Professor Tony Magana, Author at Professor Tony Magaña

Abiy Ahmed and Internal Colonialism in Ethiopia

Abiy Ahmed, Prime Minister of Ethiopia and head of the Prosperity Party

Abiy Ahmed, Prime Minister of Ethiopia and head of his self created Prosperity Party, to many rather than bringing a new vision which encourages development of a universally accepted national unity has instead re-aggravated old flames. His inability to escape internal colonialism, a recurring theme in Ethiopian politics, may be the straw that broke the camel’s back in breaking up the Ethiopian empire.

The rise of Abiy Ahmed was propelled first by the strong calls for inclusivity of the Oromia who make up at least 30% of the Ethiopian population in government. However the initial enthusiasm in cooperation was tempered when a division of the goals developed between many Oromia leaders and the Prime Minister was created. The Prime Minister switched allegiances to the Amhara elites who argued for a more traditional Amhara led model of government giving more power to the central government and less to the regional states. Even though currently the Tigray “rebellion” gets the most national attention there now opposition groups many of which are carrying out armed insurrection in most of the regional states of Ethiopia.

Jawar Mohammed seen on the right was instrumental in mobilizing young Oromian men to the cause of Abiy Ahmed. However now he is in jail on charges of terrorism

Internal colonialism is a reoccurring theme in the struggle for control of the Ethiopian federal state. We often hear the term colonialism and see it most commonly applied as an external phenomena referring to the history of European powers attempts to colonize and control African states over the past two centuries but internal colonialism especially in the case of the Ethiopia, a country which claims it has never been colonized by an outside nation, is one of the dominant forces against sustainment of peace in a empire of many nations.

In 1925 Adolph Hitler described the concept that Germany as an integral part of Europe, had the right to acquire adjacent lands that were poorly utilized and under populated as a result of the unfair treaties ending World War I in 1925. He saw his ethnic group as a part of greater Europe who by right of superiority which was inherent in their nationality had not only the right but the obligation to take control of his neighbors. A description of this type of justification for political action would wait until many years later.

Pablo González Casanova the Mexican socialist who defined internal colonialism in his book “Democracy in Mexico

Although first used briefly to describe the situation in South African apartheid in 1957 this concept becomes well defined by the Mexican sociologist, Pablo González Casanova, in his 1965 book, Democracy in Mexico where he defined internal colonialism as a result of the structure of social relations and exploitation between heterogeneous cultural groups. Although the term is named “internal” he notes the effect of outside powers global and regional does have an effect on this interaction. Traditional social struggle theory as one between classes such as in Europe and the United States is not the only relevant or maybe even predominant factor. Patrimony and oligarchy tend to develop in the push to create strong capitalist systems to engender economic viability of the state. Paulo Henrique Martins , French scholar has described that there is a relationship between social, political, and intellectual imagery that develops and helps steer political action by the dominate group over the lesser ones.

A well known phenomena commonly seen in developing countries as noted by the World Bank is that their capital cities tend to develop much faster then the rest of the country. I have written about how the Addis Ababa identity differs significantly than that of the rest of the Ethiopia. Peter Calvert has described how this accelerated growth of cities and its effects on the surrounding area becomes the center of power, identity, and social action. It should be noted that Ethiopia is most rural country in world (90%) such that Addis Ababa with a population of 4 million in a country with 110 million represents barely 0.4% of the population. As I have previously written the growth of other cities and universities is beginning in other regional states but they have little political impact.

Ethiopia was ruled by Amharic royal for centuries until attempted coups began in 1960 ultimately leading to a socialist communist takeover in 1974 called the “Derg” or worker’s party which was heavily supported by the Soviet Union. It was quite repressive although ideally not specifically linked to any particular ethnic group. Then a popular uprising revolted against the Derg leading to new leadership lead by the Tigray Liberation Peoples Front in cooperation with other ethnic fighter groups. Following the death of Melez Zenawi in 2012 uprisings in the Oromia and Amhara regions eventually lead to the placement of Abiy Ahmed, a half Oromia, half Amhara as the Prime Minister in 2018.

