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WHEN HOPE WEARS A WHITE COAT: Inside Kule Refugee Camp

Ayele Addis Ambelu Journalist at Africa News Channel and Ethiopian Mass Media (EMMA NEWS) Media Educator at Bahir Dar University. c천지일보 At dawn in Kule Refugee Camp, the dust rises before the sun. Mothers wrap shawls around feverish children. Health workers in white vests unlock the outpatient department. A line forms outside a 104-bed health center before the gates even open. Somewhere inside, a newborn cries. Outside, the wind carries a whisper: “When the world looks at us, we run from death. But death is also here.” I am standing in Kule Refugee Camp approximately 800 kilometers away from Addis Ababa and just 40 kilometers from Gambella town. Established on May 2014 and coordinated by the Refugees and Returnees Service (RRS), the 27,000m2 camp shelters more than 55,000 South Sudanese refugees as of October 2022. Around it, 59,212 host community members live in the woreda and 3,736 in Terpham kebele live with the shared weight of flood, conflict, and economic strain. Seven camps across Gambella host refugees from South Sudan. Kule is one of the largest. Five schools, one health center, one clinic, and two food distribution centers. On paper, the infrastructure exists, in reality, the needs exceed the lines drawn on maps. And yet, in this fragile geography of displacement, hope survives, in hospital wards, in vaccination campaigns, in the steady hands of doctors who refuse to look away. A Camp at the Crossroads of Global Crisis According to the latest global data from the United Nations High Commissioner for Refugees, more than 110 million people worldwide are forcibly displaced by conflict, persecution, and climate shocks. Ethiopia itself hosts one of Africa’s largest refugee populations. Kule’s demographic structure tells its own story of vulnerability: 8,811 children aged 0–4 12,878 children aged 5–11 9,927 adolescents aged 12–17 18,758 adults aged 18–59 1,150 elders over 60 Women outnumber men 28,091 to 23,433 many heading households alone after war fractured families in South Sudan. Humanitarian aid is stretched thin globally. Funding cuts ripple through refugee education programs. In Kule, schools have closed in recent months due to budget shortages. Children roam the camp instead of learning. MSF for the Medical Care Since 2013, Médecins Sans Frontières (MSF) has provided comprehensive care in the region and moved to Kule in 2014 following the Camp’s establishemnt. According to the 2025 MSF Ethiopia Annual Report, Kule remains one of its most intensive operations in the country, responding to malaria, cholera, malnutrition, and mass casualty incidents. MSF runs a 104-bed capacity health facility (primary and secondary health care services). Inside the health center, beds are rarely empty. Seventy-five percent (75%) occupancy is common; at times, it is higher. The corridors smell of disinfectant and boiled porridge for malnourished children. Million Melaku, an MSF medical team leader assistant, speaks calmly but with urgency: “We provide outpatient consultations, emergency services, surgical referrals, maternal & child health , inpatient admissions, vaccination, therapeutic feeding program for severe malnourished children under 5, chronic care (TB and HIV treatment, Snake bite, Kala Azar, etc.), WatSan & Infection & Prevention Control, health promotion, mental health and psycho-social support, treatment for survivors of sexual and gender-based violence." MSF’s services here are both primary and secondary: outpatient consultations, inpatient admissions, maternity care, and malnutrition treatment through an Inpatient Therapeutic Feeding Centre (ITFC), surgical referrals, mental health sessions, and SGBV support. In 2025 alone at Kule: 164,886 outpatient consultations 10,101 inpatient admissions 61,399 malaria patients treated 1,400 cholera cases managed 3,701 children vaccinated with the R21 malaria vaccine Nearly 50% reduction in malaria-related deaths compared to 2024 The introduction of the R21 malaria vaccine approved by the World Health Organization marked a historic first in Ethiopia: the first full vaccination round completed in a refugee camp globally. A doctor in the pediatric ward tells me: “Most of our patients are children under five. Mostly with Malaria, severe acute malnutrition or pneumonia. When food rations are delayed, the admissions increase.” 