Aid cuts threaten refugees’ lives in Ethiopia’s Gambella region

Living conditions for refugees in Ethiopia’s Gambella region are rapidly deteriorating following significant cuts to humanitarian aid from key donors such as USAID. These cuts have strained basic services including food distribution, health care, access to clean water, and sanitation.

Gambella, a border region in southwestern Ethiopia, has hosted a large number of mostly South Sudanese refugees since 2014. Today, more than 395,000 refugees are living in seven camps, including Kule refugee camp. Doctors Without Borders/Médecins Sans Frontières (MSF) has provided health care services in Kule for more than a decade. MSF teams there are now overwhelmed with the increasing needs.

An MSF staff and patients at a feeding center in Ethiopia. — MSF’s center in the Kule refugee camp offers comprehensive medical and nutritional care, therapeutic feeding, and treatment for related illnesses such as malaria. | Ethiopia 2025 © Ehab Zawati/MSF

Essential services on the brink of collapse

The general decline of humanitarian funding in the region has led to the suspension of nutrition services in four out of the seven refugee camps, leaving around 80,000 children under the age of 5 at risk of life-threatening malnutrition.

“We receive food once a month—maize, wheat, and sorghum—but it always runs out before the month ends,” said Nyauahial Puoch, a mother who traveled about five miles from Tierkidi refugee camp to seek treatment for her 17-month-old daughter at MSF’s facility in Kule camp. “Since last year, there has been a big decline. Some of the items we used to get are no longer provided at all.” Puoch’s daughter has been diagnosed with malnutrition.

Since October 2024, refugees in Kule camp have received as little as 600 calories a day—less than 30 percent of the recommended daily minimum of 2,100 calories per person. Other refugee camps in the region are also experiencing a similar situation. At times, food distribution has stopped for months due to international supply chain disruptions and funding shortages.

Nyauahial Puoch, mother of MSF patient

"We don’t know how we will cope if another child falls sick.”

My daughter Nyakhan is 17 months old. On July 7, she became very sick—she had a fever, diarrhea, and was vomiting for three days. We tried to care for her at home. We even tried giving her milk, but she wouldn’t take anything. That’s when I knew it was serious.

I have five children. This is the first time one of them has been malnourished. We’re receiving food distributions including maize, wheat, and sorghum, but it’s only once a month, and it never lasts until the next round. Food is scarce, and the children are hungry before the month ends.

Before, we used to get more. Now, the packages have been reduced by half, and some items have stopped coming altogether. The reductions began last year, but in the past four months things have gotten even worse. Everyone is struggling. Once the distributions are done, there’s nothing left, and people don’t know where else to turn.

We have a small piece of land, but it’s not enough. My husband doesn’t have a job. I tried taking Nyakhan to another camp when she got sick, but many of the health services there have been reduced. We were very worried.

Now, she is receiving treatment from MSF. I feel some relief, but I’m still worried about what will happen when we go back. There is not enough food, and we don’t know how we will cope if another child falls sick.

A mother sits next to her child at a clinic in Ethiopia.

Facility closures mean that MSF facilities are being overloaded with patients

In 2025, MSF has recorded a 55 percent increase in child admissions to its therapeutic feeding center compared to the previous year, with half of these children coming from other camps in the region.

MSF’s outpatient department has seen a 58 percent rise in patient visits compared to the same period last year, with many patients arriving from surrounding camps. The number of women attending prenatal care sessions has increased by 72 percent compared to 2024, indicating the growing demand for maternal health care services.

“We’re receiving more patients from other camps, largely because these services are no longer available locally due to many NGO’s withdrawing from the region due to funding cuts,” said Armand Dirks, MSF’s project coordinator in Gambella. “MSF is overwhelmed by the increased patient load, and we fear this number will likely keep rising in the coming months."

Nyamuon Machar, mother of MSF patient

“I still don’t know how we’ll feed her, or the rest of the family.”

I’m the mother of three children. My youngest, Nyabiey, is just 7 months old. She had a bad cough, pain in her body, and she cried constantly. We don’t have transport or money, so we walked for two and a half hours to reach the MSF health center.

When we arrived, they told me my daughter was malnourished. I wasn’t surprised. She hasn’t been breastfeeding well, and she’s always sick. I’m worried because I don’t know how we’ll manage to keep her healthy without enough food.

