Ethiopia Attains Maternal and Neonatal Tetanus Elimination

Addis Ababa, 30 June 2017: “Maternal and Neonatal Tetanus Elimination in Ethiopia is hereby validated!” That was the conclusion of the joint mission from UNICEF and WHO today at its debriefing sessions with: the Ethiopian Ministry of Health; the WHO Representative to Ethiopia; and the UNICEF Representative to Ethiopia. The Federal Democratic Republic of Ethiopia has thus become 42nd country in the world to have validated the elimination of Maternal and Neonatal tetanus.

Ethiopia began accelerated Maternal and Neonatal Tetanus Elimination (MNTE) efforts in 1999. In 2011, all the regions in the country except the Somali Region were validated for MNTE. The 2011 validation mission made recommendations that would see the Somali Region progress to MNTE over time. The recommendations were implemented especially corrective vaccination campaigns against tetanus in 2016. The administrative, as well as post-campaign survey data, revealed more than 85% coverage in each of the 9 zones of Ethiopia Somali Region. The Joint validation mission reviewed these and other related data during the period, 28-30 June 2017, and concluded that maternal and neonatal tetanus elimination had been achieved in the Somali Region and, by extension, in the whole of Ethiopia.

Receiving the good news of the validation of MNTE in Ethiopia, the State Minister of Health, His Excellency Dr. Kebede Worku exclaimed that “The country had worked hard on improving Maternal and Child Health services delivery with tangible results including the record attainment of MDG 4 three years ahead of the target year of 2015. Along with this, MNTE was given emphasis and hence between 1999 and 2009, over 15 million women of reproductive age (WRA) in 59 high-risk zones were immunized during three rounds of Tetanus Toxoid (TT) Supplementary Immunization Activities (SIA). Thus in April 2011, the validation survey concluded that the whole country except Somali region had been validated for MNTE, and now the whole country including Somali region has achieved MNT elimination. This was possible through the efforts and investments made to improve maternal and child health care. The ministry of health will continue to sustain this gain by integrating maternal and child health care services with other public health priorities”.

WHO Representative, Dr. Akpaka A. Kalu, congratulated the country and said that “WHO is grateful for this remarkable result. He added that WHO will continue to support the Ministry to sustain this achievement by prioritizing risk areas for public health interventions that need more support and interventions through specifically targeted strategies with active community involvement to achieve the desired results.” Dr. Kalu also revealed that the integration of vaccine preventable disease with other health programs will be also incorporated in the WHO response strategy.

“I would like to extend my warm congratulations to the Ministry of Health and its partners for this excellent achievement, which benefits the health of women and children,” said Ms. Shalini Bahuguna, Officer in Charge of UNICEF Representative to Ethiopia. “UNICEF will continue to support the government of Ethiopia to sustain this achievement and deliver results for every child” she added.

Zones were selected following an in-depth review of the risk factors for maternal and neonatal tetanus (MNT) using the high-risk approach. Clean delivery and cord care practices, reaching all women of reproductive age in high-risk districts through TT SIAs and immunization of pregnant women during routine immunization and conducting neonatal surveillance as it is a hidden disease, are some of the interventions that helped to achieve this remarkable result.

It is acknowledged that the validation of MNTE in Ethiopia is not an end in itself but the beginning of a new phase of interventions focused on sustaining the attainment of Maternal and Neonatal Tetanus elimination status, an endeavour that is possible only through: maintaining tetanus protection level at above 80 percent in every zone especially in the zones that achieved elimination through Supplementary Immunization Activities (SIAs); strengthening partnerships for improving Maternal, Newborn and Child Health (MNCH) activities; and  implementing the sustainability plan of action-2014 which incorporates a  switch from Tetanus Toxoid (TT) to Tetanus-diphtheria (Td) vaccine, and annual joint review of national MNT risk status  to guide the interventions.



The Government of Japan gives US$ 2 million to UNICEF for drought affected populations in Somali Region

06 April 2017, ADDIS ABABA – The Government of Japan announced a US$2 million grant to UNICEF to assist water supply, sanitation and hygiene (WASH), nutrition and prevention of acute watery diarrhoea in drought affected populations in the Somali region. The WASH sector will be taking the lion’s share with US$1,500,000 and the rest US$500,000 will be utilized by nutrition programme within an implementation period of six months. This assistance is provided as a swift response to the joint call for support by Deputy Prime Minister Mr Demeke Mekonnen and United Nations Secretary-General Mr Antonio Guterres at UNECA on 29 January 2017 on the occasion of the High Level Forum on the humanitarian situation in Ethiopia.

