Ethiopia’s health-care system has suffered greatly as a result of the country’s devastating civil war. A horrific humanitarian catastrophe has been emerging in a battle that has become the world’s invisible war, with the country’s northern Tigray area under siege and cut off from most communications.
“Our patients are not receiving basic drugs like antibiotics, IV fluids, [and] oxygen,” says Dr. Fasika Amdeslasie, a surgeon at Tigray’s Ayder Comprehensive Specialized Hospital. Without these resources, he has seen people die.
“Seeing the despair in their eyes and being the one to inform them that you can’t cure them, that they’re going to die soon,” he adds, “is incredibly sad as a personal witness as a physician.”
“You can’t help them and tell them to pray,” says Fasika, who was head of Mekele University’s medical school before the conflict. (In Ethiopian tradition, we use first names for following references.)
“This conflict has truly decimated the health system,” says Lindsey Green, a senior program officer who researches sexual violence and other human rights violations at Physicians for Human Rights (PHR).
The violent war between the Tigray People’s Liberation Front — the party that controls Ethiopia’s northern Tigray region, and the Ethiopian government forces and their allies, including neighboring Eritrea, has been raging for almost two years. It’s a power struggle fraught with ethnic tensions. Both sides blame the other for starting the conflict, which has claimed up to 600,000 lives, displaced millions and caused rampant starvation and poverty, according to researchers at Ghent University in Belgium.
A September U.N. report has faulted all sides for what it believes to be “violations [that] amount to war crimes and crimes against humanity,” including extrajudicial killings [where an official kills someone without legal process], rape, sexual violence and starvation of civilians.
“The scale of human suffering really has few parallels,” says Thomas McHale, a deputy director with PHR.
A medical system that’s been decimated
For years, the medical system in Tigray was a capable network of urban and rural facilities servicing nearly 7 million people. But now, according to the Tigray Health Bureau, more than 80% of its hospitals have been destroyed or damaged. Rural clinics and health facilities are mostly non-operational.
“They took away ambulances, they dismantled solar panels,” says Dr. Kibrom Gebreselassie, a surgeon and chief executive director at Ayder Hospital in Mekele, the capital of Tigray. “And they dispersed all the drugs to the ground, crushing it under the tire[s] of their military vehicle. No one dared to stop them.”
Medical workers, who are primarily government employees, haven’t been paid in months. Doctors have no choice but to wash and reuse gloves (occasionally resorting to plastic bags instead), distribute expired medications, halt elective surgeries and turn away cancer patients — including children — due to lack of chemotherapy.
“To tell a patient that they have cancer is tantamount to telling them, ‘You are going to die soon,'” says Kibrom. In addition, “diseases which we have controlled before start to flare up again. This includes anthrax, rabies, measles in children and leishmaniasis, to mention just a few.”
People with chronic conditions have been especially hard hit. Birhan Hailu of Mekele, 52, who has type 2 diabetes, says: “My main job now is worrying about my disease because I have children. I may die. No one will take care of them.”
Insulin is hard to come by. Birhan has borrowed some from her neighbor but often goes without. “Even our physicians [and] nurses are crying in front of us because they don’t have something to give,” she says in tears.
One of those nurses is 35-year-old Atsede Giday, who works at Ayder Hospital, where about 5,000 diabetes patients were treated before the war. Prolonged lack of care is extremely dangerous. “I’m feeling in these weeks,” she says, “I will lose many patients.”
Without reliable access to food, money and transportation, Kibrom says “patients were left to die in their houses.” Mothers have had to give birth at home.
And since it is difficult to get to health centers, treatment “outcomes are much poorer” for those wounded by the fighting and bombing, says Green.
An emergency physician, Dr. Daniel Weldu, formerly at Ayder Hospital, put it this way: “I wouldn’t want my beloved or my relatives to be treated [at my emergency department] because I know the limitations are so severe.”
