Medical Crisis in Tigray

Following the outbreak of a genocidal war in Tigray in November 2020, the region’s healthcare system has completely collapsed leaving Tigray in dire need of humanitarian assistance.

Prior to the war, Tigray was reported to have one of the best healthcare systems in Ethiopia. Tigray possessed many well-equipped and well-functioning hospitals as well as referral systems and community health posts and workers. However, since November 2020, with the health facilities across the region having been looted, vandalized, and some completely destroyed by the Eritrean and Ethiopian forces, the healthcare system struggles to offer even the most basic services at its tertiary hospitals.

According to estimates published in The Lancet in December 2020, 85% to 95% of health centers in Tigray are non-functional. Other health centers are hardly accessible due to the looting, theft, and destruction of ambulances. Ninety percent of ambulances, which were majorly used to transport women in labor, have been looted and/or turned into military vehicles by the Ethiopian and Eritrean forces. In its work between December 2020 and March 2021, Médecins Sans Frontières (MSF) was able to visit 106 health facilities, 70% of which were looted and 13% of which were functioning normally.

Another contributing factor to Tigray’s medical crisis is the lack of healthcare providers as a consequence of the war. In similar circumstances as the rest of the Tigrayan population,  healthcare providers have been forced to abandon their posts and flee their cities to seek refuge. As of May 2021, a total of 2,000 healthcare providers were reportedly registered in internally displaced people camps in Tigray’s capital city of Mekelle.

In April 2021, MSF’s Emergency Manager emphasized the extent of the destruction: “I’ve been doing this work for a long time and  I’ve never seen the complete collapse of a healthcare system as in Tigray. It’s shocking,”

Unfortunately, the situation has only worsened since these estimates were calculated as Tigray has been under siege since the end of June 2021. Little to no humanitarian aid has entered Tigray and medicine and medical supplies are prohibited to enter the region. In addition, humanitarian organizations have had to drastically scale back their operations due to safety concerns. MSF was forced to suspend its operations in Tigray and leave the region. Because of these drastic restrictions, there is incredible sparsity of health data, as the Tigray government and its defense forces attempt to break that siege that has left 6.8 million in need of humanitarian assistance.

“Later, back at the health centre it feels like we are barely making a dent. By 1 p.m., there are still about 250 people waiting. But the medics are hard at it. No food. No breaks. Military curfew is at 7 p.m. in Shire so we have to use every minute. It’s the same everywhere; the needs are overwhelming. We need to do more; we need more people, more cars and more medicines. And still it can’t possibly be enough. It’s so inadequate. It’s something though.” — Joe Belliveau, MSF Executive Director, in Tigray in March and April 2021

Children and Women at the Forefront of the Medical Crisis in Tigray

Although the region’s collapsed health system has had an impact on the population as a whole, some of the most affected groups include children, women, and chronically-ill individuals.  Caused by the shortage of food supplies and clean water, the number of children suffering from acute malnutrition is increasing at an alarming rate, making it difficult for the partly functional health facilities to deal with all of the health implications from acute malnutrition. In January 2021, UNICEF reported that the level of acutely malnourished children in Tigray was three times the global WHO emergency threshold, putting over 70,000 children at risk. In its most recent report, Tigray’s External Affairs Office reported results from the screening of 28,000 children under five in Tigray. They found that 2.8% were suffering from severe acute malnutrition, over the 2% globally recognized emergency threshold. An additional 20% of children were suffering from moderate acute malnutrition. In their screening of 18,800 pregnant and lactating mothers, a staggering 69% were diagnosed with malnutrition.

The earlier mentioned shortage of medical supplies has also led to a shortage of vaccines, increasing child mortality rates as well as the likelihood of future outbreaks of infectious diseases such as cholera, measles, malaria, and Covid-19. In August 2020, the Tigray government reported that around 195,000 children had yet to be vaccinated.

Many children are also in dire need of medical and psychological attention considering the increasing number of orphaned and unaccompanied internally displaced children.

Another extremely vulnerable group is survivors of Sexual and Gender-Based Violence (SGBV). The women and girls of Tigray have been subjected to weaponized SGBV, which invading forces have used as a weapon of war, ethnic cleansing, and genocide. As reported by several media outlets and humanitarian organizations in the past few months, the Ethiopian and Eritrean governments, along with Amhara regional forces and militia, have deployed weaponized rape against the women and girls of Tigray. According to UN OCHA, the most conservative estimate in June 2021 indicated that at least 22,500 survivors of sexual violence would seek clinical care in Tigray, although the number of those affected is likely much higher because of stigma, broken reporting mechanisms, and security concerns.

Weaponized SGBV in Tigray is characterized by extreme brutality. Women have been subjected to gang rape by as many as 20 soldiers for days or even weeks, most times in torturous manners, using nails, rocks, knives, and burning hot metals, inflicting debilitating and sometimes irreversible injury on survivors.