The funding from the Japan Government aims to improve access to safe and reliable water to 115,000 women, men, boys and girls through drilling of new boreholes, rehabilitating non-functional water points and providing non-food items for distribution. In addition, 9,000 children with severe acute malnutrition will receive adequate treatment and 31,488 mothers and caregivers will be trained on adequate infant and young child feeding practices during emergency. The funding will also help prevent and control water-borne diseases, particularly the transmission of acute watery diarrhoea among affected and at-risk populations by securing access to safe water.

Ambassador of Japan to Ethiopia, Mr Shinichi Saida said, “We sincerely hope that Japan’s urgent humanitarian assistance for the drought response will reach the most vulnerable people as swiftly as possible and have a quick impact on the affected communities. Japan appreciates the WASH sector emergency response and its delivery promoted by Ministry of Water, Irrigation and Electricity in Ethiopia and UNICEF Ethiopia.”

“Children are extremely vulnerable in emergencies, often living in unhealthy and unsafe conditions and at high risk of contracting diseases,” said Ms Gillian Mellsop, UNICEF Representative to Ethiopia. “This contribution is a tangible demonstration of Japan’s commitment to safeguard children’s future and enhance resilience building of communities affected by the recurrent drought.”

Bundesminister Dr. Gerd Müller visits Waaf Dhuug Temporary Settlement Site in Somali Region of Ethiopia
A child rests comfortably on his mother’s arms in Waaf Dhuug Temporary Resettlement Site ©UNICEF Ethiopia/2017/Sewunet

Adding to an already dire situation, during the second half of 2016, a strong negative impact of Indian Ocean Dipole (IOD) led to below-average rainfall in different parts of Ethiopia including the Somali region. As a result, the water level declined significantly with seasonal rivers, springs and ponds drying up earlier than normal and increasing frequency of non-functionality of water supply schemes due to over utilization.

UNICEF is currently involved in operations across all the drought affected regions and contributes to the ongoing drought response effort through water trucking, rehabilitation of non-functional water supply schemes, building water storage capacity at critical and good yielding boreholes, provision of therapeutic food supplies, screening of children and pregnant and lactating women for malnutrition and monitoring for the provision of quality nutrition services.

UNICEF’s drought response activities are guided by its Core Commitments for Children in Humanitarian Action, which prioritize timely response in key lifesaving sectors, namely nutrition, health, water, sanitation, and hygiene.

Reclaiming Young Lives in the El-Nino Affected South

By Bethlehem Kiros

SHEBEDINO WOREDA, SOUTHERN NATIONS, NATIONALITIES AND PEOPLE’S REGION (SNNPR), November 2016 – Looking drowsy and barely active for a two-and-a-half –year-old, Maritu Sultan is sitting on a hospital bed next to her father, Sultan Lentata. Two days ago she was admitted to the Shebedino Hospital Stabilization Centre (SC) due to oedema caused by severe acute malnutrition (SAM). Sultan rushed his daughter to the health post in his kebele (sub-district) when her feet and facial swelling and vomiting became worse. The health extension workers (HEWs) at the health post referred his daughter to the hospital as she needed immediate attention. Maritu had received treatment for SAM in the Outpatient Therapeutic Feeding Programme (OTP) at the health post in the past and recovered well, however she relapsed after a few months. Sultan admits he knows the reason for it,

“The HEWs instructed us on how to feed her after she was discharged but we did not have the means to give her what she needed,” he says.  Referring to himself as a poor farmer, he says the recent drought brought calamity on his household. “To begin with, I do not have much land and the corn I planted was destroyed by the flood and hail that came after the drought. So there was not much to eat at home,” he elaborates.

Two and a half years old Maritu Sultan is admitted at the stabilization center in Shebedino hospital to receive treatment for sever acute malnutrition and Edema.
Maritu Sultan, two-and-a-half-years-old, and her father Sultan Lentata in Shebedino Hospital Stabilization Centre for severely malnourished children. Sultan says his daughter became ill due to shortage of food. “The drought decreased our yield and flood and hail destroyed what I planted so there wasn’t enough food for the children at home.” ©UNICEF Ethiopia/2016/Meklit Mersha

The SNNPR is among the six regions in Ethiopia that have been particularly affected by the recent El Niño-caused drought and flooding, with 71 out of 137 woredas (districts) in the region classified as priority one woredas, requiring urgent humanitarian response. Consequently, UNICEF Ethiopia has continued its support to the Government of Ethiopia for the strengthening of Community-Based Management of Acute Malnutrition (CMAM), a programme that offers a package of services to tackle malnutrition.