Although initially promising free speech, welcoming of opposition groups, political prisoner release, free press, and creating a new political party based upon a unifying national identity all was short lived. He went on to imprison Oromia allies who helped bring him to power, made dissent illegal by person or press, outlawed the leaders of the Tigray regional state calling them terrorists and finally invaded Tigray with the help of an old enemy Eritrea.

When you look at Ethiopia it is a tough region in which to thrive. There is very little water for agriculture and very little land which is really productive for food. The term internal colonialism was used by Oromia opposition groups against the TPLF during their dominance as they felt the federal government was interfering too much in land use and distribution decisions. Similarly the area of Western Tigray which is also very fertile has increasingly been claimed by Amhara elites.

As I previously discussed there has never been a strong claim of a national unity except by the Amhara peoples. Many other groups continue to claim national ethnic identity that trumps their Ethiopian identity. Those who are more educated and/or spent significant time living or being in university in Addis Ababa are more likely to see their Ethiopian identity over their regional one.

Meles Zenawi here seen in his youth as a rebel to the Ethiopian regime became the spokesman for the TPLF leading the revolt against the Derg. His democratic developmental state concept created dramatic economic growth in Ethiopia

Meles Zenawi the late leader of the TPLF developed the concept of the democratic developmental state. This was based in large part in how South Korea recovered following World War II and the Korean conflict where at first their was a military oligarchy that had a first priority to create an infrastructure and lead business initially but then over time would allow more economic Ethiopian People’s Revolutionary Democratic Front (EPRDF). freedom of private interests but with significant government input. Although there was a vision of a coalition of nations in forming the government via Ethiopian People’s Revolutionary Democratic Front (EPRDF) Meles realized that there was in fact a danger of internal colonialism taking root. The argument of one nation versus a confederation of nations was continued by opposition groups which magnified upon his death in 2015.

Christian and Islamic theology justify the cause for Tigray defensive actions

Tigray women who fled a conflict in the Ethiopia’s Tigray region, wait to receive aid at Village 8, the transit centre near the Lugdi border crossing, eastern Sudan, Sunday, Nov. 22, 2020. Ethiopia’s military is warning civilians in the besieged Tigray regional capital that there will be “no mercy” if they don’t “save themselves” before a final offensive to flush out defiant regional leaders, a threat that Human Rights Watch on Sunday said could violate international law. Over a year has passed which has seen a near complete blockade preventing needed fuel, food, and medical supplies to come to Tigray. (AP Photo/Nariman El-Mofty) This a revised version of a previously published article.

The saga started by invasion of Tigray by Ethiopia and Eritrea in November 2020 is now well documented by numerous sources of evidence of a pre-invasion planned build up by Ethiopia and secret pacts with Eritrea. Killing thousands of innocent villagers, raping thousands of women and girls, as well using starvation as a weapon in the name of Jesus Christ does not justify war as claimed by Ethiopian Parliament President Agegnehu Teshager and Prime Minister Abiy Ahmed. Instead more than a thousand years of history and theological tradition for both Christianity and Islam about what constitutes a just war supports that the Tigray regional state is the righteous party.

When is conflict a just war (Jus ad bellum)?

Both the Bible and the Qu’ran both say that war is a condition that will always afflict mankind. Jesus Christ said that man will always suffer calamities both natural and war between states. The Apostle James said that wars are caused by the “lust” of what the other party has obtained and selfishly wishes to take through violence.

The ancient Jews, the Babylonians, and the Romans believed that a violent response to war was appropriate if it was of an appropriate measure to the offense suffered. A principle known as lex talionis.

There has always been a Christian disagreement on whether Jesus called for complete pacifism in responding to violent offense which would theoretically best diffuse malintent and prevent a sinful response. Ultimately the righteous would be rewarded for their suffering in this world or the next. Dietrich Bonhoeffer, the 20^th century German theologian, advocated complete pacifism which led to his execution.

For centuries beginning just a few hundred years following Christ an alternative theory has been that war was justified under specific circumstances. Jesus’s call to “love thy neighbor” and that “giving up one’s own life to save another” are acts of faith as well as his “righteous” anger at the money changers in the Temple have been interpreted to mean violence can under certain conditions be responded to by violence.