With the destruction of Tigray’s medical infrastructure by Ethiopian and Eritrean forces and the complete blockage and siege of Tigray, survivors of weaponized SGBV have not had access to the immediate medical care they need. Health services such as abortions and contraception that would have been readily available prior to the conflict are practically nonexistent. Hence, Tigrayan women and girls have been stripped of their autonomy to choose to get an abortion. As a result of a lack of medical and psychosocial support, survivors of weaponized SGBV have been left to carry their pregnancies resulting from rape to term to their psychological detriment. There have been reports of survivors committing suicide because of the trauma of these pregnancies.

Further, the lack of access to medical facilities and medical professionals has had a huge toll on women as the number of mothers dying during childbirth is alarmingly increasing.

As opposed to 73% prior to the war, there are now no women benefiting from a skilled delivery. With the shortage of ambulances, night-time curfews, and rampant insecurity on the roads many women are forced to deliver their babies in unhygienic conditions and informal displacement camps, receiving little to no antenatal or postnatal care.

Additionally, with the siege of Tigray, many women and girls in Tigray have little to no access to sanitary pads and are left vulnerable to UTIs, fungal infections, reproductive tract infections, and other major health complications.

Chronically-ill Tigrayans Left to Die

Chronically-ill individuals have tremendously suffered from the lack of medication and food supply during the war on Tigray. With over 180,000 patients with chronic non-communicable diseases having missed treatment for months, there are reports of large numbers of patients with chronic diseases such as tuberculosis, diabetes, asthma or HIV/AIDS dying at home and in hospitals because of the currently dismantled health system in Tigray.

Requiring continuous medical attention and/or a supply of life-sustaining medication, these patients have been jeopardized by the lack of medical supplies and electricity to maintain the necessary conditions for drugs requiring cold storage conditions, such as insulin, throughout Tigray’s hospitals and pharmacies.

Additionally, with the growing widespread famine and shelters housing thousands of internally displaced Tigrayans not being able to provide the needed dietary supplements as well nutritionally diverse food for the patients, chronically-ill individuals have been unable to meet their nutritional needs.

The Spread of Other Diseases

With most internally displaced person (IDP) shelters having a scarce supply of clean water and food, they are also unable to provide the sanitary conditions required to maintain the health of those with compromised immune systems.

The crowded conditions alone increase the risk of transmission of infectious diseases in non-immunocompromised individuals, among them children who may not be vaccinated against highly infectious childhood diseases.

The spread of infectious diseases has peaked with watery diarrhea, sexually transmitted infections (STIs), and Covid-19 cases being at the top of the list. The unhygienic and overcrowded conditions of informal camps and the lack of clean water have led to diarrhea being the overall second-biggest medical problem in these sites. Its transmission and severity enhanced by malnutrition, diarrhea is especially concerning as it is a leading cause of child morbidity and mortality.

Next on the list being sexually transmitted infections, the aforementioned abhorrent number of SGBV cases are causing the rise of those contracting STIs (including HIV), most of which are receiving no medical attention. With this, the demands for abortions and emergency contraceptives are also rapidly increasing, but are again, usually not provided due to the lack of required supplies and drugs.

Additionally, considering the ongoing worldwide pandemic, the appropriate Covid-19 precautions are not possible, endangering vulnerable individuals. The lack of diagnostics also results in the exposure of potentially Covid-19 infected individuals to immunocompromised patients with pre-existing respiratory illnesses. This can especially be observed in the overcrowded and unhygienic shelters where millions of displaced Tigrayans currently reside.

Conclusion

The looting and vandalism of health facilities, the theft of ambulances, the lack of access to medication, the absence of dependable electricity, and the scarce supply of food and clean water will lead to long-term public health concerns for the region.

Considering that the deliberate and cruel destruction of Tigray’s healthcare system has and will continue to result in the suffering and deaths of Tigrayan civilians for years to come, the international community should urge the Ethiopian government to immediately allow unfettered humanitarian access to all of Tigray, restore Tigray’s destroyed infrastructure (e.g. roads and hospitals), restore the health facilities throughout Tigray by funding the return of medical staff, replacing destroyed medical equipment, providing sufficient medicine, returning/replacing ambulances, providing electricity, water, and other necessary resources for the proper functioning of health facilities, and finally to secure the transportation of food to inaccessible parts of Tigray in order to alleviate the famine.

“Medical work is, of course, our core work, but it’s not the only reason for coming to all these villages across Tigray. People repeatedly tell us our just being here means something. They say it helps them feel less forgotten, like someone cares, a little bit safer.” — Joe Belliveau, MSF Executive Director, in Tigray in March and April 2021