MSF-France Assessment of Senafe Sub Zoba, Zoba Debub,
State of Eritrea

1. General Information
MSF-France started a Humanitarian Assistance program in Senafe Sub Zoba on the 27/2/2001.
With the support of the Ministry of Health (MOH) and the United Nations Mission for Ethiopia
and Eritrea (UNMEE), MSF-F was given a special access to this area prior to the formal
establishment of the Temporary Security Zone (TSZ).
The main objective of this rapid assessment is to have a small but reliable picture of the current
situation in Senafe Sub Zoba. This picture is of course influencing the nature of our operations in
the area but it will also be, we hope, a useful first-hand tool for the MOH and the other
international organization. Two separate assessments took place between the 14/03 and the 21/3.
A three-day assessment in Senafe Town where the first team visited randomly 37 households and
a three-day assessment of 7 villages and 1 IDP camp outside Senafe Town.
According to the population figures that we were able to get from the zone/ villages
representatives and from the food distribution lists, there is currently a population of
approximately 39 500 in Senafe Sub Zoba (80 000 prior to the last offensive). In addition to
MSF-F, there is only ICRC which is currently operational in the Sub Zoba (food distribution,
water & sanitation, support to health posts). Apart from the dispensary in Senafe Town, there is
only one other health post currently operational in the area (Rokoyto village). During Ethiopian
occupation, some volunteers were serving the populations (giving drugs, dressing, polio
immunization) in four locations (Senafe Town, Metera, Rokoyto, Tsaeda Korso & Zigfet). Prior
to the offensive of the 12/5/2000, 6 health posts were operational in the Sub Zoba; Senafe Town
(Caritas), Forto, Serha, Menekuseyto, Rokoyto and Golo. A 45 beds hospital was also
operational in Senafe Town. This hospital needs to be reconstruct completely since it was
destroyed by Ethiopian forces.
2. Senafe Town

The town of Senafe lies in a quite fertile valley and there is usually enough water for two crops
per year (maze, wheat, pulses and legumes). Prior to the war the town itself had been a booming
border town with a population of approximately 17,000. All the administrative buildings were
destroyed but most of the private houses were only looted (including doors, windows, etc.).
There is currently one water station which is functional (rehabilitated by the ICRC) and providing
enough water for the current population. The ICRC is planning to rehabilitate the second water
station in the coming weeks to assure sufficient quantities of safe & potable water for the whole
population of the town after the return of the displaced. The electricity was cut-down. The social
life in town is slowly but surely increasing in town every week. The market place is busy on
Wednesdays and Saturdays. Some shops are also open.

3. Senafe Town/ Demographic Information

Senafe is divided into six zones, but includes in its administration three neighboring villages.
The reported current total population and number of households per zone, as well as number of
births and deaths over the last nine months are as follows:

These population figures were provided by the zone representatives and are based on lists
prepared for the food distribution. Births and deaths are based solely on recollection because
there were no records kept after the administration left. Based on these grossly under-reported
figures, the Crude Mortality Rate (CMR) for the last 9 months would be approximately of 0.5 per
day per 10,000 population (according to WHO standards, a CMR above 1 death per day per
10 000 people indicates an emergency situation). 45% of the deaths were war-related (mostly
from Tisha residents who were caught in the crossfire because the town was located between the
two army positions), and 22% were deaths of children under 5 years of age.
4. Senafe Town/ Population Structure

A household sample survey of 37 households was done. Houses were randomly chosen, with an
average of 3-4 households per zone visited. The population breakdown by age and gender:
Adult males: 9.3%
Adult females: 25.5%
Children over 5 years of age: 50.6%
Children under 5 years of age: 19.6%
Elderly living alone 4% (8% of the households)
Most of the male and approximately half of the female population were over 50 years of age.
Most of the families live in their own house, with a minority living in rented homes, or in homes
which had been evacuated nine months ago by relatives. Houses are generally made of stone with
tin roofs and are equipped with a wood or kerosene stove, kitchen utensils and beds.
5. Senafe Town/ Food Supply at Household Level

Even though the household food supply was occasionally under-reported, all the households were
found to have some food:
99% had wheat (an average of 4kg/person)
99.5% had oil (an average of 0.4 liters/person)
43% had sugar
The survey took place approximately three weeks after the ICRC food distribution and four
weeks after the ICRC wheat distribution. According to ICRC, their food distribution was
intended as a supplement to what the population had as a baseline and included 10.7kg of wheat,
1 liter of oil, 2 kg of pulse, 1 kg of sugar, 10.5 kg of tea, 0.25 kg of salt per person per month, and
soap. Food was distributed per family.
In zones 1-7 and in Tisha, none of the families visited owned any animals. However the
neighboring villages of Afoma and Matera have land for agriculture and animal rearing, and more
than 50% of the population in these two villages own oxen, goats, sheep and/or donkeys. Afoma
has four wells, but the water pumps were removed by the soldiers, and therefore now depend on
rain for their crops.
6. Senafe Town/ Health and Nutrition