We live in Nguenyyiel refugee camp. Like many others here, we receive food distributions from organizations—mostly maize and sorghum. But over the past four months, the amount we receive has been reduced by nearly half. What we get now barely lasts a week or two. After that, we have to find whatever we can.

My husband doesn’t have a job. To get food, we collect firewood and try to sell it, but it brings in very little. Sometimes, we spend a day—or even more—without eating. It’s hard to keep the children well under these conditions.

I had been going to the outpatient clinic for my other children, but when Nyabiey got worse, I brought her here. I’m grateful she is receiving treatment now, but the challenges don’t stop once we leave. I still don’t know how we’ll feed her or the rest of the family when we go back home.

A mother and baby sit on a hospital bed in Ethiopia.

Malaria cases rising after cuts to prevention activities

Funding cuts have also caused disease prevention activities—such as malaria prevention programs—to be downsized.

As malaria is endemic in the region, MSF’s team is anticipating a sharp increase in the number of malaria patients during the current rainy season, which lasts from May to October.

In July 2025, the number of malaria patients coming to MSF’s facility has more than doubled compared to June 2025. MSF has treated more than 23,800 cases since January, with over half of these patients coming from neighboring refugee camps.

We receive food once a month—maize, wheat, and sorghum—but it always runs out before the month ends.
Nyauahial Puoch, a mother of an MSF patient

With a significant decrease in key malaria prevention activities such as the distribution of bed nets and indoor and outdoor spraying, it will be more difficult to control the spread of malaria, potentially increasing the burden on the already fragile health system.

“Cases are expected to rise sharply during this peak transmission period,” said Birhanu Sahile, MSF’s deputy medical coordinator. “This poses a serious threat to already vulnerable refugees who face heightened exposure to malaria-infected mosquitos due to overcrowded living conditions and limited sanitation."

To address this situation, MSF is enhancing its malaria treatment services in the region and plans to establish a dedicated malaria health post in the Tierkidi refugee camp in Gambella, which is home to more than 74,000 refugees. Our teams are also distributing bed nets and supporting vector control and preventive measures for refugees living in Kule camp.

Father of MSF patient

“It took us three hours on foot to reach the MSF health facility in Kule.”

My daughter Kuoth was very sick. She had diarrhea, a cough, and she was severely thin. We were worried she might not survive the journey to the hospital. It took us three hours on foot to reach the MSF health facility in Kule.

She has been staying in the inpatient therapeutic feeding center for 15 days. Thanks to the care she received, she is doing much better now. We are relieved and grateful.

We live far from the hospital in Akule camp, and I don’t have a job. But MSF treated our daughter free of charge. That has helped us more than I can explain. We had heard from others in the community that MSF provides good treatment, and now we’ve experienced it ourselves.

I have three children. Whenever they fall ill, we bring them to MSF. We depend on farming to survive—we grow maize twice a year, but it’s not enough. Sometimes we work on other people’s land in exchange for food.

We came here in 2014 from Kiothgile, South Sudan after the conflict started.

When we return home, our daughter will eat corn, and we’ll try to help her regain her strength. I still worry for her and my other children. I’ll keep looking for work so I can support them better.

A family sits on a bed of a feeding center in Ethiopia

Urgent action is needed to replace disappearing services

“Walking through the camp, you’ll see many empty buildings—spaces once used by NGOs that have now withdrawn,” said Dirks. “Their absence is deeply felt. Services that once supported this community have now disappeared.”

In Kule refugee camp, MSF is providing a range of essential services including primary and secondary health care, maternal and child health including comprehensive sexual and gender-based violence care, mental health care, water and sanitation, and health promotion and nutrition programs.

“MSF is working at full capacity, but the scale of needs in Kule far exceeds what we can address alone,” said Sahile. “Without urgent support and interventions from other actors, this crisis will continue to escalate, putting thousands of vulnerable lives at even greater risk.”

As NGOs are increasingly unable to meet the health care needs within refugee camps, we urge the government of Ethiopia to take clear and decisive steps in Gambella to advance refugee integration into local services. This includes strengthening the current health care system for everyone and enhancing its capacity to withstand future cuts.