Poor planning causes Ethiopian public hospitals to severely lack medical devices

A recent study of Ethiopian public hospitals found serious gaps in the current practices of public hospitals in planning and budgeting medical devices. Especially in all areas outside of the capital, Addis Ababa. Tigray hospitals remain essentially non-functioning and are not currently supported by the Ethiopian government.

A new published study shows the vast majority of Ethiopian public hospitals fail to have the basic required medical devices necessary to provide medical care according to WHO standards. Even worse most of these hospitals and the Ethiopian Ministry of Health have no plans to improve on this serious shortcoming. 

The study was published by officials at the Ethiopian MOH. Prior to Abiy Ahmed taking power as Prime Minister in Ethiopia Ethiopia was heralded as being a leader in attempting to develop health care in Africa. However with the diversion of government spending to wage war resulting in annual per capita expenditures decreasing from an already low $23 to now an estimated $18 (which is a hundred times less then developed countries). Millions of dollars worth of medical equipment, drugs, and other supplies were allowed to be taken to Eritrea from Tigray also apparently the Gondar region. 

ENDF sent Somali and Eritrean wounded fighters to unknown fate

What happened to the wounded Eritrean and Somali mercenary soldiers sent to Mekelle Stadium by the ENDF? No one was found there when the ENDF retreated.

We witnessed Somali and Eritrean mercenaries as casualties in Mekelle during the Ethiopian Tigray conflict.  We know that instead of being allowed to stay in Ayder Hospital, transferred to the local military hospital, or to Amhara instead they ultimately disappeared after a transfer to a stadium.  Many Somali mothers whose young men where taken by the former Somali government to Eritrea to join forces invading Tigray in November 20202 are asking what happened to their sons?  Similar questions are being asked of the Eritrean government by Eritrean mothers. 

I was present at Mekelle University Ayder Hospital as a faculty member during the early Mekelle occupation by invading forces. We cared for many casualties of war including civilians and combatants from Tigray and the invading forces. We identified both Eritreans and Somalis in Ethiopian uniform. The locals easily recognized the accent and mannerisms of Shabia which is the term they use for Eritreans. Similarly we had many doctors in training from Somalia and Somaliland who were able to communicate with the Somali mercenaries.

However, the supervising Ethiopian Defense Force quickly moved these foreign mercenaries from Ayder to a makeshift hospital with high security set up at the Mekelle soccer stadium. Apparently there were no doctors there or any type of medical equipment. One wonders what was the fate of these mercenary forces who were injured and required medical treatment? No patient was found there when the ENDF retreated. Apparently families in Eritrea and Somali have been told nothing.

Everyday the future grows dimmer for Ethiopia

Government supported security forces search the streets killing unarmed young men who look like Oromos in the southern region of Ethiopia. Source OLA spokesman Odaa Tarbii.

Everyday there are growing reports of extrajudicial killing in just about every region of Ethiopia. Clearly the population diffusely throughout the country has no faith in the government. While Abiy Ahmed makes international trips to get his picture taken with various foreigners this does not hide the lack of solidarity rising in Ethiopia. His lies about economic growth, currency stability, and domestic food security, are blatantly exposed by the millions now displaced facing hunger and insecurity from Tigray to the the Kenya border. Once stable lives for working class and middle class families in the cities throughout the country are now faced with growing unemployment and rising inflation making everyday life the most miserable in several decades. Meanwhile the Tigray siege continues unabated except for a trickle of aid which the Western democracies foolishly call progress.

When I first came to Ethiopia in 2012 it seemed to be a place that was on the way to a better future. Many hospitals and universities had been built. There had been relative peace since the 1990s. At first the change in leadership in 2018 seemed to be a continuation of progress with many promises of free speech, opposition parties without condemnation, free press and economic opportunity. Frankly it is hard to believe it is the same country now.  Educated professionals of just about every ethnic group including Amhara, Tigray, Oromo, Somali, etc. are leaving the country in droves. They have become pessimistic that the country’s situation will improve in the near future.