Discussions of just war began with classical Greek and Roman philosophers like Plato and Cicero and were added to by Christian theologians like Augustine and Thomas Aquinas. Continuing to contemporary times Catholic Pope Benedict XVI said that “defending oneself and others was a moral duty and obligation”.

The following are principles which have been generally agreed upon by Christians for a just war

1. The war must have a just cause – such as against invasion, or for self defence – and not to acquire wealth or power.
2. The war must be declared and controlled by a proper authority, such as the state or ruler.
3. The war must be fought to promote good or avoid evil, with the aim of restoring peace and justice after the war is over.
4. The war must be a last resort when all peaceful solutions have been tried and failed, such as negotiation.
5. The war should be fought with “proportionality”, with just enough force to achieve victory and only against legitimate targets, i.e. civilians should be protected.
6. The good which is achieved by the war must be greater than the evil which led to the war.

Islamic law allows the use of force in self defence and in defence of those who are oppressed and unable to defend themselves.

1. Only under certain conditions allow anticipatory self defence.
2. Only the head of a Muslim state (a ruler or caliph) is allowed to declare jihad.
3. Islamic law imposes certain restrictions on the use of force in self defense, i.e., military necessity, distinction, and proportionality.
4. Accepting an offer of peace and humanity are also relevant conditions. If an enemy stops fighting then the war must stop and peace immediately sought.

The onset and course of the conflict

After the selection of Prime Minister Abiy Ahmed in 2018 he began to diminish the power of the Tigray People’s Liberation Front (TPLF). Being just 6% of the population they had little representation in the Parliament. Although there was a brief honeymoon, the PM began to decrease their power by cutting the regions budget, labeling them as terrorists, and removing them from positions of authority in government. There existed a bitter feeling of resentment especially in the Amhara region against the TPLF for claims that the TPLF had illegally taken land from the Amhara region and carried out violations of human rights on Amhara in past decades. Ultimately the Parliament under the PM’s direction labeled them a “terrorist group” unable to hold any position in government. No formal actions called for or specified in the Ethiopian constitution were carried out which were created to settle disputes between member regional states. Action by fiat was carried out without attention to legal remedy for accused wrongs.

Several attempts were made to land Federal police forces in Mekelle to arrest prominent TPLF members which were repelled. Then on the early morning hours of November 4^th the Ethiopian National Defense Forces in Tigray and the regional Tigray police and militia forces went into conflict. The exact circumstances are unclear although it seems to may have been a pre-emptive attack by the TPLF.

The Tigray region was overrun by Amhara militia, ENDF, and invading Eritrean forces causing a retreat by the TDF(Tigray Defense Force). There have been reports of atrocities by both sides although clearly the enormity of starvation, extra-judicial killing, prisoner execution, raping of women, killing of children, theft of property, destruction of medical facilities and utilities, ransacking of schools, etc. is overwhelmingly evident to be by the Ethiopian forces and their allies.

The TDF rebounded and was almost at the gates of Addis Ababa having basically decimated the Ethiopian forces whilst the Tigray civilian population has no water, no food, no electricity, no hospitals in good shape, no medical supplies, ransacked schools, no phone, no internet, and an ongoing siege against supplies except for a small trickle.

Western diplomats and others being fearful that a break-up of the Ethiopian state would bring regional instability pressured the TDF to withdraw if a promise of a truce was given by Ethiopia. Yet the siege continued along with continued drone strikes, imprisonment without due process of many Tigray throughout Ethiopia , and no clear intention to seek peace by Ethiopia. That Abiy Ahmed’s real intention was that Tigray would be starved and deprived into submission is now evident.

The government of Ethiopia has maintained that it is performing a law enforcement action against Tigray while maintaining that there is no hunger problem and that they are acting on the best interests of the Tigray people despite the fact the TPLF won more than 9o% in an election shortly before the war started and by the words of the Prime Minister that the people of Tigray were too supportive of the TPLF.

