In Ethiopia, children are increasingly facing food insecurity. Humanity & Inclusion uses stimulation therapy to prevent development delays for children experiencing malnourishment.

The Horn of Africa is experiencing one of the worst droughts the area has ever seen. In Ethiopia alone, more than 8 million people have been affected and over 17 million people are in need of agricultural support. 4 million livestock have been lost, and 30 million more are at risk of starvation, further reducing food sources. Additionally, the average price of food items has increased by 40% since 2019.

“When children face malnutrition, it is highly likely that they will suffer developmental delay,” explains Gadisa Obsi, a physical therapist with Humanity & Inclusion in Ethiopia. “They may have difficulty performing daily activities compared to other children of the same age. Malnutrition can also lead to disability in the long term.”

Preventing long-term consequences

Humanity & Inclusion is present in the largest refugee camp in Gambella, Ethiopia, supporting displaced children with developmental delays resulting from malnutrition.

Complementary to nutrition support provided by Humanity & Inclusion partners, stimulation therapy uses play-based rehabilitation exercises to strengthen child development and prevent the disabilities that might occur as a result of malnutrition.

Obsi and his team identify children in need in the community, provide therapy sessions and do as much follow-up as possible. They also inform caregivers about early-childhood development and the importance of early exposure to stimulated play and human interactions in physical and cognitive development.

Making a difference

Nyatut Tholbok is is an 18-month-old child originally from South Sudan. She’s living as a refugee in Gambella with her mother, Nyabem Kher. When she first met Humanity & Inclusion’s team, Nyatut showed signs of severe malnutrition, and her motor skills had suffered tremendously. She struggled to stand on her own, or even to crawl like other children her age. With Humanity & Inclusion’s ongoing therapy sessions and nutrition assistance from partner Action Against Hunger, Nyatut has made noticeable improvements in her follow-up sessions. She has already begun to stand and continues to improve her mobility.

“The impact on the life of the child, their family and the community is immense,” Obsi explains. “We are so proud to have been successful in preventing developmental delay for many children while they were recovering from malnutrition.”

These activities are funded by the U.S. Department of State Bureau of Population, Refugees and Migration.

Humanity & Inclusion’s regional logistics manager, Tilahun Abebe, shares the highlight of his recent visit to Tigray, Ethiopia.

I was able to visit Tigray for a week this summer. No one had been able to visit our team in Tigray for quite a long time due to security constraints.

One morning, during breakfast with my colleagues, the silhouette of a woman appeared in the distance and caught my eye. I could see her making her way across the cobblestone pathway, fading in and out of my view between the many passing pedestrians in the road, crawling on her hands and knees. We crossed the street to find her propped up on some stairs leading to a roadside shop, with one hand supporting her weight, and the other stretched out to ask for money. Neither the man in the shop nor the people passing by seemed to pay her any attention. I was not surprised, as I had already noticed an overwhelming number of people soliciting assistance in the street since my arrival in Mekele: from small children to elderly persons, clearly internally displaced from other parts of Tigray. You could tell from the looks on their faces that many were new to this way of life and were living very differently only a few weeks or months earlier.

I am an Ethiopian citizen, still living in Addis Ababa, and I have traveled to many regions of the country. The desperate situation of the people I saw on the streets of Mekele that week is something I will never forget.

Meeting Freweyni

The woman sensed us standing next to her and turned toward us. I still remembered some Tigrigna language from childhood friends and social media, so I greeted her and introduced myself. She returned the greeting with a smile and kindness, and shared her story with us.

Her name is Freweyni, which means “grapefruit” in the local language. She is a mother to three children and she was born with a physical disability. In the previous years, she was displaced from her home and has since been staying in various shelters around the major market area of Mekele. Her oldest son left home when the war began, but her two younger children still live with her and she is their sole provider. She spends her days asking for money around the market to try and support her family.