The nutritional status of children under 5 years of age was assessed during the household survey.
Of the 40 children reported in the 37 families visited, 28 had a green MUAC (normal), and 5 had
a yellow MUAC but wt/ht over 80% (normal). Of the 7 children not checked, 4 were absent, and
3 were <6months of age. This findings are supported by the screening done in our dispensary,
where the number of moderately (wt/ht <80%) and severely malnourished (wt/ht <70%) children
has been relatively low. For the whole sub-zone of Senafe of 176 children under five seen in
consultation, more than 50% have been screened for malnutrition, 5 have been found to have
moderate malnutrition, and 4 (including one child from the town of Senafe) ware found to have
severe malnutrition. The incidence of severe malnutrition would be about 4% in this very biased
group of children.
In the survey, at least 10% of the households were composed of only people over 50 years of age,
whereas in 10% of the households women were taking care of both their children and their
parents. In at least 4 households, there were people with mental disorders, including severe
depression/social withdrawal requiring total care. Five children < 5 yrs of age had current
illnesses including cough, fever, vomiting/diarrhea and one partially treated TB patient. Of 53
children born in those households in the last 5 years, 8 had died, and 50% of these deaths had
taken place in the last 9 months (diarrhea x 3, fever x 1).
After the MOH evacuation, Senafe received health services provided by an informally trained
health worker who had been an employee of the Caritas dispensary prior to the last offensive.
His only support came from ICRC in the form of donated basic drugs (paracetamol, chloroquine,
some basic antibiotics etc.) and transport of patients to Adigrat Hospital when very patients were
very ill. Unfortunately no records were kept of these medical activities during the last 9 months.
For disease patterns documented after the opening of the MSF-F dispensary, please see our
weekly activity reports. During the last nine months, the <5 population was immunized against
Polio on two different occasions, however there was no campaign against Measles.
7. Senafe Town/ Non-Food Items

On the average, the reported monthly expenditures in non-food items per family included:
135 nakfa in wood
27 nakfa in kerosene
37 nakfa (3 nakfa/person) in water (obtained mostly through general population pumps,
occasionally through running water within the house, or wells)
More than 95% of the families use wood as primary source of fuel, and 50% of the households
use kerosene when available. There is a shortage of currency, although some manage to trade
their wheat, oil, etc for other non-item foods. Among the NFI most consistently reported as
needed were clothes and shoes.
8. Senafe Town/ Security Issues