Even previous skeptics of immoral acts by the Ethiopian government such as the poorly regarded Ethiopian Human Rights Commission are now admitting growing horrors. Probably in part because they fear future criminal liability for being conspirators in genocide.

European democracies and most of the American political establishment although wanting to support the poor status of the population especially in Tigray need to finally realize that sustaining the current failed leadership is only leading to a failed state of death and misery. There is no medemer or unity.

For Eritrean youth most have no future but unending military conscription

A funeral procession for some of the thousands of Eritrean conscripted soldiers who died in the Tigray invasion. Source Eri TV

A funeral procession for Eritrean soldiers who died fighting in the Tigray invasion points to the way young peoples future is wholly decided by the government. Human Rights Watch research finds that most Eritreans have to go through compulsory military service with many  “spending their entire working lives at the service of the government in either a military or civilian capacity”. In my work at Mekelle University Ayder Hospital I saw and interacted with student refugees and hundreds of patients sent by the United Nations and International Organization for Migration over the past 10 years of being in Ethiopia. They told many horror stories.

Those with close ties to the the despotic leader, Isaias Afwerki, are the only ones exempt. Otherwise all teenagers must attend Warsai Yekalo Secondary School, located in the Sawa military camp which is isolated and restricted from visitors  near the border with Sudan, for the final half year of secondary school.  Satellite imagery and reports from refugees describe large mass burial grounds where noncompliant students end up. Over the past twenty years more than 500,000 young people have fled Eritrea often risking a perilous crossing of the Mediterranean sea.

New conscripted soldiers are paid about 2000 Nakfa per month which is about $132 dollars. This is about half of what government civil servants are paid.  Their families can be threatened if the soldier has poor performance. During the Tigray invasion Eritrean prisoners of war were found with lists of items they were supposed to acquire and help bring to Eritrea including medical equipment, computers, cars, farm equipment, telephone equipment, factory machines, and the list goes on. It is known that Ethiopia paid at least $4 billion for the mercenary services which benefited the ruling elite but only brought death for thousands of young people.

Political chameleon morally bereft Abiy Ahmed cannot bring Ethiopia peace

Misplaced trust by many Western democratic leaders that political chameleons will ultimately bring good has cost Myanmar and now Ethiopia.

Is Ethiopian Prime Minister Abiy Ahmed taking a cue from previous Nobel Peace Prize winner, Ang San Suu Kyi, who herself became immersed in controversy when she appeared to have compromised with military generals in Myanmar rather then stand up against the oppression of the Rohingya? The history of Abiy Ahmed since he took power in 2018 has been one of statements and actions which can turn 180 degrees from the previous one.  Domestic and international stakeholders holding on to fantastical confidence that somehow under Abiy Ahmed Ethiopia will find peace and prosperity is doing the opposite. The gift of charisma does not guarantee devotion to democratic values or good leadership.

The once heralded leader has seen his image degenerate to what can be best described as another self-centered African despot willing to sacrifice both the blood and treasure of Ethiopia to retain power. The standard of living for the average Ethiopian is plummeting with state security and economy in a nose dive. At this moment he is ordering military action against the Amhara militia group, FANO, who was key to securing the Prime Minister’s influence in Ethiopia. The Eritrean Ethiopian alliance is crumbling because Ahmed no longer sees it as key to his political survival.  

Even though he was once elected to Parliament as a representative of the Oromo people and often championed the rights of Oromos to housing near Addis Ababa most of his actions have been seen to be favoring Amhara over Oromo interests since 2018. 

Now however as he comes under heavy scrutiny of international leaders in the Western democracies with many being unabashedly critical of his actions.  Yet even in criticism they are reluctant to give up on his leadership. He seems to creating a new strawman on whom to blame his woes. Whereas before he claimed the Tigray were the bogeyman causing all Ethiopia’s lack of potential achievement that has been replaced his previous allies, the Amhara expansionists.