Through the provision of ready-to-use therapeutic food (RUTF) at health posts and therapeutic milks and essential drugs at the SCs, a high number of SAM cases are being treated in the region.

Shebedino hospital, where Maritu is being treated, is among the 286 health centres and hospitals that have SCs for in-patient care in the region. According to Zerihun Asres, a stabilization nurse in the hospital, the number of SAM cases referred to them is declining, as the majority of cases are treated as outpatient at health centres and health posts.

Though it has only been a couple of days, Sultan is pleased with the progress his daughter is showing. “She can now take the milk they give her without throwing up,” he says. “I do not want any of my children to go through this again. Once she is discharged from here, I have to do my best to provide for her so that she can grow healthy.”

Tigist Angata is another parent grateful for the SAM treatment her firstborn son, Wondimu Wotei received. “I had almost given up because he was very small and I did not have enough milk to nurse him,” she recounts.  At six months old, the HEWs in Telemo Kentise health post found in her kebele referred him to the SC in Shebedino hospital. He was only 3.5 kg at the time, approximately the size of a healthy newborn. Upon his return from the SC, he ate RUTF for a month and was discharged when he reached 4.4 kg. “He ate so well, which made me realize how much my son was deprived of food,” says Tigist. She adds that she is trying her best to prepare food for him at home, based on the lesson she received from the HEWs. However, eight-month-old Wondimu has not gained any weight since he was discharged from OTP. Her family’s livelihood is based on what her husband earns working on other farms. Due to the drought, he has not been able to work much since last year, which has caused a serious food shortage in their home.

Tigist Anagata with her first born, 7-months-old Wondimu Wotei.
Tigist Angata with her firstborn, eight-month-old Wondimu Wotei, who was treated for SAM at the Telemo health centre Stabilization Centre as an in-patient and later at the Telemo health post as an outpatient. He was discharged from treatment after he gained one kg. UNICEF Ethiopia/2016/Meklit

Though poverty seems to have a firm hold in her home, Tigist feels like the situation is better than what it used to be when her son was sick. “I was very distressed at the time because I was sick and he did not seem like he had much hope. But the therapeutic milk and food have brought him back to life and I am very happy and thankful for that,” she says. Her hope is for Wondimu to grow strong, become educated and find a better life than her and her husband’s.

Through the contribution of many donors, including the European Commission’s humanitarian aid department (ECHO), UNICEF supported the Government in treating 272,165 SAM cases across the country from January to October 2016. Of those treated, 21,671 children were admitted for treatment in SCs while 250,494 received SAM treatment in the OTP. In SNNPR alone, CMAM services are available in all 106 woredas.

UNICEF commits to speed up its efforts to end the violent practice of Female Genital Mutilation/Cutting (FGM/C) 

Addis Ababa, 06 February 2017 As the world observes International Day of Zero Tolerance on Female Genital Mutilation/Cutting (FGM/C), UNICEF Ethiopia commits to accelerate its efforts to end the violent practice of FGM/C through strengthened partnerships with key actors in support of the national theme, “Let us keep our promise and fulfil our commitment by ending FGM/C.”

“FGM/C is a harmful practice inflicted on girls which deprives them of their rights to sexual and reproductive health, endangers their health by causing complications during delivery and even untimely death,” said Gillian Mellsop, UNICEF Representative to Ethiopia. “In order to fast-track the elimination of the practice once and for all, we need to work at grass roots level, at scale and hand in hand with communities – boys and girls, women and men, and most importantly, traditional and religious leaders who are influential communicators with the potential to reach the hearts and minds of millions of people. We also believe that it is equally important to address health and psychological complications caused by FGM/C- by providing the necessary health services for survivors to help them lead a healthy life.” 

According to the 2016 Ethiopian Demographic Health Survey (EDHS), FGM/C among the age group of 15-49 is most prevalent among the ethnic groups of Afar and Somali regions (98 per cent and 99 percent, respectively), followed by Welaita and Hadiya (92 per cent for both). In addition, 54 per cent of urban women have experienced FGM/C as compared to 68 per cent in rural areas. FGM/C is less prevalent among women with higher education and those in the highest wealth quintile. The 2016 EDHS shows a decreasing trend in FGM/C nationwide with the prevalence in 15-19 year olds down to 47 per cent as compared to 65 per cent in the 15-49 age group.