Since meeting with Freweyni and learning about her situation, I put her in touch with our teams. Humanity & Inclusion has provided her with a new wheelchair. This means that for many months or years to come, she will no longer have to crawl on her hands and knees to move around. She’s one of 50 people to recently receive wheelchairs from Humanity & Inclusion in Tigray. Having served in many humanitarian organizations for over two decades, this experience remains at the top of all I have encountered. It’s part of what makes me love working at Humanity & Inclusion.

 Tilahun Abebe, Humanity & Inclusion’s regional logistics manager

After her home caught fire in her sleep, Hawa developed emotional stress and feared for her family’s safety. Psychosocial support from Humanity & Inclusion has helped her find peace of mind.

Hawa, 40, is a single mother to eight children. The family lives in a one-room household and depend on Hawa as their sole provider and caretaker.

“Hawa’s home once caught fire while she and her family were inside sleeping,” says Zelalem Ketema, Humanity & Inclusion’s project manager in Ethiopia. “They made it out alive—but before receiving support from Humanity & Inclusion, she had frequent nightmares and didn’t trust anyone new, as she thought they were trying to hurt her family. She was quiet and preferred to be alone. On occasion, she was even aggressive. She would carry her children out of the house on her back and guard them with a stick for defense.”

Accessing mental health support

With help from Humanity & Inclusion, Hawa received psychosocial support, including individual counseling, group consultations and psychosocial education sessions. She also received essential items such as laundry detergent, body soap, jerrycans, a basin and a 5-gallon bucket for her family.   

Hawa says that individual counseling services saved her life and her situation has improved. She gradually began to interact with other people and develop a sense of trust for them.

“After receiving individual and group counseling, a significant change in my life occurred,” Hawa explains. “I used to believe that psychosocial support was just a joke, but now I see that it is medicine for people like me. My counselor once told me that we need psychosocial help like we need water daily. I really believe this is true, since the support has transformed me into a mother who cares for her children without worry. I now communicate with others, trust them, and send the kids to school.”

Hawa also attends group counseling sessions and shares her story to help people in the community with similar situations.  

“The advice I give to community members who experience similar incidents is to seek information from the Humanity & Inclusion team, particularly psychosocial support,” she continues. “I am happy to help anyone in the same way that Humanity & Inclusion has helped me.”

Without any mobility device available, Omod relied on others to get from place to place. With Humanity & Inclusion’s support, he has a new wheelchair and newfound independence.

Omod, 11, has cerebral palsy. Unable to walk on his own, he also needs assistance completing daily tasks such as eating and getting dressed. His grandmother, Athiep Ojulu, has been his caretaker since he was 3 years old. She prepares Omod’s meals, feeds him, bathes him and washes his clothes. Before Omod received a wheelchair, Athiep carried him on her back when they needed to go from one place to another.

Though Omod dreamed of playing and having fun with the other children his age, he was nervous to approach them and his mobility limitations ultimately kept him from joining in. Occasionally, his grandmother would try putting him in social situations, but the other children did not want to play with him.

Humanity & Inclusion has launched a disability awareness campaign in the community to promote inclusion of people with disabilities.

A wheelchair changed everything

During a door-to-door screening in Ethiopia, Humanity & Inclusion staff met with Omod and his grandmother, and referred him to the organization’s rehabilitation team to determine how they could support him. A physical therapist conducted an evaluation, and provided Omod with his first wheelchair to help improve his mobility and grant him independence.

“I was thrilled and in tears when Humanity & Inclusion visited my home to support us, because no one had done that before,” Athiep Ojulu says. “Now, everything is easier for my grandson and me. Everywhere I go, I can take him with me. I am so grateful to Humanity & Inclusion for doing such a fantastic job. It is truly amazing and I consider it to be a miracle. Thank you so much.”

Humanity & Inclusion’s team also provided family counseling and basic hygiene supplies to Omod and his grandmother.

