After nearly 18 months of conflict between the federal government and Tigray rebels, the health system of the beleaguered region has “totally collapsed”, according to health officials and doctors there.
Health workers in Tigray told The New Humanitarian by phone that shortages are so acute they are using expired drugs to treat chronic conditions, while tens of thousands of patients with diabetes, cancer, and HIV haven’t been treated in months.
Patients are being asked to bring old clothes with them into hospital for surgeons to use as gauze during operations. Test tubes, surgical gloves, and air tubes are all being reused, and there’s not enough detergent to wash soiled hospital bed linen.
A doctor at the flagship Ayder hospital, in the capital, Mekelle, likened Tigray’s health system to a “Swiss cheese” with most key components missing – from medicines to spare parts for vital equipment.
“This isn’t like the 21st century anymore; it’s more like the 16th or 17th,” said the doctor, who requested anonymity like others The New Humanitarian spoke to. “Patients just die in front of your eyes.”
Health workers are using warm salt water to wash wounds, clinics receive erratic supplies of power, and a lack of fuel is forcing pregnant women to walk – or be carried on stretchers – for days to health posts in order to deliver their babies.
Those who receive medical attention are the lucky ones: Most new mothers are delivering at home, alone, meaning thousands of women are likely dying from complications, health workers said.
“This isn’t like the 21st century anymore; it’s more like the 16th or 17th.”
Last week, Ayder hospital sent home 240 patients who were unable to buy their own food. New patients with neither food nor money are no longer being admitted.
Meanwhile, doctors haven’t been paid in months and are also struggling to feed themselves. As a result, stories of nurses and surgical residents fainting from hunger during procedures are commonplace.
More than half of Tigray’s doctors aren’t working – either because they’ve been displaced by fighting or because they’ve left their posts in search of food, said a senior regional health official, who asked not to be named so he could speak freely.
“The whole system has totally collapsed,” he added. “We are trying to do our best to serve our patients with what we have available, but things are getting worse and worse every day.”
Looting and vandalism
War erupted in northern Ethiopia in November 2020, the result of long-running tensions between the federal government and the main party in Tigray, the Tigray People’s Liberation Front (TPLF). Mekelle was captured in a matter of weeks.
The conflict has seen the participation of Eritrean troops, who invaded Tigray from the north in support of federal forces. They have been accused of a deliberate campaign of looting and vandalism against health infrastructure during the early days of the war.
A survey by the regional health bureau said 90 percent of Tigray’s 40 hospitals and roughly 1,000 smaller clinics were damaged, while medics have described watching Eritrean troops cart away valuable medical equipment using trucks and even helicopters.
Access to Tigray has been restricted since the TPLF recaptured the region in June last year, with all communication links, roads, and banking services cut. This prompted the EU’s top humanitarian, Janez Lenarčič, to accuse Addis Ababa of laying “siege” to the region.
On 24 March, the government declared a humanitarian ceasefire, raising hopes that aid would start to reach Tigray. Four weeks on, just five convoys of around 150 trucks have entered, despite a UN assessment that at least 100 trucks of food and other emergency supplies are required each day to meet the needs of the region’s six million people.
The government has dismissed claims it is restricting aid. It previously accused the TPLF of looting aid trucks and blocking the route used by humanitarian convoys by launching an incursion into the neighbouring Afar region. But relief workers question why aid still isn’t flowing.
"A convoy every couple of weeks is not helping anyone," said one Western aid official, who requested anonymity to avoid jeopardising a working relationship with the government. "They've proved it can happen, that they can get the trucks in, but the reality is that the government is using aid as part of the political process.” He added: “This shouldn't happen, it is a right under international law."
Flights of medical and nutritional supplies into Mekelle by the World Health Organization and the Red Cross have provided some relief. But the airlifted drugs are just four percent of what’s required, and the lack of fuel in Tigray means many of the medicines expire before they can be transported to the health centres that need them.
“The reality is the lucky patients are getting expired drugs,” said the senior official from Tigray’s regional health bureau. “The others are suffering and dying without any treatment.”
Trying to improvise
“We have tried to improvise,” said a physician on the maternity ward of Ayder hospital. “We must tell women to bring their own clothes to the hospital to use them as gauze and packs during surgery and delivery.”
Patients who can afford their own medications come with them. “Cold chain and quality metrics have not been followed [for these drugs] but we have no other option,” said the doctor.
He has seen several pregnant women develop complications after enduring long journeys to the hospital due to the lack of transport.
One 20-year-old woman lost one of the twins she was carrying and developed a fistula after her neighbours carried her for 18 hours on a wooden stretcher to Ayder. Another woman, aged 31, died because there was no blood to give her for a transfusion after she bled heavily during labour. A third, who was 28, died from an easily treatable infection.
“These cases are the tip of the iceberg,” the physician said. “Most of them are dying at home. This is because of a lack of access and because health facilities aren’t functional. It can be easily prevented, for sure.”
Lost to the system
Tens of thousands of patients have been lost to the system. The regional health official noted that 46,000 diabetic patients were receiving treatment across Tigray before the war broke out, but only a small amount of insulin has been received through the Red Cross since June, and no oral antiglycemic drugs.
Another 64,000 patients were being treated for diseases related to hypertension during peacetime, while 58,000 people with HIV were also getting regular check-ups.
“Because of the communications blackout, we don’t know how many of these patients are still getting follow-ups,” the health official said. “We are trying to treat around 45 percent of HIV cases with limited resources. The rest, we don't know their whereabouts. Maybe they died.”
Power cuts have also caused interruptions to the oxygen supply at Ayder that have killed dozens of people since the start of the war. The health centre’s oxygen plant has caught fire twice in the last month because staff aren’t able to maintain it due to a lack of spare parts.
“We are pushing it too hard,” said another doctor. “Sometimes it stops for a few weeks, and when that happens we have to beg for oxygen from factories in the city.”
The hospital’s life support machines are backed up by a generator, but on several occasions, nurses – and sometimes even the relatives of patients – have had to operate breathing apparatus “with their own hands” due to power outages.
“When this happens, most of the time they die,” said the doctor. “It is very traumatic.”
Edited by Obi Anyadike.