UNICEF supports the Government’s efforts through enhancing capacity to implement both preventive and responsive programmes at scale, and strengthening coordination mechanisms at different levels. UNICEF works with the National Alliance to progress ongoing roadmap development to end FGM/C and Child Marriage. It also, supports the involvement of faith based, traditional and community leaders, as communities usually link this harmful traditional practice to cultural and religious norms. In this regard, UNICEF signed a Memorandum of Understanding (MoU) in August 2016 with major religious institutions in the country to improve the lives of children, women and adolescents by promoting positive behaviour and social norms and to bring about the necessary societal shifts in communities.

UNICEF supports the Government in the health sector in the Afar and Somali regions to address FGM/C related complications by providing training to health workers; raising the communities’ awareness on health risks caused by FGM/C; identifying girls and women affected by FGM/C; developing training materials; recruiting gynaecologists and equipping selected hospitals with basic FGM/C care equipment.

Ensuring every child is accounted for and no one is left behind in Ethiopia

By Hannah Godefa

On August 6th, I was fortunate to be a part of a campaign in Ethiopia when the establishment of the Vital Events Registration Agency (VERA) kicked off throughout the country.

VERA is an incredibly important institution for individuals, societies and government. For individuals, registration can be used as legal documents and proof for identification purposes. Information complied from these areas are then needed for admin applications like public health programmes and the electoral roll.

On the first day of the campaign, I visited the Gulele Sub City, Woreda 9 VERA team. UNICEF supports the campaign to ensure all resources needed for registration like registry, certificates, awareness creation, materials and logistics make it to all regions, all the way to the lowest levels of administration.

Vital events registration kicks off in Ethiopia

This process is incredibly important because it will ensure that every child will be accounted from the earliest days of life. This means big advancements for accountability when it comes to harmful traditional practices including child marriage, as every individual will have a marriage certificate with the new system from VERA. It will also make it easier for government, non-profit and civil society partners to identify when these practices are occurring.

Birth registration is the first recognition of a child’s existence by the state. Where births remain unregistered, there is an implication that these children are not recognized as persons before the law. The absence of the system of birth registration results in the violation of children’s rights to name and nationality; to protection from abuse, neglect, and exploitation, including early marriage, child labour  and trafficking; to basic social services, including education and health; and the personal rights of orphans and other vulnerable children.

Currently, birth, death, marriage and divorce will be kept recorded from the kebele civil status office to the federal level, so that there is less room for discrepancies and human rights crime.

Participating in the registration process was an incredibly humbling and powerful experience for me, and I am very excited to see how UNICEF will work with VERA and local partners to ensure that every child is accounted for, and no one is left behind.

After a harrowing journey, a bittersweet homecoming for Ethiopian migrant children

By Christine Yohannes

ADDIS ABABA, 29 June 2016–One year ago, 14-year-old Tesfaye* set off from his hometown of Hadiya in the Southern Nations, Nationalities, and Peoples’ Region of Ethiopia towards South Africa. Like many young people, Tesfaye sought what he thought would be a brighter future abroad.

Unfortunately for Tesfaye, his journey came to an abrupt halt after one month when he was arrested in Zambia. Along with 39 other Ethiopian children, he was charged under the Anti-Human Trafficking Act that prescribes a minimum mandatory sentence of 15 years for smuggling or consenting to be smuggled.

UNICEF- IOM partnership assisted voluntary returning children to Ethiopia
Tesfaye 15 and one of the youngest from the returnees is slowly readjusting to the possibility of reuniting with the family he had decided to leave behind. He is now finding relief in the piece of paper as he draws and writes his past struggles to be a living example to his peers who would consider a similar escape. UNICEF in collaboration with IOM returns children from third countries. Which is facilitated through a Cooperation Agreement signed between the two agencies since 2013 and renewed in 2016. This collaboration supports the Government of Ethiopia’s (GoE) Safe Return and Reunification Programme for Unaccompanied and Migrant Children. ©UNICEF Ethiopia/2016/Tsegaye

Although he was not yet 15 at the time, Tesfaye was tried as a 23-year-old because of the eight-year difference between Gregorian calendar used in most of the world, including Zambia, and the Julian calendar used in Ethiopia. Tesfaye was unable to explain the situation due to his limited English and was subsequently convicted and jailed in Mukobeko Maximum Security Prison in Kabwe, which houses adult criminal offenders,along with other children who had been detained.

