Context

Key points

Geography and Population

Ethiopia is a large, landlocked country located in the Horn of Africa. It shares borders with Eritrea to the north, Djibouti and Somalia to the east, Sudan and South Sudan to the west, and Kenya to the south. The country features great geographical diversity, with much of its landmass comprising mountain ranges and high plateaus divided by the Great Rift Valley. More than half of the country is 1,500 meters or more above sea level.

This topography has resulted in three primary climatic categories: Dega (cool) in the highlands over 2,500 meters above sea level; Woina Dega (warm to cool) in the intermediate zone between 1,500 and 2,500 meters above sea level; and Kolla (warm to hot) in the lowlands.

Overlapping these three temperature tiers are three seasons, defined by the presence or absence of monsoon rains. The season of spring rains (known as Belg), from February to May, features short periods of rainfall. Kiremt, which runs from June to September, is the season of long, monsoon-driven rains. The third season, Bega, brings dry and cool weather for most of the country from October to January.

Ethiopia is now the second most populous country in Africa, after Nigeria. Its population has expanded steadily over time, growing from 66.5 million in 2000 to 100.8 million in 2015. In 2015, 42 percent of the country’s population was under the age of 14.¹

Ethiopia is also an extremely diverse country, consisting of more than 90 distinct ethnic groups who collectively speak more than 80 languages. According to the most recent national census (2007), the largest ethnic groups in Ethiopia are the Oromo and Amhara, who respectively make up 34 percent and 27 percent of the population. The most common religions are Ethiopian Orthodox Christianity (44 percent) and Islam (35 percent).²

In 2015, a large majority of the country’s population (81 percent) resided in rural areas. Two-thirds of all land in Ethiopia is pastoral, used for the grazing and support of cattle, sheep, and other livestock. The herds and flocks – and the people who raise them – are highly mobile, shifting locations with the climate.

Ethiopia’s pastoralists (an estimated 10 to 12 million people) reside mainly in the country’s east, with the Somali and Afar regions respectively accounting for 53 percent and 29 percent of the total. Pastoralism also exists in Tigray, Benishangul-Gumuz, and Gambella regions.³

The relative lack of health infrastructure in pastoralist areas, and the highly mobile lifestyles of the pastoralists themselves, present significant challenges for Ethiopia’s health system and others seeking to deliver health interventions.

The center of Ethiopia—politically and economically as well as geographically—is Addis Ababa, the capital and largest city, with an estimated metropolitan-area population of 4.5 million.

The Oromia Region, an arc-shaped jurisdiction that surrounds (but does not include) Addis Ababa and spreads southward and westward, has 35 million people. Oromia and two other large regions—Amhara and the Southern Nations, Nationalities, and Peoples’ Region (SNNPR)—together accounted for an estimated 81 percent of Ethiopia’s total population as of 2012.

These and other regional states and city administrations are divided into 800 woredas (districts), which are further divided into over 30,000 kebeles (sub-districts).⁴

History and politics

In the past 50 years, Ethiopians have lived under three different political systems, each of which has projected a radically different image to the world.

Unlike most African countries, Ethiopia was never colonized (although it was occupied briefly by the Italians in the 1930s). As late as 1974, it was under the imperial rule of Emperor Haile Selassie. Although Selassie was popular around the world, he reserved the power and wealth of Ethiopia for himself and a few privileged supporters. Following the devastating Wollo famine in the early 1970s, frustration boiled over and Selassie was overthrown by a group of military officials known as the Derg who received backing from the former Soviet Union.⁵

Ethiopia spent the next 17 years under the rule of the Derg, although rebel armies waged civil war throughout the period. During this period, per capita income decreased by 0.8 percent. In the late 1970s, the Derg assassinated thousands of opponents in what became known as the Red Terror. Although the devastating famine of the mid-1980s was the immediate result of drought, it is widely recognized that the policies of the Derg worsened conditions. According to Human Rights Watch, more than half of the deaths that occurred during the famine were related to human rights abuses.⁶ In 1984, a BBC news report labeled Ethiopia “the closest thing to hell on Earth,” bringing the crisis to the world’s attention.⁷ The global public responded with a huge influx of donations.⁸   With support from the former Soviet Union, however, the Derg was able to hold on. It lost its grip on power only when the Soviet Union began to fall apart in the late 1980s.

In 1991, a coalition of opposition forces toppled the Derg and established a constitutional democracy, organizing the country into nine regions of varying size, each associated with a major ethnic group. The country includes dozens of ethnic groups, some of which have been in conflict for centuries. These conflicts have led to frequent violent clashes, including the ongoing civil war during the rule of the Derg and a string of border wars with Eritrea and Somalia. Under Prime Minister Meles Zenawi (1991–2012) and his successor, Hailemariam Desalegn (2012–2018), some critics questioned the strength of democracy in the country. The current prime minister, Abiy Ahmed, ran as a reformer and received the Nobel Peace Prize for his role in bringing an end to the conflict with Eritrea.

Since 1991, Ethiopia has been known increasingly as a development success story, with impressive economic growth, ambitious policy making, and rapid progress across a wide range of development indicators, especially in the health sector.