These activities are funded in part by the U.S. Department of State Bureau of Population, Refugees and Migration.

Malnutrition prevented Pal from developing like other children his age. With Humanity & Inclusion’s nutrition support and stimulation therapy, Pal can now sit, stand and walk on his own.

11-month-old Pal and his mother, Nyayual, 34, live in the Nguenyyiel refugee camp, in Gambella, Ethiopia. Originally from Nasir, South Sudan, Nyayual was forced to flee her home in 2017 due to war and unstable conditions. After leaving her husband behind in the conflict, Nyayual is raising her five children as a single mother in the camp and working as a cleaner.

Living in the refugee camp, Nyayual is faced with a lack of resources, insufficient finances and increasing drought, all of which make it difficult to access food and nutrition for her children.

Malnutrition has a particularly strong impact on babies and young children, like Pal, who are still developing their minds and bodies. Malnutrition and undernutrition are major factors in child mortality, illness and disability. Children may show delays in motor and cognitive development, associated with behavioral and communication problems. These can consolidate over time and lead to irreversible disabilities if left untreated. Most neurological disorders related to malnutrition are preventable.

“I was worried a lot about my baby,” Nyayual says. “His growth rate was slow and he was unable to sit up without support like other children his age.”

Overcoming developmental challenges

Nyayual brought her son to Humanity & Inclusion to begin stimulation therapy sessions and to receive emergency nutrition supplies. Early childhood stimulation therapy for children experiencing malnourishment stimulates motor skills and cognitive development through personalized care and playing with toys. Humanity & Inclusion’s rehabilitation specialists developed the therapy to use alongside emergency nutrition initiatives, rehydration and essential medical care to give children the best chance of survival, resilience and an improved quality of life.

After attending sessions with his mother, Pal began to show improvements. He can now sit without any support, stand by himself and he has recently started walking independently. Nyayual also learned skills to continue Pal’s progress at home.

“Being able to play with his peers and siblings at home also helps Pal to improve his social interactions and learn some gestures, which improves his language skills,” explains Gadisa Obsi, a physical therapist for Humanity & Inclusion in Ethiopia.

It’s been five months since Pal’s family began receiving nutritional support from Humanity & Inclusion, and Nyayual says she is very pleased with her son’s performance, which now fits with his age group. Pal’s favorite activities are dancing and “playing drums” by beating on household objects. His favorite food is mashed potatoes with milk.

“My ultimate goal is to see him go to school,” Nyayual says. “I hope one day he can become an educated person who will bring real change for our family.”

These actions are funded by the United States Department of State’s Bureau of Population, Refugees, and Migration, and implemented by Action Against Hunger, Humanity & Inclusion and other partner organizations.

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In Ethiopia's Tigray region, Humanity & Inclusion has identified an urgent need for mental health and psychosocial support as the crisis continues.

People are isolated, facing food insecurity and have spent months living under the constant threat of violence. Stress levels are high, and the population is experiencing widespread psychological trauma.

More than 5,400 children have lost or been separated from their families. With nearly 2 million people forced to flee their homes, shelters are often overcrowded and there have been increased reports of sexual violence against women and girls. Unaccompanied children and girls with disabilities are at even greater risk of harm. The UN Population Fund estimates that more than 22,500 victims of sexual violence will seek clinical support this year. The number of unreported assaults remains unknown, as widespread fear and stigmatization prevent many from coming forward.

At this time, only a fraction of the region’s care services is active or able to respond. Many have been forced to close indefinitely due to the crisis and others are overwhelmed by the Covid-19 pandemic.  

Along with rehabilitation and inclusive initiatives, Humanity & Inclusion has listed mental health support and protection among the top priorities for its emergency intervention plan in Tigray. Mental health specialists will be mobilized to access people in remote and isolated areas as well as dozens of camps housing internally displaced people. Teams will provide psychosocial support and refer individuals in need of additional care, including those with new or pre-existing disabilities, to appropriate resources. Group therapy sessions will also be implemented alongside recreational activities such as sewing, beading and art therapies to improve mental health and wellness.