This reversal of amity to enemy happened with the Oromo leader, Jawar Mohammed, whose followers, the Querroo, were primarily responsible for deposing the previous regime making way for Abiy Ahmed to come to power. Abiy Ahmed had Mohammed accompany him for his USA tour but jettisoned him later in favor of the Amhara expansionist whom he thought offered him substantially more political security.

No doubt he knows a reckoning is happening within the international community that a blow to the potential for Ethiopian democracy has happened under his tenure. One can easily imagine that he is creating scape goats of the Eritrean and Amhara leadership now. Likely he is telling the international community that these influences whom he trusted to act righteously in the “law enforcement operation” turned it into a wrongful act against the people of Tigray. This he will claim was not his intent.

What allows this possibility is the fact that even in the face of incontrovertible evidence of cruelty and genocide many Western leaders cannot accept two realities. One is the nefarious conception there is still potential benefit in having Abiy Ahmed as leader. Naively they must feel by that his inexperience or trust of his deceptive advisors accounted for the evil that has happened in Ethiopia. The other falsehood is reminiscent of the Yugoslavia experience where the global community thought for sometime that preserving the state against division was more important then protecting human rights. This cost the former Yugoslavia years of death and destruction. Similarly I fear the same is true for Ethiopia until Ethiopians, Africans, and the world at large wake up to the reality that it is time for change in leadership. These false assumptions are costing Ethiopia its future.

Wounded fighters for Ethiopia were ill treated by their own government

Fighters for the Ethiopian government against Tigray were denied healthcare for their injuries and even that they existed. They suffered vocal abuse and rock pelting when they return to the border area with Amhara after release from Tigray. Photo source TGHAT

The treatment of war injured Ethiopian National Defense Force soldiers and their allies speaks volumes about Abiy Ahmed’s philosophy regarding the value of the common person. As much as possible Ethiopia wanted to portray the military action taken in Tigray as having few causalities or blood shed. They wanted to hide the fact that many soldiers in the Ethiopian National Defense Force as well as their mercenary allies, Eritreans and Somalis, were even present. When we recognized them as foreign fighters in Mekelle they were whisked away to the stadium as I describe below. This report is based upon my own experience in Mekelle as well as discussion with various persons in many regions of Tigray and Amhara. 

Many fighters for Ethiopia were scooped off the street while working as shoe shine boys or from the homes of their families with promises of bonus payments, land, and other rewards none of which never came true. Even worse when they were injured in battle they were often cursed as cowards and frequently assassinated by FANO militia behind the lines. This was part of a cover-up to minimize the portrayal of war vs a law enforcement operation. 

We know that prior to the onset of conflict between Tigray and Ethiopia on November 4, 2020 there were plans made with prominent Amhara members of the academic medical community in Addis Ababa and other Amhara centers to recruit medical staff for the upcoming expected conflict. The Ethiopian military itself normally has almost no doctors. The few military hospitals such as the largest Torhayloch in Addis Ababa relies upon many civilian full time generalists and part-time specialists usually recruited from medical school staff. In fact several years ago I was consulted by Ethiopian military leaders to discuss how we might train “military physicians” as they knew about my experience in the USA.

A part of this Tigray conflict plan was to avoid the public seeing that there were causalities of Ethiopian military personnel. This would match the concept that the operation was a “law enforcement” operation with little impact on civilians and with little sacrifice of life. In fact it was planned that a triage site and receiving center would be in the town of Woldia in Amhara near the southwestern Tigray border where trusted politically loyal doctors recruited would be established early on the fighting. Remember Ethiopian Prime Minister Abiy Ahmed’s boasting that there were few military casualties and not even one civilian killed early during the fighting.

When the Tigray Defense Force retreated and the ENDF forces advanced eventually through Tigray and finally into Mekelle they destroyed medical facilities in their path. Within their ranks were ENDF fighters mostly from Amhara and Oromo regions but also Eritrea and Somalia. For the first few weeks of occupation all these  combatants were treated initially at Ayder but not in great numbers. for long. The story we were told is that there many Tigray dead and almost no ENDF injuries. 