By any reasonable measure the evidence is clear as to the aggrieved status of the Tigray

While at the same time saying that the Tigray people(Tegaru) are somewhat innocent of wrong doing the government of Ethiopia has not recognized that they have any standing or rights in persecution driven by ethnic identity. The elected government of Tigray acted in self-defense against egregious acts of failing to provide basic human services which threatened the security, livelihood, and lives of over 7 million Tigrayans. There are constitutional and federal proclamations available which could have been used to address the grievances against the government of Tigray. It is glaringly obvious that the savage military campaign carried out and continuing by the Ethiopian government is really a lust for revenge and power. There was no threat to Ethiopian government evident until the situation escalated by the unconstitutional actions of the Ethiopian government.

Addis Ababa identity vs regional identity in Ethiopia :Role in the Conflict

My experience in Ethiopia has taught me that how the people of Addis Ababa see Ethiopia is often from a much different perspective than how those in other ethnic groups living outside Addis Ababa especially those not Amhara see the country. This creation of a capital identity group versus a regional identity group plays a role in understanding the current Ethiopian conflict. The different perception of an Ethiopian identity creates an ideological conflict that is difficult to overcome.

I have lived in Ethiopia since 2012 functioning as an academic neurosurgeon training students, neurosurgical residents, fellows, acting as an advisor, as well as doing intense research on the scourge of neural tube defects. Initially I lived in Addis Ababa, the nations capital, then in Dessie in the Amhara region and then since 2015 in the capital of the Tigray region, Mekelle. When I moved away from Addis Ababa, still for many weekends I would travel to Addis Ababa to see patients and also do consulting for NGO development, business interests, and government health concerns. In both Amhara regions and the Tigray region I made trips to the countryside rural areas to meet with the rural people to try to understand how they live and what contributed to the incidence of neural tube defects for which I helped create research sites throughout Tigray and recently trying to establish in Oromia which was interrupted by the war.

The creation of monarchial command center
Addis Ababa is a relatively new city. Although there was some settlement there by the Oromia who called it Finfinne its urbanization began when the Ethiopian Amharic Emperor, Menelik II, moved there in the late 19^th century to create a more centralized command post to control his domain that extended much farther south then northern Ethiopia. As has been well written about about the capitals of many developing countries, Addis which is the short term used by locals, became more cosmopolitan then other areas. A large influx of Amhara gradually moved into what had previously been Oromia. They encouraged the development of educational institutions, commerce, diplomatic interaction, and modernization of the city which rapidly outpaced that of the other areas of Ethiopia.

Immigration from many regional states to Addis Ababa blends into a city identity

Workers from many regional states seek opportunity and work in Addis Ababa

Immigrants from every region of Ethiopia came seeking work and opportunity they could not find in the countryside. Whereas in the countryside, which makes up the largest percentage of a rural population in the world among countries, lived a life less cosmopolitan and urban. While inter-ethnic marriage became very common in Addis it rarely happened and is often shunned in the countryside. The everyday language and identity in the countryside is the local one whereas in Addis those who were born and raised there identify themselves commonly as from Addis Ababa adopting Amharic as their main language and the Addis identity. They transform from their local ethnic culture to the Addis culture in one generation.

Rural Ethiopia is often one ethnic group following strong long standing cultural traditions

The current generation who was born in raised in Addis Ababa or went to university in Addis Ababa is more likely to accept the idea of a national identity to Ethiopia which makes a very small percentage of total Ethiopian population. Many have never been to the countryside and cannot relate to it other than it was where their ancestors grew up. This division of identity and experience no doubt plays a role in what is happening in Ethiopia today.

Those living in Addis Ababa have been raised with and most easily accept the idea of single Ethiopia identity predicted by such western social writers such as Levine. On the other hand researchers who spent time in the country side such as Young see Ethiopia as an empire of differing nations prone to recurring conflict.

The autonomy of the regional states and regional educational development empowers regional identity

Since the post Derg era began all the regional state capitals have had universities built. Although initially they were staffed by mostly Amhara faculty that is giving way to more regional ethnic faculty. Many of these faculty have had to chance to study abroad or least cooperate with international institutions.

Major universities now exist in all the major regionals states of Ethiopia

Over the past several decades thirty-three universities have been built in the many different regions of Ethiopia. Whereas the center of intellectual development was in Addis and primarily dominated by Amhara now there is a new spring of ideas and identity perceptions arising in each region. Thus new growth of regionalism is a strong counter to centralized Addis Ababa identity which promotes one national identity. Instead of all regional leaders going through a transformational experience of living in Addis Ababa for a time during their education that may alter their identity they are now being educated in regional universities by increasing regionally trained faculty and influenced by regionally experienced elders of the community.