“In times of crisis, people are in dire need of mental health and psychosocial support. Emergencies eliminate sources of support and care that are normally available and they increase the risk of developing psychological distress while also amplifying pre-existing ones. Crises like this can have long-term impacts on the development and well-being of an entire population, create psychosocial disabilities, and overall, negatively impact physical health and social cohesion. HI’s mental health and psychosocial support (MHPSS) activities promote optimal mental health and social participation which takes into account the social and psychological aspects of support and access to medical care.” — Chiara Beguin, mental health specialist for Humanity & Inclusion

Widespread starvation and volatile conditions continue to overwhelm the people of Tigray, Ethiopia. Humanity & Inclusion reveals its four-sector intervention plan. 

With each passing day, the crisis in northern Ethiopia weighs more heavily on the people of the Tigray region. An alarming 5.5 million people are now in need of humanitarian assistance, as people experience widespread hunger and malnutrition, ever-present security risks, and extremely limited resources. 

Hunger and malnutrition

At least 4 million people, representing more than 90% of the population, are facing alarming levels of food insecurity. According to the Integrated Food Security Phase Classification, 1.8 million are facing emergency levels of hunger and over 350,000 people have reached the “catastrophic phase,” defined by an extreme lack of food, evident starvation, destitution and critical acute malnutrition. 

Children make up more than 2.2 million of those experiencing acute food insecurity and severe malnutrition, which can lead to serious delays in child development and even to lifelong disabilities. Without urgent intervention, millions are at alarmingly high risk of developing permanent disabilities or starving to death.  

Protection

Persistent danger in the region continues to threaten the safety of Tigray’s most vulnerable people. In the month of May alone, more than 500 cases of gender-based violence and sexual assault were reported, including around 70 offenses against children. Schools and shelters that are currently used to house thousands of internally displaced people have been repeatedly looted and damaged, raising further security concerns for those already forced to flee their homes. Some areas have become completely inaccessible due to safety risks, further isolating the inhabitants, who are in critical need of food, supplies and protection. 

People with disabilities are most at risk

In an already devastating humanitarian context, people with disabilities and older people are at even greater risk of harm. So far, Humanity & Inclusion teams have identified more than 4,650 people with disabilities or special needs. Always disproportionately affected in times of crisis, these populations are more likely to experience isolation, reduced access to basic care, and mobility limitations, which could prevent them from fleeing dangerous areas. 

HI’s intervention plan

"The need for basic supplies and services grows each day,” says Jeff Meer, U.S. Executive Director for Humanity & Inclusion. “Our colleagues in Ethiopia see it as people flee their homes and seek refuge in larger cities. They see it among people living in rural, isolated areas, which are dangerously cut off from assistance. Funding needs are high, to enable our teams to safely and effectively work alongside affected communities. Our priority is to see people with disabilities and individuals in vulnerable situations safely accessing basic and specific aid.”

Humanity & Inclusion teams are on-site and preparing to provide vital assistance to the population. Staff has assessed the situation and humanitarian needs by meeting with impacted community members, other INGOs, and experts in security and logistics. Humanity & Inclusion, which has been working in Ethiopia since 1986, has developed an emergency intervention plan in the sectors of Mental Health and Psychosocial Support, Rehabilitation, Inclusive Humanitarian Response, and Protection. These include: 

• Psychological first aid through individual and group counseling sessions and trauma-informed training for aid and health workers;
• Quality rehabilitation services, including physical therapy sessions, training of health care workers and mobility aids for people with disabilities, those facing complications after injuries and over 300,000 internally displaced persons;
• Inclusive humanitarian response that focuses on people with disabilities, unaccompanied children, women at-risk of violence and exploitation, and vulnerable populations; and
• Child protection initiatives in refugee camps and sites hosting internally displaced people.

