A year and half ago, the chronic conflict in Ethiopia’s Somali Region scaled up dramatically, exposing civilians to increased violence – including, reportedly, execution and rape – and causing widespread displacement and loss of livelihood. Compounding matters, this year’s drought has pushed large numbers of already vulnerable people to the edge of survival.

“It is the worst drought in the last 30 years,” a Somali-Ethiopian man told the Médecins Sans Frontières (MSF) team in Wardher, a town in eastern Somali Region. Normally, when times are tough, nomadic herders and bush-dwellers are drawn to the towns to wait out the worst of it. But this year the numbers are much larger “because the drought is worse than usual,” says an elder from the town.

“A drought like the current one is a disaster for us,” says an old woman living in the camps on the outskirts of Wardher. “We lost most of our animals and now we have nothing to eat because all we have is our animals to trade and their milk. Out of 40 camels, my family is left with 17 only. Out of 100 goats, now we have only 25 of them, but some families have lost even more of their herd.” As a last resort, many are seeking refuge on the outskirts of towns like Wardher. The camps are dominated by women and children, the men having led their remaining herds to what little pasture they can find, or perhaps deliberately avoiding the towns for fear of being perceived as combatants. Those who do come to the towns at least have a better chance of obtaining food, water and healthcare, whether through clan links or humanitarian aid.

Many are arriving already in urgent need of healthcare and nutritional support. Over the past couple of months, MSF has seen a jump in admissions to its therapeutic feeding program. Obtaining enough food to keep their children – who are particularly vulnerable – from becoming malnourished is a major problem. Not only have the nomadic herds been severely depleted, but harvests are down and importing food to the region is a difficult and dangerous task. Transporters are charging far more than normal, leading to sparse markets and food prices beyond the reach of many. Some food has been delivered through humanitarian channels, but it is sporadic and often doesn’t reach those who need it. MSF recently distributed food in Wardher to help stave off malnutrition but it is a minor stopgap for a widespread acute problem.

MSF has also vaccinated more than 1,300 children under the age of five against measles, and provides primary healthcare, together with the Ministry of Health, to the displaced and resident populations in and around Wardher. A team of community health workers is also busy in the camps alerting people to the health risks of living in cramped and meager conditions, screening children for malnutrition and urging pregnant women and sick people to seek care in the clinic.

Under such circumstances, the provision of independent and impartial humanitarian assistance remains critical. And there is not enough of it. Many humanitarian actors have been deterred from operating in the Somali Region by security concerns, logistical or administrative hassles, or threats to their operating principles. MSF too has faced its share of obstacles, but continues to provide what assistance it can to some of the people who need it most.