1 Total Population Affected: Total Children Affected

March 16, 2021 UNICEF ETHIOPIA COUNTRY OFFICE TIGRAY PREPAREDNESS AND RESPONSE PLAN March – September 2021 SITUATION OVERVIEW Ethiopia’s humanitarian crisis in the north of the country has moved into th 1 its 5 month. According to the HNO the conflict in the Tigray Region Total population affected: has prompted a major displacement within the region and outside, with 12.7 millionmillion, (150,083 refugees) a large part of the regions 5.7 million inhabitants in need of emergency assistance and protection. Total children affected: Total children affected: 1,334,185 children: UNICEF has seen greater access to the region and as such have revised 1,334,185 children, (84,797 its response plan to match the greater and upcoming needs of the refugees) population. This plan seeks to increase the capacity of UNICEF to sustain Total people to be targeted existing support to the already existing vulnerable population in Tigray, Total2,676,021 people to be targeted to advocate for protection, freedom of movement, ensure 2,826,104, including 1,334,185 unhampered, safe and equitable access to goods, services, and the childrenTotal children to be targeted protection of the civilian population. 1.34 million Total children to be targeted The plan also seeks to respond to the protection and assistance needs 1.34Total million estimated cost: of an additional caseload of people that are likely to be affected in $31.49 million Amhara and Afar regions by the on-going crisis in the next six months Total estimated cost: (March 2021 to September 2021). $ 47.0 million HUMANITARIAN CONCERNS The security situation in Tigray remains volatile and unpredictable. Displaced people moving across Tigray continue to be verified and are growing. A complete communication blackout was experienced again in February 2021 again affecting the humanitarian operations, and limiting the ability to collect, assess, and share information on emerging humanitarian needs. With better access for humanitarian actors, serious allegations of violence and atrocities are being reported2. Even though two refugee camps located in the northwestern part of the region remain inaccessible by any partner or the UN, the relocation of refugees from Hitsats and Shimelba to May-Ayni and Adi-Harush camps is ongoing with a high number of refugees remaining unaccounted for, including unaccompanied and separated children (UASC). The UN High Commissioner for Human Rights, in a statement published on the 4th of March, informed that its Office has been receiving information about ongoing fighting across the region, incidents of looting by various armed actors, indiscriminate shelling, mass killings, more than 136 cases of rape, indicating that there are many more such unreported cases3. According to the draft HRP only 77,000 people in Mekelle and its surroundings, and nearly 300,000 people in areas of Eastern Tigray have received food support from humanitarian partners. 1https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/documents/files/ethiopia_2021_humanitarian_needs_overview_hn o.pdf 2 https://www.dw.com/en/ethiopia-un-officials-allege-war-crimes-in-tigray/a-56777495 3 https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=26838&LangID=E 1 March 16, 2021 According to NDRMC the Government of Ethiopia has reached 2,007,882 people with emergency food distribution in Tigray as of Feb 8/2021. As noted, and while the actual impact and the humanitarian consequences of the conflict continue to evolve and become clearer, below are some of the impacts expected to be tackled: ▪ loss of life, widespread destruction and a subsequent dramatic increase in the humanitarian caseload, including mass displacement; ▪ increased exposure of already vulnerable populations4, particularly children, women, IDPs, refugees, migrants, safety net clients, the elderly and the disabled to exploitative conditions as well as various forms of abuse, who in the absence of access to essential services, may also likely resort to negative coping mechanisms, that would further endanger their wellbeing; ▪ overall inability of the humanitarian community to meet the new as well as the existing humanitarian needs, financially as well as operationally ▪ impact of the conflict on COVID-19 preventative efforts, abandonment of preventive measures, shortage of PPE, disruption of preventive/curative health services, disruption of WASH services, leading to an increase in infections and morbidity/fatalities. KEY SECTORAL HUMANITARIAN NEEDS HEALTH ▪ Tigray region had a well decentralized primary health care (PHC) system with a network of 919 health facilities; today, only a few hospitals and health centers are confirmed functional and accessible, though severely damaged and looted. ▪ So far, the number of health facilities confirmed to have resumed their services with medicines and supplies delivered has reached 88 in all five zones of Tigray. ▪ Out of 263 health facilities (40 hospitals and 223 health centres) in