Image: Humanity & Inclusion teams drive to the Tigray region of Ethiopia to begin crisis intervention efforts. Copyright: J. Avery/HI

Over a million people in Ethiopia's Tigray region are suffering in the midst of a violent crisis. Humanity & Inclusion teams are on-site providing aid and support to those most affected.

The humanitarian crisis is worsening each day in Ethiopia’s Tigray region. People are facing death, injury and trauma. Women and children are reporting instances of violent sexual assault. Health facilities, schools and other public infrastructure have been destroyed, looted or are being used as shelter for internally displaced persons. 

It’s estimated that 1.3 million people need humanitarian aid, ranging from health services to food and shelter to basic hygiene items. Forced to flee dangerous areas or left without access to necessities, 735,000 people have left their homes across the region, migrating primarily to the northern city of Shire. On top of that, thousands of Ethiopians have sought refuge in neighboring countries, while nearly 100,000 Eritrean refugees living in Tigray have been relocated to other camps. The circumstances are only exacerbated by the Covid-19 pandemic and food insecurity caused by extreme floods, droughts and locust infestation affecting the region.

The need for basic supplies and services grows each day as people flee their homes and seek refuge in larger cities. Humanity & Inclusion teams on-site say this is particularly true for people living in rural, isolated areas, which are dangerously cut off from assistance. Funding needs are high, to enable them to safely and effectively work alongside affected communities. Their priority is to see people with disabilities and individuals in vulnerable situations safely accessing basic and specific aid.

Humanity & Inclusion’s teams have assessed the situation and humanitarian needs by meeting with impacted community members, other INGOs, and experts in security and logistics. Humanity & Inclusion, which has been working in Ethiopia since 1986, is forming emergency intervention and protection plans that include:

• Psychological first aid through individual and group counseling sessions and trauma-informed training for aid and health workers;
• Quality rehabilitation services, including physical therapy sessions, training of health care workers and mobility aids for people with disabilities and those facing complications after injuries;
• Inclusive humanitarian response that focuses on people with disabilities, unaccompanied children, women at-risk of violence and exploitation, and vulnerable populations; and
• Storage, transportation and coordinated distribution of humanitarian aid supplies with partner INGOs.

Image: A fleet of Humanity & Inclusion vehicles travel into Ethiopia's Tigray region to provide humanitarian aid. Copyright: HI

Nyaduoth, 16, has newfound freedom with her tricycle, along with the chance to go to school. She serves as a shining example to her fellow Nguenyyiel refugee community that with access, anything is possible. 

"My life was bad before I met the Humanity & Inclusion team," Nyaduoth says. In fact, she doesn't really like to think about it.

The young girl could not move on her own, was not allowed to go to school, and her own mother believed her disability was a curse from God. Nyaduoth comes from Ochom, a town in South Sudan, and has been living in Ethiopia’s Nguenyyiel refugee camp for several years. 

Her life changed when she first got a wheelchair from Humanity & Inclusion and then a tricycle—finally she could move around freely. The Humanity & Inclusion team later convinced her mother that children with disabilities should enroll in school. Thanks to psychosocial support, Nyaduoth has gained more confidence. She's also made friends. She helps her church community and, to her mother’s delight, is a diligent student. 

Nyaduoth participates in all of Humanity & Inclusion’s community awareness raising events for disability rights and inclusion, where she boldly shares her own experience. She also works in community outreach for another organization, teaching people in the camp best hygiene practices.

Equal rights

She could only crawl across the floor, whether it was dry as dust or muddy. Going to the bathroom was especially difficult. Nyaduoth’s father died when she was 3, and her mother felt her child was a burden. The local school did not accept her either. Nyaduoth had no opportunity to interact with other children, to learn or to make friends. 

