Emergency response to acute and complex health emergencies and increased access to health care service for vulnerable populations in Tigray and Afar Regions Ethiopia The project responds to the emergency health needs of conflict-affected and vulnerable communities in the context of the COVID-19 pandemic. The original project is targeting Enderta, Kilete Awulalo and Wukiro, Endega Hamus and Sasie Woredas in Tigray Region where GOAL has current operational presence in responding to the complex humanitarian needs in the sectors of health, nutrition, WASH, ESNFI and protection. The current health activities include capacity strengthening of health facilities, supporting Mobile Health and Nutrition Teams (MHNT) and the provision of essential medical supplies that are affected by the conflict. 
Access into Tigray region has become very challenging, and though access within the region is not an issue, the project staff are not able to access cash, fuel, and other supplies needed to implement the project. The supplies procured under this project could therefore not be delivered to the targeted health facilities. However, there is already high humanitarian need in the nearing regions of Amhara and Afar where the conflict has expanded. Although there are uncertainties in woredas where active conflict is ongoing, IDPs are moving towards the safest places near to the regional capital in Afar. 
Considering the temporary access issues being experienced in Tigray region, GOAL is proposing to extend the project duration of 3 months (up to 31st March 2022) and to expand the target woredas towards Afar region and implement the proposed health activities in the selected woredas (Elidar and Dubti).
The project is proposed for a total 9 months period (including NCE) and will improve the capacity of health facilities to provide lifesaving and essential health care services through minor maintenance of damaged health facilities. The project will also equip essential service rooms and drug stores, and procure and provide emergency medical supplies, which will ensure the provision of basic health care services for conflict affected population in the targeted health facilities.
Health-care services in Tigray and Afar regions are alarmingly limited, leaving hundreds of thousands of people, including those who are chronically ill and others who were injured during the fighting, without adequate access to essential medicines and basic services. Of the nearly 230 health centers in Tigray, only 29 are fully functional, and 5 are partially functional. Ongoing assessments by WHO indicate that 141 of the 198 assessed hospitals and health centers were either partially or fully damaged. All hospitals and health centers urgently need more medical supplies, drugs and equipment, according to WHO.
Child and maternal services have been drastically disrupted. Less than 16 per cent of the health facilities are providing vaccination services while only 17 per cent are providing maternal services, such as antenatal care and birth delivery, according to health partners. Access to drugs also remains critically low at 16 per cent. Most Woreda health offices are not yet functional, according to the Health Cluster. This project’s targeted woredas are categorized under priority one by the health cluster, because of the damage to the health system and the presence of internally displaced communities. In our current health facility assessment in the project targeted woredas 95% of health posts and 50% of health center and hospitals are totally damaged. 
The conflict in Tigray is having a  spillover effect and is now also affecting Afar region, where health facilities have been looted, basic health care services disrupted and there is huge lack of routine drugs and medical supplies.
Thus, GOAL is planning to implement the same activities mentioned above to the 2 additional woredas in Afar regions, in order to address the surge in health needs and reach the most vulnerable beneficiaries while access to Tigray remains a considerable challenge.