Floridians reluctance to COVID-19 immunization

“You can bring a horse to water but you can’t make him drink!”

A reflection on Florida’s #COVID-19 Crisis and reluctance to vaccination

So yesterday I am in my local Walmart store in Florida which has become the new town square of suburban America. Every five minutes the speaker system throughout the large superstore is announcing that free COVID 19 vaccines are available with minimal waits right now. It was about 6 PM on a sunny afternoon and the store was moderately filled with a heterogeneous group of shoppers of different ethnic groups and ages. I wondered how many of them knew that Florida had become the number one state of new infections over the past week.

I remembered that the Republican party in Florida had said that yes COVID 19 was dangerous but only to seniors and that young people should not worry. Florida Governor DeSantis just a few months ago said the virus was no worse then the flu and that it would not cause significant hospitalizations. Now of course the rising tide of affliction is affecting, hospitalizing, and killing greater numbers of people ages 20 to 40 because the delta variant making up 83% of cases is much more infectious. In Florida this group has had low vaccination rates.

As I walked through the Walmart nobody was wearing a mask. The hand sanitizing station was unattended. Everyone entering the store just passed by it. Then I wondered over to the pharmacy to see if there was a line to get immunized. To my surprise there was none.

This made me think about an an old saying I learned a long time ago when I was working on ranch in South Texas. “You can bring a horse to water but you can not make him drink!” If we look at vaccination as an analogy to water we can see that the constant barrage by conservatives and other anti-vaxers has created a malignant lie that the water is poisoned. Large numbers of people have been convinced that they should act against not only their own interest but against that of their family, their community, their nation, and even the world. Let us hope that the horse will get thirsty enough to finally take that drink. For this to happen they have to realize that they have become pawns in a political power struggle that cares about winning not about health.

Ethiopia has always been an empire not a nation for the Tigray

Tigray Defense Forces parade their success

Introduction

There is a global misperception often forwarded by Amhara expansionists that Ethiopia has been a nation for centuries. But instead the area we call Ethiopia came into being less than 200 years ago when Amharic kings become dominant over the Tigrayan monarchy and then conquered Cushitic peoples in Oromia, the Southern Nations, the Afar, and were “gifted” part of Somalia by European powers. In reality the Tigray have always thought of themselves as a nation in an empire.

Recently the world was stunned when the very small region of Tigray managed to retake most of its territory back from the federal forces of the Ethiopian national government last summer who had one of the largest armies in Africa. To those who know the past 100 years this is not so surprising. A look at the recent history of the Ethiopian empire, a collection of many ethnic groups struggling for dominance, over the past century lends insight to current events.

How Western Civilization Has Looked at Ethiopia

Many scholars had looked at what had happened to Ethiopia in the 19th and 20th centuries trying to understand its evolution and how it would progress. Donald Levine wrote in his work Greater Ethiopia: The Evolution of a Multiethnic Society that Ethiopia would develop a national identity due to experience of war, famine, religious conflict, trade development etc. The dominance of Amharic emperors during this time period until the late 1960s favored the development of an idealistic concept of Amharic elitism as a central theme as well.

Although many languages both Cushitic and Semitic are spoken in Ethiopia, for approximately the past 150 years the Amhara leadership of the country (beginning with the monarchy) as well as the Ethiopian orthodox church essentially mandated that the Amhara language would be the official language of commerce and government. Elite schools and universities taught in Amharic thus its speakers were seen as superior to the non-speakers of Amharic. Those wishing to become “educated” had to learn Amharic. Political ideas and policies thus became mostly associated with this Amharic elitism. Until just the past two decades attendance of the prestigious Addis Ababa University was limited to the Amhara.

