Joanna Kotcher Medical Evaluator in Dolo, Ethiopia

Joanna returned to work with Doctors of the World (DOW) in August 2011 as a medical evaluator in Dolo area of Ethiopia.  It is located on the border of Somalia.  Joanna was sent in response to the famine crisis to create a needs assessment plan.

“There are 4 camps in the Dolo area, including a transit (border) camp. When we first arrived in the region I focused on getting a broad public health picture of the situation. For the first days of the assessment, I spent time at the UN base, interviewing the field managers responsible for health, shelter, and nutrition. From there I moved onto the camps. After securing the permits, we held daily meetings with refugee families. I discovered quickly that there were many children and women who had not received any medical care. In the transit camp I started my assessment outside the official border of the camp, it was here that we found thousands of people living rough in the bush with no shelter. Although they were able to get into the camp twice a day, hot meals, the sanitation and water needs were enormous.

The water situation was critical. The problem was that the ground on which the camps have been developed is rock bed that requires special equipment for drilling, there was no alternative land. The agencies responsible for water worked very hard to supply the minimum needed for drinking and sanitation, but it was a difficult task. Many refugee families had less than 8 litres per day to live on. Everyday we met with refugees who had given up trying to get water from the tap stands and simply left their water containers in neat rows until the water might flow again. The most challenging situation is that there were simply not enough services to meet the needs. Everyone was working at their maximum but it was simply not enough.

After several weeks in the camps, we decided that the best use of our resources would be in establishing mobile health services in the larger camps, to try to shorten the distance between health care and those refugees who had scant access to services. We also made the decision to assist the Minister of Health together with the host population who were under great pressure to balance their own needs in the drought, and that of the refugees.

After returning to headquarters we put together a workable plan to put Doctors of the World’s resources where they can really work – in helping both the refugee and host populations. Aid equity is always an issue, but it is always surprising when a host population needs as much help as the refugees that arrive on their borders. My previous medical co-ordination work in Kosovo, Central Asia, and Darfur were almost identical. Whenever there is mass migration or people fleeing war and famine, the health and psycho-social problems are similar. But the worst situation, for me as a medic, is when we cannot get into the areas where the conflict is occurring. This is what happened in Kosovo and Tajikistan (Afghanistan).

I think the future of the famine crisis depends on continued response from the international community and on co-ordination from the ground. It’s always difficult to coordinate so many organisations and activities and this crisis is no different. I hope that we are able to get into Somalia itself as soon as possible to implement programmes for aid there. It is gratifying to know we are helping on the refugee side, but thousands are suffering on the Somalia side. In mass crises such as these, we have to look at options that involve the refugees and host populations too. We can’t work in a vacuum or ethically implement programmes that institutionalize refugee camps so that they become long term communities.”