Although none of the households visited had experienced thefts, or even heard of such incidents
in their neighborhoods, more than 90% reported fear of theft as the number one security issue,
and voiced concern over the absence of local police authorities and the administration.
9. Serha Village
The village of Serha is located south of Senafe Town, the last village before the southern
boundary of the TSZ on the main road between Senafe Town & Zalambesa. The population of
the village was of approx. 800 before the last offensive and currently of approx. 394 (150 <5
children). The population is mostly a mix of elderly people & young children. It is one of the
only village in Senafe Sub Zoba which was totally destroyed during and after the last offensive
(private houses in concrete & public buildings, including the health post which was operated by
the MOH prior to the last offensive). The remaining population of the village resettled in the
country side few kilometers west from the destroyed village. The Ethiopian forces
positions/trenches are at a maximum of 5km south from the inhabitants households and the
population is reporting acts of harassment (stealing of goats, threats, thefts). The population of
that area is certainly living in fear and is complaining about the absence of basic security
During the war, the population was living in Tisha camp (near Senafe Town). During Ethiopian
occupation, they came back to Serha and were able to get health services in Tsaeda Korso.
Since the Ethiopians withdraw few weeks ago, they need to go to Senafe Town to get health
services from the MSF-F dispensary. Health status of the populations is not alarming, same as
nutrition status of the <5 population. Since the population came back in the area (nine months
ago), three deaths were reported (epilepsy, heart problem and TB case). 12 babies were born in
the area in the past nine months. Polio vaccination was done in Tsaeda Korso during Ethiopian
occupation. We did spontaneous MUAC screening during our visit and among a very small
sample of 15 children screened, 9 were normal, 4 were at risk of malnutrition and 2 were possibly
moderate malnutrition cases (we did only MUAC screening).
In terms of water and sanitation, the population is going directly to the river to fetch water. There is
a spring down in the country side. The water points in town were destroyed. There is clearly
problems in terms of sanitation/ hygiene among the population, particularly when you look at the
condition of the children. During Ethiopian occupation, the population got 4 food rations and since
Ethiopians withdraw, they are receiving the monthly food ration from the ICRC in Tsaeda Korso
(one time already). The school was also destroyed.
10. Tsaeda Korso Village
There is currently approx. 450 people living in this village which is located few kilometers north
of Serha village on the main road between Senafe Town and Zalambesa. The population
configuration is quite the same as in Serha. This village is intact except for the 5 water pumps
which were destroyed. The population is currently going to Serha to fetch water from the river.
The ICRC monthly food distribution for 68 villages is currently done in this village (one time
already). Like for Serha, the population reported 4 food distributions during Ethiopian
occupation. The school is close. Prior to the last offensive, the population was going to Forto
health post (managed by the MOH).
During Ethiopian occupation, a health post was functioning and supported by the ICRC in this
location. The building which was used at that time is still intact. Consultation room, dressing
room and pharmacy were operational. Emergency cases were transferred to Adi Grat. This
health post closed when the Ethiopian forces withdraw from the area (19/02/2001) and now, the
population is coming to Senafe Town for health services. Polio vaccination was also done during
Ethiopian occupation. Three people over 50 years of age died in the past ten months in the area
(chronicle disease cases). But the nutritional & health status of this population seems stable and
no specific morbidity pattern was reported to us. The main issue now is access to health services
(like for Serha village) since the population have to walk to Senafe Town to get medical care
(more then two hours of walk). Here also, problems seems to be more related to the water &
sanitation situation (access to safe & potable water, hygiene conditions).
11. Forto Village
This village is located few kilometers north of Tsaeda Korso village on the main road between
Senafe Town and Zalambessa. The distance between Forto and Tsaeda Korso is of approx.
10 kilometers. The population of the village and surroundings if of approx. 500 people. An
MOH health post was operational in this village prior to the last offensive. The structure needs
rehabilitation work (roof, windows, doors) but the structure is intact. Same situation for the
school, which is close. Private houses are also intact.
The humanitarian picture (food, health, nutrition, sanitation/ hygiene) is the same as the one
described for Tsaeda Korso village. In terms of access to safe & potable water, the population is
fetching water from a well in the village, but this well needs rehabilitation work as soon as
possible since it is open & not protected (animals are going there, the distribution area is very
dirty, etc.). A <5 children died in this village two weeks before the assessment (diarrhea case, the
only death reported) and we can expect more health problems linked to the water situation in the
coming weeks, more particularly when the displaced population will come back from the camps.
12. Rokoyto Village
The humanitarian situation in this village is the most positive one that we were able to see outside
of Senafe Town. A health post serving 40 surrounding villages is operational with one health
assistant (between 10 and 30 consultations per day), a water distribution point was rehabilitated
by the ICRC and is providing sufficient water to the whole population of the agglomeration and
for the animals. The private houses are intact and good number of goats & cattle were seen in the
area. People are also cultivating. This village is at approximately 45 minutes of drive west from
Forto village. The current population of the village is of approx. 600 people and 3000 people
were living here prior to the last offensive. For the food distribution situation, the same pattern as
described above during Ethiopian occupation and since the withdrawal. But the population is
complaining that the ICRC food distribution is not enough (no milk, no DMK). The school was
looted but the structure is intact.
The morbidity patterns are the one for a normal health post (malaria, pneumonia, eye disease,
anemia, respiratory infection, diarrhea, gastritis, abdominal pain, etc.). No specific morbidity
patterns that we can link with a potential epidemic. Again here, polio vaccination was done
during Ethiopian occupation. During Ethiopian occupation, 3 deaths were reported by the health
assistant; 2 tuberculosis cases and 1 malaria case (all >50 years old). There is no sign of
malnutrition among the <5 population but here again, sanitation/hygiene seems a problem when
we look at the condition of the children. According to the statistics of the health assistant, there is
a significant number of tuberculosis cases in this area.
13. Rokoyto Displaced Camp
Approximately 15 kilometers east from Rokoyto village, a population of 350 people are living in
a camp under tents. The population of this camp is coming from Ambesete Geleba village
(extreme south-center of the Sub Zoba, between Zalambesa & Serha). It is difficult to say for the
moment if their village of origin is falling inside or outside the Temporary Security Zone (TSZ).
This caseload was displaced from Ambesete Geleba to this camp in 1998. During the last
offensive, the healthiest people from this camp were able to move to Harena camp. The
population left behind in the camp is mostly a mix of elderly people, women and young children.
The global picture is preoccupying in terms of living condition. The tents are old, the camp is
located in a remote area, the non food items seen in the tents (jerry cans, blankets, cooking sets)
are in limited number and old (most probably distributed in 1998). In addition to that, the
population is fetching water directly from the river near the camp (quality is questionable).
They are going to Rokoyto for heath services and they are included in the food distribution of the
ICRC in Rokoyto. Because we are mostly talking about mix of elderly and young children, the
health status of this population is more fragile. Three people died in this camp during Ethiopian
occupation (all cases of tuberculosis) and we saw few other cases of TB among the population.
Malaria seems also a problem which can increase in the coming weeks. All children screened for
malnutrition (MUAC) were normal.
The population don’t want to move from this camp until the return of the civilian administration
in the area. For the moment, they are requesting assistance to improve their living condition.
Their only wish is to go back to Ambesete Gelaba. When the civilian administration will come
back in the Sub Zoba, a quick decision will have to be taken about this caseload. If the village of
origin is falling inside the TSZ, the best option is a fast return there. If it is not falling inside the
TSZ, the best option is to resettle this displaced population to a less remote area near Senafe
Town where they will have easier access to health services, humanitarian assistance, etc.
14. Menekuseyto Village
This village is located at the extreme south of the Sub Zoba, very close to the southern boundary
of the TSZ, at approximately 25 kilometers from Senafe Town. The current population is of
approx. 300 people and prior to the last offensive, 800 people were living here. It is the only
village where we were not able to find any counterpart. The population is still living in fear and
we can presume, according to some individual interviews, that there is still an Ethiopian presence
in the area (or so called Eritrean opposition). The population is cultivating and there is a good
number of cattle/ goats in the area.
The population is mostly a mix of children, women and elderly people. The health post is intact
but closed one year ago. Small scale rehabilitation work needs to be done, mostly for the water
supply (windows, doors, roof and even material inside the structure were not looted). During
Ethiopian occupation, a priest was giving basic drugs to the population which had otherwise
access to the health post of Zigfet (operational during Ethiopian occupation). The <5 population
was immunized against Polio in Zigfet. Same situation here in terms of health status or
nutritional status of the population as described above for the other villages. We are talking about
normal morbidity patterns, no signs of a potential alarming situation. Four deaths were reported
during Ethiopian occupation (2 >50 years old TB cases and 2 <1 month old children who did not
survive after birth). The main problem is access to health services. The village is at five hours of
walk from Senafe Town and a good number of people needs to be treated for chronicle disease
(TB, diabetes, etc.). It must be a priority to open soon a health post in this area.
Another problem is again access to safe & potable water. The population is going directly to the
river, with the animals, to fetch water. In terms of food distribution, the same situation here as
described above for the period of Ethiopian occupation & after withdrawal. The school is intact
but close.