What is the Tigray Identity

The Tigray people claim their ancestry to the Axumite empire which was started by the Queen of Sheba, a Biblical figure, who lived thousands of years ago ( an aristocrat of the ancient Saba people who lived about the eastern and western areas bordering the Red Sea and spoke a Semitic language). Legend has it she conceived a son with King Solomon of Israel and converted to Judaism. Centuries later the Axumite empire converted to Christianity under King Ezana. Although early kings of Northern Ethiopia were Tigray they eventually lost power to the Amhara whose background is also related to that of the Tigray. The Tigray have a long tradition of being a warrior clan. In fact going back centuries in both domestic battles and battles against foreign invaders their abilities as fighters and commanders of armies were always sought. At same time these qualities have always fostered suspicion by other ethnic groups especially when the military services of the Tigray were no longer needed. Most recently the term Tigray is most often used to describe the region while the term Tegaru is coming more into use to describe its people and now even being used to differentiate them from Eritreans.

The Rise of the Tigray

The rise of the Tigray who make up only 6% of the population of Ethiopia to lead an alliance that would topple a powerful government without any outside assistance starting from essentially no resources was unexplainable to scholars. Daniel Young a journalist with the Sudan Times began to follow their rise in 1988 and eventually wrote the definitive scholarly work, The Peasant Revolution of Ethiopia.

He did numerous interviews with peasants after gaining their trust. He noted then as did others that although there has always been talk about a greater nation for the most part over the past century there have always been nationalist movements within Ethiopia. Ethiopia has always been a empire and not a nation. Although the goal of the Tigray (Tigray Peoples Liberation Front) was primarily to overthrow the Derg (a quasi communist-socialist multiethnic movement which included many military leaders and was supported by the Russian communist party) the TPLF developed the concept that to be successful they had to gain great support from the countryside peasants. One important component was they incorporated educated Tigray women into leadership roles. The Tigray were remarkable for developing and sticking to their ideals and goals, creating alliances, strong action against dissent for which they have been criticized, and finally for basing their strength from a bottom up approach which is significantly different then the Amhara elite model which is a top down scenario.

Bottom Up versus Elitist Lead Revolution

From a social science perspective there has always been controversy over whether a revolutionary movement can be driven by perceived peasant led initiatives (bottom up) or by elitist lead initiatives. The successful revolt of the Vietnamese against French Colonialism and American interference is often demonstrated as a model of the bottom up approach. Thus what we are seeing now is a repeat of this ongoing struggle in Ethiopia of peasant based vs elite based focus and empire vs nation identity once again. How will it turn out?

This article has been updated from its original form

Physicians duty in war

A woman is taken to Ayder Referral Hospital, in Mekelle, after an airstrike in Togoga, Ethiopia’s Tigray region June 22, 2021. Picture taken June 22, 2021. Tigray Guardians 24 via REUTERS

Being in the middle of the Tigray-Ethiopian conflict for three months and now following it I have pondered about were do health care workers duties fit into this all too common human situation. In the midst of war questions may come up about what are called conflicts of dual loyalty for doctors. However physicians of the Jewish, Christian, and Islamic faith recognize that they have a duty to their patients be they ally or enemy. This ethic goes back to the times of the medical scholars Hippocrates, Maimonides, and Al-Ṭabarī.

The Jewish rabbi physician Maimonides in discussing his interpretation of the Jewish law in the Mishneh Torah said that everyone who found anyone missing a possession should have it returned to him. That included health which meant physicians had to treat all comers including those of different faith and ethnicity. He said “ On the basis of this reasoning, the art of medicine is given a very large role with respect to the virtues, the knowledge of God, and attaining true happiness. To study it diligently is among the greatest acts of worship.”

Religious medical scholars on ethics of the Jewish, Christian, and Islamic faiths have given a very large role with respect to the virtues, the knowledge of God, and attaining true happiness. Al-Ṭabarī , Islamic and medical scholar, expanded upon Hippocrates incorporating Islamic principles found in the Qur’an of dignity of the individual, charity, dutiful study of the healing arts, and faith playing a role in the formation of a good healer.

Christians are familiar with the parable of the Good Samaritan where Jesus tells the story of an abandoned injured man presumable a Jew on the road between Jericho and Jerusalem a place of frequent violence who was ignored by a Jewish priest and a Levite. Traditionally there was hatred between Samaritans and Jews but when a Samaritan encounters him he decides to render him aid and pays his expenses to recover in an inn. Jesus demonstrates charity when asked Who is my neighbor? The response is that all men are our neighbors (All men are a part of God’s loved creation?)

