Adawuka Mukna
Adawuka lives in Afar, Ethiopia. Conflict and climate change drive pastoralists like her further from vital services. Her nearest health centre is 50km away - a journey too far and too costly to make.
Meet Adawuka
"My name is Adawuka, and I am 30 years old. I have five children: four girls and a boy. The boy is the youngest. I am eight months pregnant."
Adawuka belongs to a pastoralist community in Afar region. They rely on their livestock for income and sustenance. When she met with a team from Amref Health Africa's mobile outreach service in late February 2024, she was eight months pregnant and experiencing issues.
Pastoralist and mother from Chifra, Afar
Adawuka lives in Chifra, in Ethiopia's arid Afar region. It borders Tigray, where conflict displaced hundreds of thousands of people and damaged vital infrastructure.
In Chifra, the community herd livestock for a living. The landscape is vast, arid and mostly flat where they are.
Though, the wider Afar region is famously picturesque with volcanic mountains and lava lakes, and beautiful flora and fauna. Afar is also one of the hottest places on earth, where temperatures consistently exceed 40 degrees Celsius.
Due to the drought, our livestock moved. Now we’re still living in the place that the livestock has left. Now, this is the worst drought. We moved our cattle to the areas that get rain. We were not displaced by the conflict, but the drought has forced us to move.
Conflict and climate change are impacting Adawuka's life
As drought conditions dried up pasture and water sources, Adawuka and her community have had to travel further and further to find sustenance for their herd.
She says that where they currently are, around Chifra, there are still huge challenges getting water: "There’s also a problem with access to water. The access is only in Mile [several hours' walk away], where there’s also a river. Those who don’t have donkeys have to carry the water on their backs. Those who have donkeys, fetch water by donkey, but it’s not enough."
It is likely that Adawuka and her community will have to move on again, even further from services and vital medical help.
Conflict has played its part in damaging the already-weakened health infrastructure. In Chifra district, there were four health centres and 19 health 'posts' [with more limited services]. All four centres and 11 posts were severely damaged in the conflict, with the rest looted for medicines and equipment.
Since ceasefire in 2022, the regional government has repaired and restored services in most of the centres and posts, and has upgraded one health centre to a primary hospital.
Opportunities and dreams
Adawuka says that the conflict has also cut short her dreams for her children.
"My eldest daughter is 16 years old. She got married. I used to take her to school, and she was in grade 3. In Sisibli school...The school has been destroyed.
"I wanted for her to learn, I was planning for her to get an education, but the school has been destroyed...If the school opens here, I will immediately register her.
"I want my eldest child to benefit from education. And I want to educate my son."
Pictured right is Adawuka's daughter Meyrem Hamed Hussien, aged four.
Adawuka's challenges in pregnancy and childbirth
"[For all my previous pregnancies] I gave birth at home. I didn’t face any problems. Now, after that, I am facing problems and as time passes, my health is becoming weak in my current pregnancy."
Adawuka knows that this pregnancy is different, and that she may not give birth at the expected time because of these complications. Although she lives several hours' journey from the nearest health centre, and the journey alone will cost her between 1,000 and 2,000 birr (£6.50-£13), she knows she must choose the safest method of childbirth she can.
"I have problems [with the pregnancy]. But with your medication [from the mobile clinic], I got relief. I would prefer the best method of childbirth so that I stay healthy. If you tell me to go to the health facility, I will go to the facility."
But she knows there are more challenges that she faces if this is the decision she must take: "The livestock we sell doesn’t cover the cost of medical expenses."
I would prefer to be healthy, I’m saying that. If I have the time and money for it. Money is needed. For transportation, money is needed. For food to eat, money is need. We have financial problems. I trust in Allah and in the way that Allah will support me.
Bringing Health Closer to Adawuka
In between Mille and Chifra, a distance of more than 100km, there is no doctor, says Adawuka.
The Amref-supported mobile clinics bring health workers, essential medicines, vaccinations and disease prevention education to communities like Adawuka's.
Adawuka says a visit to the clinic gave her relief from complications: "Last time, when I was sick, they came and gave me medication, and I got relief from that sickness. After I took that medication, my heartburn was relieved. My gum scars improved. The bad feeling I had at night, has improved. They [the mobile clinic health workers] are better than the town doctors. I personally got improvement thanks to the service. If you take medication for your health, you benefit. If you take medication, it has benefits."
Pictured left, Henok Sitatow (midwife) and Adawuka inside the mobile clinic.
All images were taken in February 2024 (c) Amref Health Africa / Genaye Eshetu