15. Zigfet Village
This village is located at approximately 15 kilometers south of Senafe Town on the way to
Menekuseyto, with a current population of approx. 280 people (500 prior to the last offensive).
The land is fertile, people are cultivating and there is a good number of cattle/ goats. Population
composition is a mix of children, women and elderly. Food distribution pattern is the same here
as what was described above from the period of Ethiopian occupation and after the withdrawal.
A health post managed by a Christian congregation prior to the last offensive was supported by
the ICRC during Ethiopian occupation, providing basic health services (pharmacy, dressing,
consultations, polio immunization). This health post is intact and can be used immediately. It is
close since Ethiopian withdrawal and the population is currently walking 3 hours to get health
services in Senafe Town dispensary. The school is also close but intact. With the exception of
significant number of diarrhea cases among the <5 population, the health and nutritional status of
the population is quite the same as what was seen in the other villages that we visited. Diarrhea
cases are most probably linked to the problem of access to safe & potable water. A well located
in the town was destroyed, so now the population is going directly to the river to fetch water.

17. Conclusions

The general health and nutritional status of the population in Senafe Sub Zoba remained stable
during the last nine months. The mortality patterns reflect the direct effect of war more than a
change in morbidity patterns. The current health needs are those typical of the age groups
remaining behind, and the psychological consequences of war. One of the main problem is about
easy access to health services since there is currently only one health posts operational for the
whole Sub Zoba outside of Senafe Town. The second one is about access to safe and potable
water and sanitation.
The current fragile but stable situation in terms of health & nutritional status of the population
can potentially be disturb by the return of the displaced populations. Population figures will
double and the pressure in terms of access to water, food and health services can potentially be
problematic if no rapid humanitarian response is organize prior to the return from the camps.
An additional information is about the health post of Golo village (approximately 20 kilometers
north of Senafe Town, few kilometers north of the TSZ), which was operated by the MOH prior
to the last offensive. This health post was closed when the MOH withdraw in May 2000. The
structure was looted but intact with a need for rehabilitation work (doors, windows, roof). The
population of that area (approx. 750 people in Golo village and ten surrounding villages) is
currently coming to Senafe Town for health services.
There will be a need for Measles vaccine campaign, as this was not done along with Polio. To
make it easier, MSF-F will do the campaign before the IDP’s return to Senafe.
The nutritional status has remained stable, and so far there seems to be no indication for
development of targeted supplementary feeding programs in the town of Senafe.


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