The Islamic faith has long seen medical practice has having an intimate relationship with their faith. A good physician is a faithful one who shows mercy and charity to all men. Incorporating their beliefs into a commonly used oath of which a partial quote is “The doctor will protect human life in all stages, in all circumstances and conditions, and will do his utmost to rescue it from death, disease, pain, and anxiety. He will extend his medical care to the near and the far, to the virtuous and the sinner and to friend and enemy.”

There is a shared believe among the descendants of the covenant that Abraham made with God so many centuries ago that physicians have a common ethic to care for all who are in need.

Although health care providers around the world have been consistent in following this universally accepted moral imperative especially since the medical experimentation done by the Nazis the same cannot be said about the destruction of medical facilities and killing of health care workers. Although the United Nations and member countries have signed multiple treaties forbidding these actions. Despite these diplomatic measures ongoing research has shown their progression.

In Ethiopia during the onset of the Tigray-Ethiopia-Eritrea conflict I spoke with physicians and nurses who had to escape military bombardment and ransacking of medical facilities in Humera, Axum, Adigrat and other places often killing both staff and patients. One wonders what if any consequences will come of these illegal war crimes?

Learning how to succeed in life on a ranch in South Texas

I grew up in the 60s and early 70s in McAllen, Texas located on Texas Mexican border . It was routine for us as teenagers to get a job for spending money or to buy that first car. Sometimes that job could be on a ranch or farm. This is story of one outstanding businessman who influenced us for the rest of lives through our “part-time” job.

Young men need role models in addition to our fathers. Mr. Harold Judson Brady, Navy veteran and former wildcat oilman who then became a successful businessman, was one of the most amazing people I have ever known. He was stern but forgiving, commanding but understanding, was probably the most confidant and self assured person I have ever met. He had a colorful vocabulary and was always clear in his messages. Although the work was hard and sometimes took up a lot of our free time it no doubt kept us out of trouble that teenagers can often find. We learned how to overcome obstacles and deal with new challenges literally everyday. Planning, analyzing, and not giving up if there is failure at first were instilled in us.

Beginning in 8th grade and continuing through high school one of the most character forming experiences of my life was doing ranch work at the Brady ranch on Montecristo road in north Hidalgo County, Texas. At the strong urging of my father who believed in hard work and his friend Mr. Brady, his son Bob, my brother, and myself embarked on a journey. The ranch raised Beefmaster cattle breeders.

Example of a dehorned Beefmaster bull. They were breed to be not aggressive but living on ranch with predator around this was not always the case

Prior to this we had no agricultural experience being suburban kids growing up in McAllen, Texas. Suddenly we were thrust into cutting and making hay bales, working with cattle in squeeze shoots, and raising feed crops. We learned to operate all sorts of heavy equipment like tractors and trucks, to brand cattle and fix fences.

Texas brush country is very dry with little rain so irrigation is absolutely necessary. We grew alfalfa in traditional furrows on uneven land. Irrigation releases to farmers and ranchers were strictly regulated and could come in the middle of the night. This meant on a Wednesday night at 2am we could be out doing an irrigation. Because the land was not well leveled we used devices the locals called lunas which was a board with a waterproof canvas attached to divert the flow of water. As the water flowed into the field we would be running around in the thick mud that quickly formed moving the lunas around to insure an even distribution of water. At the beginning we knew nothing of the lunas or how the field would flood. We had to learn by trial and error and gradually gained experience over many times to get good at it.

Mr. Brady passed in 2016. His obituary said “He possessed a strong work ethic and was a tireless worker always enjoying a good challenge. Jud loved the outdoors, hunting, flying his private planes and most of all, being with his numerous and faithful dogs.”

Years later I like to think that a lot of what I learned at the ranch helped me become a neurosurgeon. Mr. Brady taught us a Christian lesson that live does require hard work to be successful as reflected in Scripture below:

2 THESSALONIANS 3:10-12

“For even when we were with you, we used to give you this order: if anyone is not willing to work, then he is not to eat, either. For we hear that some among you are leading an undisciplined life, doing no work at all, but acting like busybodies. Now such persons we command and exhort in Christ Jesus in the Lord Jesus Christ to work in quiet fashion and eat their own bread.”