A wheelchair from Humanity & Inclusion was her first step toward independence. Next, was training her family and community in understanding that Nyaduoth has the right to choose her path in life, and that children with disabilities must have equal rights, not be discriminated against. Nyaduoth received psychosocial support, a barrier-free toilet and a hand tricycle, with which she can be mobile all by herself. 

“Thanks to the tricycle and the support of Humanity & Inclusion, I developed my self-confidence and can now ignore the barriers of my disability,” Nyaduoth explains. 

Today, she is a role model for anyone living with a disability. She appears at events and shows that education with a disability is possible. And, her mother no longer equates disability with incapacity.

"I am so happy when I see my daughter moving independently from one place to another," says the mother of seven children.

Her daughter is growing just like all the other girls in the camp. Nyaduoth has a boyfriend, and the young couple has promised to get married and take care of one another.

Image: Nyaduoth sits in her hand-operated tricycle outside her home in a refugee camp in Ethiopia. Copyright: Till Mayer/HI

To mark International Women's Day on March 8, we talked to Reiza Dejito, a strong woman who is deeply committed to both her family and her role at Humanity & Inclusion. Currently serving as the Program Director for Nepal, India and Sri Lanka, Reiza has worked in numerous countries affected by humanitarian crises for two decades.

Why did you decide to join Humanity & Inclusion?

I graduated in science and physical therapy, and I earned diplomas in teaching and then management. I also completed several volunteer missions in the Philippines (my home country) and Ethiopia. And then, three months after leaving Ethiopia, I joined Humanity & Inclusion as a victim assistance project manager in Bor, South Sudan. Since then, I have worked in Kenya, Bangladesh, the Philippines and now Nepal.

Is there one experience that really stands out?

Working with Rohingya refugees in Bangladesh. They’ve suffered so much. One woman told me how she watched helpless as her husband was murdered and her house was burned down. A 9-year-old child, who was injured in the arm by a bullet after being caught in the crossfire, told me he’d forgiven the attacker for hitting the wrong target. Men, women and children walked for days and days to cross the border with little food and water. Awful. 

As a director in the Philippines, I joined the emergency team to help the victims of Super Typhoon Goni. I was extremely impressed by the resilience and generosity of Filipinos. And the commitment of my team and partner organizations to provide assistance to those who needed it most.

What’s the hardest part of your job?

As Program Director, I’m responsible for the security and protection of my teams and ensuring they are safe and sound, and in good health, especially during emergencies, crises and conflicts. In 2016, I had to manage the evacuation of Humanity & Inclusion’s teams in South Sudan following a series of deadly clashes between armed groups. It was the most trying experience of my career.

What's really important when it comes to working with your team?

Trust. Transparency. Empathy. And being able to laugh together.

Humanitarian and mother: how do you strike the right balance?

For many women, achieving this balance is a huge challenge and often prevents them from taking on more responsible positions. I’m extremely fortunate to have a supportive family and a husband who takes care of our child when I’m working. Thanks to their support, I can do the job I do. My family is my biggest incentive. They really inspire me to do better every day.

Is gender equity a challenge in the humanitarian sector?

I’ve been personally fortunate to work with male colleagues and team leaders who are advocates for women's leadership. But while many women work in the humanitarian sector, there are still too few in senior positions. Many organizations have made a lot of progress, but not enough. There is a great deal of work to do before we achieve greater equity. It’s not an easy task, because these inequalities run deep. They’ve been entrenched in cultural, social, financial and political life for generations. It’s not simply a question of empowering women and advancing their rights, but of changing corporate cultures. Men also have a role to play here. I want to see women access positions of responsibility just like men. I think we'll get there...slowly but surely.

Header image: A Filipino woman named Reiza (wearing the blue visor) and another woman carry a tub of supplies after Typhoon Goni in the Philippines. Copyright: HI

Inline image: Reiza squats down to talk with a girl who has an artificial leg at a refugee camp in Kakuma, Kenya, in 2015. Copyright: Xavier Bourgois/HI