However the invading ENDF began to set up a sort of field hospital at the new soccer stadium in Mekelle. They began to transfer all ENDF, Eritrean, and Somali fighters to that facility. They also took almost all Tigray fighters in Ayder  to parts unknown. There was a recently built new military hospital in Tigray which was staffed with part time Mekelle University medical staff but this was closed within a few weeks.

Following the retreat of the ENDF from Ayder we learned that hospitals in Gondar, Dessie, and Bahir Dar were overwhelmed with so many medical causalities that regular civilians services were stopped or at least severally curtailed. Very few Tigrayan prisoners were seen at these facilities leading many to believe that the invading forces most likely executed immediately any potential prisoners.

Of the tens of thousands of prisoners held in Mekelle in the rehabilitation camp many were given adequate food and what health care was available. Many government employed medical personnel as well as Mekelle University faculty volunteered to care for both their own soldiers and captured prisoners in the field in makeshift facilities.

Interviews of ENDF and their allied prisoners have revealed that some were shot were retreating from the battlefield to seek treatment by FANO militia. Additionally it is now well established that commanders in ENDF attempted to hide causalities by blocking when possible their access to medical facilities. Some prisoners in Mekelle have related that many wounded were shot and placed in mass burial site.

Now we are hearing that of the 4,000 prisoners of war released who were screened and found to not have committed war crimes, many of these were captured outside Tigray, were heckled and suffered pelting from thrown rocks when they reached the Amhara borders. Subsequently they were quickly collected in buses by local representatives of the federal government and taken to parts unknown.

Growing opposition against Abiy Ahmed predicts likely country collapse

Over the past few months over 4,000 Amhara including members of militia group FANO, Ethiopian Defense Forces, and others have been arrested reports Reuters. Just a few months ago many Amhara cities like Dessie pictured above supported Abiy Ahmed but now that loyalty seems to have evaporated.

The coalition Abiy Ahmed hastily constructed to consolidate power in Ethiopia seems to be collapsing at a rapid rate. In a not unexpected paradox diaspora supporters of Abiy Ahmed’s military actions and civil rights violations against Tigray and Oromo peoples actions against are now complaining that such actions are illegal when applied to the Amhara. The Ethiopian American Development Council in an Open Letter to Abiy Ahmed complained

We are compelled to write this letter in light of the recent developments in Ethiopia where, based on published reports, over 4,000 citizens, journalists, and patriots in the Amhara region alone, are being kidnapped and detained by the Ethiopian security forces…..
Even more perplexing is the government’s use of unconstitutional and illegal tactics of kidnapping and dramatic abductions of citizens, with no regard to the rule of law or the need to maintain public trust. Maintaining public trust and securing peace is the hallmark of a responsible government. The current actions of the Ethiopian government are counterproductive and are effectively making a bad situation even worse.

After his rise to power in 2018 Ethiopian Prime Minister Abiy Ahmed built an alliance of Eritrean supporters of Isaias Afwerki, Amhara expansionists, former Derg supporter diaspora especially in the USA, and former diaspora monarchists by creating a unified front against a strawman represented by ethnic Tigrayans. This targeting was simplified by the strong unity of the Tegaru for their ruling Tigray Peoples Liberation Front which won an election handily just before the Ethiopian Tigray conflict began in November 2020 in defiance of declaration of the TPLF as terrorists and the Tigrayan election as illegal.

Studies of Ethiopian immigration to the United States and Europe showed that the vast majority came between the mid 1970s to the 1990s as former monarchists and then Derg supporters who fled following the Derg’s defeat.  These groups dreamed of a return of a strong political leader to overcome the Zemene Mesafint (referring to a period where Ethiopia had no central leader in the 19th century which lead to the Amharic dominance and expansion of Ethiopia) they saw again prior to Abiy Ahmed.

