Challenges of providing health care for the needy during war: The experience of Tigray

Source: Tigray Bureau of Health

Tigray is located in the northern part of Ethiopia, Bordered by Sudan and Eritrea. We are in active war for almost 16 months. You can imagine how much difficult to run a health system in a war situation where around seven million people striving to live.

The health care situation in Tigray (prewar)

• The health system of Tigray was one of the strong health systems in the country
  • More than 1000 health facilities with a mix of primary, secondary, tertiary level Health facilities
  • Functional referral network, and had more than 300 ambulances (60% of the ambulances were bought by community contribution )
• It is the birth place of the Flagship HEP that changed the Primary Health Care (PHC) in to practice
• The Potential coverage for PHC had reached 95% and the actual health service utilization was improved to the level of 13 million visits every year (2 times Per capita per year).
• Before the war, we had achieved exemplary success both by national and international standards in attaining the core health indicators (Skilled birth delivery was 81%, Immunization 84%)
• Under 5 and maternal mortalities have been declined to 30/1000 and 186/100,000 live births respectively.

The current health situation in Tigray (after the war)

• The Health sector was tragically targeted and destroyed by Ethiopian and Eritrean forces
• Health facilities were deliberately destroyed and burnt in to ash, Health workers were killed and displaced in and out.
• Ambulances and medical equipment’s were looted and vandalized with no mercy.
• As a result almost all the health facilities in Tigray were either fully (77%) or partially (13%) dysfunctional.
• The gains of the last twenty five years in the health sector have faced with a near-total collapse just in 16 months.

The Humanitarian response

Before July 2021 (Nov 2020 – Jun 2021)

• Access was severely constrained within Tigray
• More than 20% of the health facilities were military camps for ENDF and its allies (not accessible for civilians)
• Health workers faced gang rape, intimidation, killing and injury
• Medicines have been frequently seized at different Checkpoints and almost not accessible to the rural community.
• Ten thousands of mothers were gang raped, and they didn’t get any support.

After July 2021 (The evacuation of the Ethiopian and Eritrean forces from Mekelle, the captal of Tigray and beyond.

• Since July 2021, Tigray is under de-facto blockade for the last 8 months.
• Humanitarian operations have faced serious challenges of medicines, food, fuel, cash shortages and communication blackout which is against the United Nations Universal declarations and human right conventions.
• Drone and Air strikes continued, targeting Health facilities, IDPs, Refugees, civil institution, which is additional burden to the health system.

The impact of the health system collapse and the siege (The total blockade)

• High burden of morbidities and mortalities (we are counting high number of deaths everyday though most of them were preventable)
• Thousands of children and mothers are dying due to vaccine preventable diseases and malnutrition.
• Deaths due to COVID 19 are alarmingly increasing. Yet we didn’t receive any COVID vaccine, No functional oxygen plant. (In January we have tested 1601 patients for COVID 19 in Mekelle town, the positivity rate was 55%. Out of positive cases 72 of them were admitted to hospitals and 30% were died)
• We are using expired drugs to treat HIV patients and skin infections.
• The health professionals working in the health sector haven’t paid their monthly salaries for the last 8 months. They are in a very deep frustration.

The response from the International community

• We are calling EU, AU and the international community to work on peaceful resolution and act immediately for the entry of lifesaving medicines, vaccines and medical equipment to save further loss of lives due to man-made humanitarian catastrophe.