2025년 7월 에티오피아 감벨라 지역 쿨레 난민촌에 있는 국경없는의사회(MSF) 외래진료과(OPD)에서 대기 중인 환자들. Women in the Eye of the Storm Kule is a camp of mothers. Nyabol Jock sits beside her twins in the maternity ward at MSF health center. She has been hospitalized for seven days. “They treated me well,” she says. “They stayed with me day and night.” Ntajuok Tut also shared similar experience “They are with us 24 hours for our health doing all they can for our health.” But healthcare cannot replace food. Women representatives speak bluntly: “MSF is strong in health. But food support is low. When there is no food, children come back to the hospital.” Sexual and gender-based violence (SGBV) compounds with trauma. Survivors receive confidential clinical care, post-exposure prophylaxis, counseling, and referrals. An MSF mental health counselor explains: “We never ask survivors to relive trauma. We focus on recovery. Safety first. Dignity always.” Nyajnok Tut Lual, a community representative, tells me: “Women suffer a lot, no water, no firewood. When we go outside, we risk attack.” Psychosocial support sessions fill small rooms daily. Trauma does not end when conflict stops; it migrates with the displaced. Education Closed, Futures Suspended Funding cuts have shuttered refugee schools in Kule. Klur Malooth, a youth representative, says: “We escaped the war and found safety. But without education, what future do we have?” Globally, humanitarian appeals remain underfunded. The United Nations Office for the Coordination of Humanitarian Affairs has repeatedly warned of severe funding gaps affecting food assistance, education, and protection services in displacement settings. Global Patterns, Local Realities From Afar’s malnutrition wards to Tigray’s mental health programs and Somali Region’s emergency vaccination campaigns, MSF’s footprint across Ethiopia reveals a pattern: need layered upon needs. Armed conflict. Epidemics. Displacement. In Gambella, climate change compounds with conflict and then seasonal floods isolate communities. Malaria surges with rising temperatures. Cholera follows contaminated water. The World Food Programme reports rising global hunger levels due to conflict and climate variability. Food pipeline disruptions directly impact refugee rations. In Kule, reduced food assistance correlates with spikes in malnutrition admissions. The world faces what experts call a “polycrisis” overlapping global emergencies. But in Kule, it is not theory. It is a child with a fever. A mother with anemia. A malnourished toddler struggling to breathe. Case Study: The Malaria Vaccine That Changed the Curve One story stands as a model for global solidarity: the R21 malaria vaccination campaign. Malaria has long been a leading killer in Gambella. In 2024–2025, MSF introduced the WHO-approved R21 vaccine in Kule. By November 2025, 3,701 children received full vaccination. Malaria related deaths dropped by nearly half compared to the previous year. This was not just a medical intervention. Broader prevention and control efforts include vector control measures such as indoor residual spraying and environmental management, alongside community outreach activities focused on mosquito net distribution and education. It was a message: Even in a refugee camp. Even amid funding cuts. Even in a remote corner 817 kilometers from the capital. Innovation and coordination can save lives. The Workforce of Witnesses MSF employs about 1,500 local personnel in Ethiopia. Many cross conflict lines and hard to reach areas to reach patients. An MSF nurse tells me quietly: “We do not choose sides. We care for everyone who needs us .” Founded in 1971 and awarded the Nobel Peace Prize in 1999, MSF operates under principles of Medical Ethics, neutrality, independence, and impartiality. . “What One Message Should the World Hear?” I ask the closing question to every interviewee. Nyakoch Rick, a women’s representative, answers: “Do not forget us. We did not choose to leave our homes.” Klur Malooth says: “Education is as important as food.” Million Melaku states: “Sustained funding. Without it, the burden doubles.” Mr. Khan adds: “Support both refugees and host communities together.” An anonymous survivor of violence whispers through a counselor: “Support saved my life.” Wiyual Gach, an elder, reflects: “We pray every day to return home. But peace is not coming. Our hope is not real yet.” 2025년 7월 에티오피아 감벨라에서 국경없는의료구호단체(MSF)가 쿨레 난민 캠프에 설립한 중증 급성 영양실조 아동들을 위한 입원 치료식 센터(ITFC) 2단계 시설. Hope vs. Disaster The world is at a crossroads. Global displacement is rising. Climate shocks intensify. Humanitarian budgets shrink. Yet in the camp in western Ethiopia, hope wears a white coat. It administers vaccines. It transfuses blood. It counsel's trauma. It listens. Kule is not only a story of a crisis. It is a story of coordination, RRS, and partners working in alignment. It is a story of resilience: 55,000 refugees surviving in land not their own. It is a story of warning: if global solidarity fails, camps like Kule will bear the cost first. As the sun sets over Gambella’s plains, mothers still line up outside the clinic. Children still cough in the dust. Elders still pray for return. And somewhere inside the health center, a newborn takes her first breath. The world may be torn between hope and disaster. In Kule, the choice is made every morning: To stand. To treat. To witness. To hope.