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As East Africa grapples with an escalating crisis driven by a combination of climate shocks, persistent conflicts, and the resultant displacement of populations, the humanitarian situation for internally displaced persons (IDPs) and refugees has reached alarming levels. The limited availability of essential health services, coupled with inadequate water, sanitation, and hygiene (WASH) facilities, has exacerbated the vulnerabilities of these communities. This situation is particularly concerning for women and girls, who are at heightened risk of gender-based violence in such precarious environments.
The region is currently enduring the repercussions of a historic four-year drought that has devastated agricultural productivity and led to widespread displacement. According to the Food and Agriculture Organization (FAO), the drought has caused crop failures in up to 80 percent of the affected areas, severely impacting food security. This crisis has been further aggravated by extreme weather patterns linked to climate change.
From March to May 2024, heavy rains and flooding affected approximately 1.6 million people across Eastern Africa. Countries like South Sudan and Sudan are facing severe flooding, worsened by the release of 2,600 cubic meters of water per second from a dam in Uganda, impacting over 789,000 individuals. These floods have not only displaced families but have also inundated homes, destroyed crops, and disrupted essential services.
According to the Greater Horn of Africa (GHoA) Food Insecurity and Health Crisis 2024 Public Health Situation Analysis (PHSA), the situation is grim. Over 20 million people in the GHoA are estimated to be acutely food insecure, with about 5.6 million facing emergency levels of food insecurity classified as IPC Phase 4.
Reports from humanitarian organizations indicate that food prices have surged by up to 200 percent in some areas, making it increasingly difficult for families to access basic necessities. The prolonged drought has had a devastating impact on agricultural production, leading to significant crop failures and livestock losses. This not only undermines food security but also disrupts livelihoods, pushing many families into extreme poverty.
The report also highlights alarming malnutrition rates among children and pregnant or lactating women, with certain regions reporting rates exceeding the emergency threshold of 15 percent. The nutritional status of these vulnerable groups is critical, as malnutrition can lead to severe health complications, long-term developmental issues in children, and increased maternal mortality rates.
The health implications of this crisis are severe. The heavy rains have led to a resurgence of waterborne diseases, exacerbating existing health vulnerabilities in the region. Sudan is currently grappling with a new cholera outbreak, with over 1,500 reported cases since early 2024. Meanwhile, South Sudan is seeing a significant rise in malaria cases, with the World Health Organization (WHO) reporting a 50 percent increase in malaria infections compared to the previous year. The combination of flooding and the proliferation of such diseases poses a major public health threat, especially in areas where healthcare infrastructure is already compromised due to ongoing conflicts and historical environmental crises. In addition to these, access to clean water is critically limited, forcing many communities to rely on unsafe water sources, which further heightens the risk of disease transmission.
The backdrop of this crisis includes heightened vulnerability stemming from the prolonged drought and subsequent flooding in late 2023 that displaced more than four million people in the Horn of Africa. The heavy rainfall from March to May 2024 has resulted in riverine floods, flash floods, and landslides across several countries, including Kenya, Somalia, Ethiopia, and Uganda.
In Kenya, the impact has been particularly severe, undermining communities’ coping capacities and making them increasingly susceptible to food insecurity, malnutrition, and disease. The Kenyan Red Cross reported that more than one million people have been affected by flooding, forcing many into overcrowded IDP camps where living conditions are dire, and resources are scarce.
In these camps, the lack of adequate shelter, sanitation facilities, and healthcare services creates an environment ripe for the spread of diseases. Overcrowding in these settings often leads to the rapid transmission of infectious diseases, while limited access to medical care means that even minor health issues can escalate into life-threatening conditions. The psychological toll on displaced individuals, particularly women and children, is also significant, as they face daily challenges that threaten their safety and well-being. Reports from humanitarian organizations indicate an increase in mental health issues, including anxiety and depression, among displaced populations.
The ongoing conflicts in Sudan, South Sudan, Ethiopia, and Somalia further complicate the situation. Armed conflicts disrupt essential health services and WASH infrastructure, leading to shortages of food and non-food items. In conflict-affected areas, healthcare systems are under immense strain, with healthcare workers often fleeing or being unable to operate, leaving communities without vital medical care. A recent report by the International Rescue Committee (IRC) highlights that 70 percent of health facilities in conflict zones are non-functional, severely limiting access to necessary medical care. The disruption of surveillance and vector control efforts further exacerbate the risk of disease outbreaks, while humanitarian access remains limited, complicating the delivery of aid and support to those in need. The violence not only displaces populations but also hampers the efforts of humanitarian organizations to provide crucial assistance.
Looking ahead, predictions indicate that from August to October 2024, wetter-than-usual conditions are expected in central to northern Ethiopia, South Sudan, Sudan, Uganda, and parts of western Kenya. In contrast, eastern areas, particularly western Ethiopia and parts of northwestern South Sudan, may experience drier conditions. This unpredictable climate pattern poses further risks to food security and the stability of health services in the region. The possibility of continued flooding will place additional stress on already fragile communities, while those facing drought will struggle with dwindling resources and increased competition for food and water.
Furthermore, there is a 66 percent likelihood of a La Niña phenomenon occurring between September and November 2024. This climatic event could bring heavy rainfall to certain areas while others face drought, complicating the already precarious situation in the Horn of Africa. Historically, La Niña conditions have been associated with droughts in the region, potentially leading to increased healthcare demands, food shortages, and significant public health challenges, including the resurgence of vaccine-preventable diseases. As conditions fluctuate, the cyclical nature of these crises will further strain humanitarian efforts and resources.
In 2025, the situation in East Africa will likely be shaped by several ongoing and emerging factors. The region will experience cycles of drought and flooding, leading to increased health risks, particularly for waterborne and vector-borne diseases. Communities will need ongoing support to manage these health threats. As displacement due to conflicts and climate disasters continues, the number of IDPs and refugees may rise, with humanitarian organizations facing challenges in accessing affected populations. Food insecurity will remain a critical issue, necessitating both immediate relief and long-term strategies.
The state of WASH facilities and healthcare infrastructure in refugee and IDP camps will continue to be a pressing concern. Investments in these areas will be essential to prevent disease outbreaks and ensure the well-being of vulnerable populations. The humanitarian response must prioritize the establishment of safe drinking water sources, adequate sanitation facilities, and accessible healthcare services to mitigate the risks associated with overcrowding and unsanitary conditions.
Ongoing conflicts will likely persist, influencing humanitarian access and the overall stability of the region. Efforts to empower women and girls will be vital, especially in light of increased risks of gender-based violence. Support services that provide protection and healthcare for women and girls must be prioritized to mitigate these risks. This includes ensuring access to mental health services, reproductive health care, and safe spaces where women can seek refuge from violence.
There may be heightened global attention and funding directed toward humanitarian responses in East Africa, focusing on climate adaptation and resilience-building initiatives to address the ongoing crises effectively. In light of these challenges, the need for coordinated humanitarian efforts is more critical than ever. Access to essential health services, clean water, and sanitation is paramount to mitigating the impacts of these crises. Health providers must be equipped to address the surge in malaria and cholera cases while ensuring that the most vulnerable populations, particularly women and girls, receive the protection and support they need to safeguard their well-being.
The ongoing challenges in East Africa underscore the urgent need for comprehensive solutions that address the interconnected issues of climate change, public health, and gender-based violence. Without immediate action and sustained support, the consequences of this crisis will continue to unfold, threatening the lives and futures of millions. The international community must rally to provide the necessary resources and support to ensure that essential health services and WASH facilities are made accessible to all, particularly to those most in need.
Contributed by Theódros Tadesse Ayele
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