the region, 205 have been assessed and 162 (79%) have infrastructure not damaged; 24 partially damaged (12%) and 19 fully damaged (9%). However, equipment is fully damaged in 104 (51%) due to attacks and conflict. ▪ Out of 186 health facilities assessed in terms of functionality, 40 health facilities are fully functional (22%), 36 partially (19%), while 110 (59 %) are non-functional. Major cause for non-functionality are lack of supplies (31%), staff (25%) and equipment (26%). WASH ▪ Damages to WASH facilities in Tigray have been identified by the Regional Water Bureau (RWB). Based on the assessment conducted and estimated in hard-to-reach areas, around 2 Billion ETB (US$ 51 million) is required to fix the damages and resume functionality of WASH facilities, including both water and sanitation. ▪ Recent assessments in 13 towns have revealed that 57 per cent of the boreholes are not functional, namely 47 boreholes in Adigrat, Wukro, Mekelle, Adaga-Harmus, Agulae, Negash, Tsigereda, Hagereselam, Adigudom, Samre, Gilet Fanruba and Dengolat. The HeRAMS assessment has further revealed that out of 53 assessed health facilities, most have water sources from piped supply network (42 per cent); tanker truck (17 per cent); unprotected springs (13 per cent); boreholes (11 per cent) and 4 The fact that Tigray has been one of the worst-affected regions by the ongoing desert locust infestation, and the current threats of new swarms arriving in the coming weeks damaging crops, pasture and rangeland, is likely to make a dire situation even worse as far as food security and livelihoods are concerned. Furthermore, another key humanitarian concern as highlighted by UNOCHA is the possible interruption of COVID-19 prevention and control activities, in the connection to the Tigray conflict. According to an internal situational update from UNICEF Tigray Field Office, as of October 29, a total of 85,809 COVID-19 tests had been conducted in the region, with a total of 6,666 confirmed positive cases and 45 deaths in total and 1,233 cases under treatment centers. Similarly, the Ethiopian Public Health Institute Sitrep No. 277 of October 31, had put the region as third in terms of its COVID-19 caseload, while its daily testing capacity has been challenged by shortage of reagents and testing kits, a trend that was already noticeable across the country even before the conflict erupted. 2 March 16, 2021 unprotected dug wells (9 per cent). In terms of sanitation, among 70 assessed facilities, 63 per cent have pit latrines or improved latrines; while 27 per cent have flush/pour-flush to piped sewer system or septic tanks. Uncovered pit latrines are used in 6 per cent of the facilities and 4 per cent use flush pour-flush without water. ▪ Most water supply infrastructure has been damaged or looted, and information from 10 sites assessed by UNICEF, shows that over 700,000 people are facing severe water supply shortages and though bill of quantities and prices being finalized, it is estimated that up to $5mill will be required to restore water supply services in the 10 towns alone. NUTRITION ▪ Even before the beginning of the crisis in November 2020, Tigray had higher rates of stunting than the rest of the country (48.7 % as compared to 39.3% as the national average) and the rate of wasting was 2% above the national average. ▪ Prior to the crisis according to the 2019 mini EDHS, the wasting prevalence (GAM) in Tigray was 9.2 % (2% higher than the national average of 7.2%). ▪ After the crisis 5 partners screened in February 7,039 under five children in multiple locations with 168 (2.4%) SAM and 950 (13.5%) MAM. ▪ In February 2021 week 3 alone, the nutrition situation of children under-five based on malnutrition screening indicated the following: out of 984 children under five screened in 3 accessible woredas in Tigray, the analysis showed 7.2% moderate acute malnutrition and 4.1% severe acute malnutrition giving an approximate wasting rate of 11.3%, which is considered high. ▪ SAM admissions are projected to be even higher in 2021 according to the different scenarios: i) 15,761 children (54% increase of 2020 admissions), ii) 22,065 children (double of 2020 admissions). ▪ With a conservative 3% SAM estimate (1.3 % pre-crisis, according to the 2019 TSA Nutrition Survey), UNICEF has already mobilized resources from CERF-RR and FCDO to meet the needs. However, if we reach 7% of SAM an additional USD 2.4 million would be required to procure the necessary supplies. In addition USD 4.5 million is required to support partnership with CSOs for nutrition interventions and set up 22 Mobile Health and Nutrition Teams (MHNT) in all seven Zones in Tigray . ▪ In terms of nutrition the HeRAMS5 assessment has so far revealed that among 76 facilities there is Middle Upper Arm Circumference (MUAC) screening only in 14 of them (18 per cent; partially available in 36 health facilities (47%) and in 14 health facilities MUAC screening not available (17%).

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