A long  journey

In response to news of this detainment, UNICEF and the International Organization for Migration (IOM) worked together with the Zambian Human Rights Commission and Zambian officials to get the children released from prison and sent home. Following high level advocacy and personal commitment from IOM and UNICEF staff members, all 39 children were pardoned by the Zambian President.

IOM Zambia provided support to the Zambian authorities to ensure that protection assistance, including safe shelter and medical assistance was provided to all children once they were released from prison. Their first stop for these children once in Ethiopia is the IOM Assisted Voluntary Return and Reintegration (AVRR) Transit Centre, which is operated in close collaboration with UNICEF and the Government of Ethiopia, in Addis Ababa. The centre receives some 100 to 200 unaccompanied minors every month who have returned from other transit or destination countries.

UNICEF supports the Ethiopian Bureau of Women and Children Affairs with trained social workers to conduct documentation, family identification and reunification of the children. The social workers provide psychosocial support services at the transit center and accompany the children to their families, where they also provide a reunification grant to each child’s family.

Although Tesfaye is now safe in the IOM Transit Centre, he will not soon forget the ordeal he went through. He says, “I want to teach and raise awareness for others that might try to do this,” adding, “It should stop with me!”

Dreams cut short

Jacky* 17, also from Hadiya, was a straight-A student with big dreams for his future when he left home in search of better opportunities. “I do not blame my country for my decision to leave and for trying my luck in South Africa,” he says.

He recalls 25 days of travelling on foot, his subsequent arrest and confinement in a prison room shared with over 200 other detainees, going days without food and enduring brutality and theft.

“I sold my cow and my inherited share of my father’s land to pay for my trip, only to be arrested a 120km from my destination,” said Jacky. “I had high hopes for my future in South Africa but being exposed to deadly diseases in prison made me realize that it is worth striving for a better life in my own country.”

Home at last

UNICEF- IOM partnership assisted voluntary returning children to Ethiopia
UNICEF in collaboration with IOM returns children from third countries. Which is facilitated through a Cooperation Agreement signed between the two agencies since 2013 and renewed in 2016. This collaboration supports the Government of Ethiopia’s (GoE) Safe Return and Reunification Programme for Unaccompanied and Migrant Children. ©UNICEF Ethiopia/2016/Tsegaye

Harrowing as their stories are, at least Tesfaye and Jacky are home at last. Some children remain in Kabwe as they had come of age while in prison. The Zambian Human Rights Commission , with support from UNICEFand IOM, continues to work to enable the release of these children and their return to Ethiopia.

Going forward, UNICEF, in partnership with IOM, will support the Child Justice Forum and the Zambian Human Rights Commission to prevent this from happening to other children in the future. UNICEF will also extend its support by monitoring prisons and police cells to identify and help children in similar situations as there are reports of more smuggled and trafficked children; eight more children await trial on a similar accusation.

“I cannot say I have come [home] when half of me [more children] is still in prison” Jacky continued “ I have learned from my mistakes, so I would like to teach everyone about creating jobs in our lands.”

*Names of the children have been changed to protect their privacy

Nearly 50 million children “uprooted” worldwide – UNICEF

28 million forcibly displaced by conflict and violence within and across borders

Across the globe, nearly 50 million children have been uprooted – 28 million of them driven from their homes by conflicts not of their making, and millions more migrating in the hope of finding a better, safer life. Often traumatized by the conflicts and violence they are fleeing, they face further dangers along the way, including the risk of drowning on sea crossings, malnourishment and dehydration, trafficking, kidnapping, rape and even murder. In countries they travel through and at their destinations, they often face xenophobia and discrimination.

A new report released today by UNICEF, Uprooted: The growing crisis for refugee and migrant children, presents new data that paint a sobering picture of the lives and situations of millions of children and families affected by violent conflict and other crises that make it seem safer to risk everything on a perilous journey than remain at home.  

“Indelible images of individual children – Aylan Kurdi’s small body washed up on a beach after drowning at sea or Omran Daqneesh’s stunned and bloody face as he sat in an ambulance after his home was destroyed – have shocked the world,” said UNICEF Executive Director Anthony Lake. “But each picture, each girl or boy, represents many millions of children in danger – and this demands that our compassion for the individual children we see be matched with action for all children.”