This coalition supported the brutal invasion of Tigray, confiscation of assets and property, imprisonment without due process, and minimized any violation of human rights against the Tigray saying they were justified. Now that the Abiy Ahmed government has developed concerns that these Amharic expansionist elements are plotting against him possibly in cooperation with Eritrea the tide seems to be turning former allies into threats. Academic studies of despotic regimes in Africa and other regions done by the Rand Corporation, a frequent advisor to the United States intelligence services, has shown that such reversals are not uncommon. The direction of chaos in which Ethiopia seems to be following have a high chance that the current government will not sustain itself base upon historical factors seen in successful insurgencies.

Ethiopian economy cannot pay debt, beat inflation, or find new loans

The Ethiopian Central Statistics Agency continues to report unrelenting inflation making it difficult to afford the necessities of life such as food for most Ethiopians. Source New Business Ethiopia

While commitment to continue government loans is being drastically cut by foreign lenders Ethiopian inflation continues to grow monthly  reaching 34.7% in March 2022.  The major lender of 2021, World Bank International Development Association, gave $3 billion in 2019-2020 pre-war then $1.4 billion 2020-2021, and now drastically reduced the amount this year to $774 million. Ethiopia can barely keep up with the almost $2 billion in debt payments of just interest to the foreign lenders which just about equals what used to be its overall government budget.

The unresolved Ethiopian Tigray conflict, Oromo rebellion, news actions against previous supporters such as in the Amhara region, poor crop yields requiring more than 25% of food needs be imported, and  falling birr value against international currencies are among the many things adding to an uncertain future for the Ethiopian economy. This contrasts greatly with the decade of 10% annual growth that preceded Ethiopian Prime Minister, Abiy Ahmed, coming to power in 2018 and pursing conflict with Tigray, Oromo, and others.

Although the Ethiopian government gives a false explanation that loans are being decreased because “projects are nearing completion” the reality is that the failure to find peace and stability is driving lenders and investors away from Ethiopia. Loans payments were temporarily reduced by $116 million by the Group of 20 countries when the Ethiopian government promised timely resolution of the conflict and disunity. Currently there exists no progress for a new loan agreement on the Ethiopian government’s official debt which does not include government guarantees of private loans from foreign entities which may increase the total debt upwards of $60 billion or more by the end of this year.

WHO Director-General Tedros Adhanom has an undeniable record of accomplishment

In 2019 when the Ebola crisis in central Africa in a region undergoing civil war Tedros Ahanom was instrumental in helping form an effective international response limiting the spread of the deadly virus as well commencing research efforts. Source Nature

World leaders and analysts have complemented the work of  Dr. Tedros Adhanom Gebreyesus who was elected for another term as Director-General of the World Health Organization. These complements are not just limited to his recent work but began almost twenty years ago beginning with his appointment to the Ethiopian Ministry of Health and continuing during his subsequent office of Minister of Foreign Affairs.  Complaints by malcontents at the current Ethiopian government of covert actions have never been proven. At the same time Dr. Tedros Adhanom Gebreyesus has fully cooperated with international NGOs and the UN to send aid to Amhara, Afar, and other regions of Ethiopia while the Ethiopian government blocked similar aid to Tigray.  I was fortunate to share a table with him at an African Union summit on health care development about 8 years ago. He is articulate and driven by a higher sense of duty not just to Tigray, Ethiopia, or Africa but to mankind.

The expansion of Ethiopia’s health care system commenced in 2004,  when over 30 000 Health Extension Workers were trained and deployed in Ethiopia and over 2500 health centers and 15 000 village-level health posts were constructed. Some analysts have attributed Ethiopia’s successful reforms a to strong leadership and “political will”. However an academic study of these reforms by Kevin Croke from the Harvard Department of Global Health and Population at the T.H. Chan School of Public Health determined that the reality was there was more to the story then will. This analysis was published in December 2020 in Health Policy and Planning. The focus on rural development and stressing the primacy of development as well building alliances among different regions as developed by Prime Minister Meles Zenawi and Tedros Adhanom Gebreyesus is what drove the success in reform. The WHO Director-General has been tested with the Ebola crisis, COVID 19, immunizations, global health inequity, and other issues yet he has stayed on course. 

