessments showed that rates of severe acute malnutrition among children under five and pregnant and lactating women were well above the emergency threshold.
In the early days of this new emergency response, each week at least one child would arrive dead at the health facilities supported by MSF in Gotiti and Gedeb. This year, the severity of patients' conditions has been higher compared to last year. Since April 2019 we have enrolled some 2,340 children in outpatient nutritional programmes and treated 560 children suffering from severe acute malnutrition with complications in stabilisation centres.
In May 2019, Ethiopian authorities demolished the camps for displaced people ahead of a third plan to return them to their areas of origin. While many have indeed returned, the health of both returnees and those who stayed on in Gedeo is still at risk.
MSF teams in Gedeo continue to see large numbers of patients, including some who have come all the way from Guji mainly to treat their malnourished children.
Poor living conditions
"Since the camps were dismantled, there hasn't been a big change in the medical conditions of the patients we see in Gedeo," says MSF medical team leader Caroline Harvey. "We treat mainly diarrhoea and respiratory infections, with some cases of meningitis and a lot of skin diseases - all related to people's poor living conditions."
"Even if they are no longer in camps, those who opted to remain in Gedeo are still living in very poor conditions, whether they have rented shelters, bought land, or are staying in churches or schools or with relatives," Caroline adds.
Although the healthcare that MSF provides is free of charge, visiting a doctor in Ethiopia generally costs money, which deters many parents from taking their malnourished or sick children to health facilities until they are in a critical condition.
In some locations, malnutrition treatment does not go beyond distributing Plumpy'Nut (a highly calorific peanut-based paste), with the result that children are often not referred for specialised treatment in a timely manner.
Limited humanitarian assistance
For some, the events of the past year have brought additional challenges. Simein, a 26-year-old woman from Kercha woreda, not only has to look after her three young children, but also the two children of her sister, who died some months ago. She sits in the waiting room at the hospital in Gedeb, where her two-year-old nephew has been admitted for malnutrition treatment.
"I have all these children with me. I feel worried about how to bring them up as I have no sources of assistance," says Simein. During the crisis, she worked for a while as a community mobiliser and managed to save a little money, but her savings are now depleted. Simein's story is similar to that of Desalegn: one of constantly moving from one place to another over the past 15 months.
"This last time, when the government announced the return plan [in May 2019], we decided to join others and go back too," says Simein. "The authorities in Guji gave us blankets and plastic sheeting, and we started building a temporary shelter on our land. They promised they would provide more assistance - some essential items and food. We built the shelter and waited for further assistance, but it never arrived."
As they waited, Simein and her family received threats and their shelter was destroyed, forcing them to go back on the road. After an absence of just two weeks, the family was back in Gedeo.
Renewed life, new hopes
Not all returnees face the same difficulties. Some have managed to leave behind the ghost of the conflict that uprooted them and restart their lives. This is the case with Bekele, his three wives and 15 children. They sought safety last year in Guji after fleeing inter-communal tensions in Gedeo, but are now back in their home, which had been spared the violence and was still standing.
"After leaving our property, every moment was challenging and we had no comfort, no money," says Bekele. "My children often became sick; they didn't have clothes to wear. We returned here permanently in May . All of my neighbours are back as well."
Bekele is confident that the bad times are over. "Now there is peace and, if the situation continues like this, there shouldn't be renewed violence," he says. "We don't have a problem anymore with the Gedeos and we communicate well with each other. Now I have planted corn again and I am waiting for the new crop to grow."
Bekele and his family are fortunate and look to the future. But for many others, there is still a very long way to go.