Uprooted shows that:

  • Children represent a disproportionate and growing proportion of those who have sought refuge outside their countries of birth: they make up about a third of the global population but about half of all refugees. In 2015 around 45 per cent of all child refugees under UNHCR’s protection came from Syria and Afghanistan.
  • 28 million children have been driven from their homes by violence and conflict within and across borders, including 10 million child refugees; 1 million asylum-seekers whose refugee status has not yet been determined; and an estimated 17 million children displaced within their own countries – children in dire need of humanitarian assistance and access to critical services. 
  • More and more children are crossing borders on their own. In 2015, over 100,000 unaccompanied minors applied for asylum in 78 countries – triple the number in 2014. Unaccompanied children are among those at the highest risk of exploitation and abuse, including by smugglers and traffickers. 
  • About 20 million other international child migrants have left their homes for a variety of reasons including extreme poverty or gang violence. Many are at particular risk of abuse and detention because they have no documentation, have uncertain legal status, and there is no systematic tracking and monitoring of their well-being – children falling through the cracks.
Kueth Tney,13, Nyamuoch Gatdet, 9 and Nyatayin Both, 25, (from left to right) victims of the abduction during a deadly cross border raid on 15 April.
Kueth Tney,13, Nyamuoch Gatdet, 9 and Nyatayin Both, 25, (from left to right) victims of the abduction during a deadly cross border raid on 15 April ©UNICEF Ethiopia/2016/Mersha

According to Uprooted, Turkey hosts the largest total number of recent refugees, and very likely the largest number of child refugees in the world. Relative to its population, Lebanon hosts the largest number of refugees by an overwhelming margin: Roughly 1 in 5 people in Lebanon is a refugee. By comparison, there is roughly 1 refugee for every 530 people in the United Kingdom; and 1 for every 1,200 in the United States. When considering refugee-host countries by income level, however, the Democratic Republic of the Congo, Ethiopia, and Pakistan host the highest concentration of refugees. 

The report argues that where there are safe and legal routes, migration can offer opportunities for both the children who migrate and the communities they join. An analysis of the impact of migration in high-income countries found that migrants contributed more in taxes and social payments than they received; filled both high- and low-skilled gaps in the labour market; and contributed to economic growth and innovation in hosting countries.

But, crucially, children who have left or are forcibly displaced from their homes often lose out on the potential benefits of migration, such as education – a major driving factor for many children and families who choose to migrate. A refugee child is five times more likely to be out of school than a non-refugee child. When they are able to attend school at all, it is the place migrant and refugee children are most likely to encounter discrimination – including unfair treatment and bullying.

Outside the classroom, legal barriers prevent refugee and migrant children from receiving services on an equal basis with children who are native to a country. In the worst cases, xenophobia can escalate to direct attacks. In Germany alone, authorities tracked 850 attacks against refugee shelters in 2015. 

“What price will we all pay if we fail to provide these young people with opportunities for education and a more normal childhood? How will they be able to contribute positively to their societies? If they can’t, not only will their futures be blighted, but their societies will be diminished as well,” Lake said. 

The report points to six specific actions that will protect and help displaced, refugee and migrant children:

  • Protecting child refugees and migrants, particularly unaccompanied children, from exploitation and violence.
  • Ending the detention of children seeking refugee status or migrating by introducing a range of practical alternatives.
  • Keeping families together as the best way to protect children and give children legal status.
  • Keeping all refugee and migrant children learning and giving them access to health and other quality services.
  • Pressing for action on the underlying causes of large-scale movements of refugees and migrants.
  • Promoting measures to combat xenophobia, discrimination and marginalization.

Ethiopia has a long history as both a sender and receiver of refugees, and its location in the Horn of Africa places it at the centre of one of the largest refugee-generating areas in Africa today. As of 1 July 2016, the United Nation High Commissioner for Refugees (UNHCR) reported a total of 741,288 refugees living in Ethiopia, of which nearly 60 per cent (57.2 per cent) are children. This is an increase of more than 600,000 since 2009 with the majority from South Sudan, Sudan, Somalia, and Eritrea. The volatility of this influx has put significant pressure on the government capacity to provide basic social services in affected areas. Host communities and refugees alike suffer from limited social services, including lack of schools, overstretched health facilities, shortage of water and sanitation facilities.