Today the Ministry of Health has been mostly Addis Ababa centric. The level of spending per capita for health care has gone down from $23 to $18. Even though Tigray is claimed to be a part of Ethiopia no expenditure is currently directed there for any government activity including health care. What aid that comes issues from the World Health Organization, International Red Cross, and other international sources.

After becoming Foreign Minister in 2005 where he served until 2012 he expanded his advocacy for health care development in underdeveloped nations not just in Ethiopia. He joined in international efforts to deal with malaria, tuberculosis, HIV-AIDS setting in motion movements to control these maladies with good results. To some extent this  has followed a general trend in public health among academics to place health care front and center in political considerations for funding and priority.

Dr. Tedros as he is known in Tigray where use of first names is matter of custom was unanimously elected again because of his history of accomplishments recognized by health authorities and elected leaders except for Ethiopia who judges him wrongly because he is Tigrayan.

Time for Ethiopian leadership to stop living in a fantasy

The wrongful association of self centered Amharic expansionism combined with fantastical expectations of greatness by subjugation has cost Ethiopia many precious lives and opportunities for development. People confuse fantasy comic characters with reality.

The leadership of Ethiopia continues to function in imagined fantasy of grandeur while its people descend into misery. The current status of Ethiopia compared with just three years ago finds the once growing nation now with three times more debt ($66 billion), a currency which as devalued 50%, millions displaced, waning investor interest, and growing civil unrest. While Abiy Ahmed has instilled a fantastical misdirected sense of destiny similar to comic heroes  unfortunately the saddest thing is that Abiy Ahmed’s disregard for the welfare of his country is now shared by the UN security Council who have tired of thinking about Ethiopia. No doubt they see it as just another expected African tragedy.

This week Tigray as a sign of good faith released over 4,200 Ethiopian National Defense Force prisoners most of which were captured outside Tigray and have not committed atrocities. Many of them were disabled and the group included many pregnant women. Instead of positive response Ethiopian officials denigrated this act. Tigray continues to receive only a trickle of much needed food, medical supplies, and other necessities causing continuing death and suffering. In violation of the Ethiopian constitution Western Tigray remains occupied and with horrors concealed. 

Today most of the population in the capital city of Addis Ababa waits for upwards of several hours to buy diesel or gasoline fuel at three times the normal price. Food, diapers, cooking oil, clothes, housing rents, and other normal items of normal life have doubled in one year. Police and security officials are everywhere looking not just for Tigray or Oromo dissenters but now concentrating on the growing Amhara dissent against Abiy Ahmed.

Abiy Ahmed and his ministers ridiculously claim that they will become wheat exporters because of a limited irrigation project. Meanwhile based upon satellite analysis of crops of Ethiopia and other data Ethiopia is expected to import upwards of 25% of food requirements this year. Wheat which is normally imported from Ukraine is no longer an option because of a war by Russia which the Ethiopian government officially supports so wheat imports will cost even more. 

Recent photos from Djibouti show imports of Russian model tanks designed in the late 1950s which Abiy Ahmed purchased at $1 million a piece buying as many as 200 so that he spent $200 million for tanks that reasonably should cost less then $200,000. These tanks have limited ability to be used off road and become easily stuck in muddy conditions making them useless and easily ambushed by the Tigray Defense Forces and the Oromo Liberation Arm. They are useful for military parades however.

The idea that Ethiopia’s action where widely supported as anti-colonial acts by Africans does not hold water.  A few days ago sixteen recognized African civil service organizations wrote a public letter to the UN Security Council asking for their intervention into the conflict in Ethiopia. Citing the lack of timely and effective action in Rwanda twenty eight years ago which resulted in a genocide they are pleading for a different outcome in Ethiopia. Their letter was focused on Tigray without mentioning the current instability in other regions including Amhara, Oromo,  and Benishangul-Gumuz.   They proposed an arms band on all parties, unfettered transport of needed food, medical, and other supplies to Tigray, and serious mediation for peace and stability.