Neurosurgery Should be Leading Light in Medicine and Community

The case load and distribution of neurosurgeons around the world

The other day someone showed a photo of an angry person with the caption of a neurosurgeon responding to the complaint of the neurological status of his patient. Since the days of the pioneers of neurosurgery including Harvey Cushing we as a specialty have always struggled to prove our relevance and necessity to society. Among our medical colleagues they often feel sympathy for our hard work but doubt that it really helps most of our patients. Similarly the public often views us at times heroically or other times seriously impotent to treat hopeless conditions.
In 2018 a global survey of neurosurgery (see the enclosed photo)showed growing around the world and even in developing countries. This is a good thing. At the same time over the past several decades there has been increasing emphasis from stakeholders and political authorities for medical providers to show the effectiveness of their work and costs. What doctors do is now called relative value units and it is matched against assigned niches for our small specialty in health care budgets (both public and private).
Since I was resident about 40 years ago wonderful developments have occurred such as MRI, intravascular intervention for aneurysm, spinal instrumentation, computerized navigation, endoscopic procedures etc. As a resident we are fascinated by these wonders and the science behind them but then when residency is over we do have to make our way in the real world. It is easy and totally understandable to be drawn to lucrative fields especially spine surgery as I was because it offers frankly good rewards for hard work as well as being so ubiquitous in the population. Unfortunately it is also the field most rift with poor science and loose surgical indications such that many of our medical colleagues tend to look down upon those whose career mostly deals with this field.
The enthusiasm for complicated cases of the brain and head injury treatment often wane as one passes from the academic training environment to the realm of sustaining oneself in the world which is understandable. In discussing this I am not passing any judgment just reflecting upon a fact of life.
My advice to young neurosurgeons including my residents and fellows as well as especially those developing their careers in countries where neurosurgery is relatively new is to try to balance your contributions to society with your own financial rewards. Stay involved in teaching and research. Joining with public health officials in documenting the needs of traffic and accident victims will make society see the need for advancing neurosurgical care. Cooperate with fellow neurosurgeons and the medical community to educate stakeholders and public about how emergency care and neurosurgical centers (including trauma centers) can save so many who will continue to lead productive lives. Promote professional standards about spine care and be wary of becoming too entwined in the medical legal system. During surgery on patients who are not a risk of neurological deterioration but are likely to continue to be chronic pain sufferers does not improve your reputation or that of your profession. Let neurosurgery be the light of your medical community.

Multifaith community alliance saves hospital in Mekelle, Tigray

drone view of Ayder Comprehensive Specialized Hospital — Shows Ayder Hospital and the streets lining it where a brave protest occurred

How a community of different faiths and ethnicities came together to save their hospital, Ayder Comprehensive Specialized Hospital, in the city of Mekelle, Tigray region of Ethiopia in the face of a horrific invasion by Ethiopian National Defense and Eritrean forces. In the previous post I described the culmination of events that deterred the ransacking. Here I will tell the story of how it began.
I have gathered some more information on how the heroic unarmed resistance began to stop pilfering and ransacking of Ayder Comprehensive Specialized Hospital in Mekelle from the occupying Ethiopian National Defense Forces and Eritreans.

The Adishmdhun mosque where the muazzin made a call to action

Among the first to call citizens to action was the muazzin of the Adishmdhun Mosque. Although there was no electricity in the city using the mosque generator and microphone he called people to guard the hospital. The message was ” to all residents of Mekelle be Muslim, Christian, males or females : Ayder is being looted, so go and protect your hospital “. Immediately the people began to make the gatherings. There was was a group of motorcycle men who tended to gather at a pub just a few blocks from the hospital who began calling the same thing using a speaker. Youth groups and community elders answered the call. The demonstration and blocking of the roads was done with people of all faiths and different ethnicities.

The Nejashi mosque in Tigray was bombed and looted

The Muslim community would later hear about the desecration of the Nejashi mosque in Tigray by ENDF and Eritrean forces. This mosque is particularly significant as it was founded by the first followers of the Prophet Mohammed (Peace be upon him) who were given refuge in Ethiopia from the pagan Saudi rulers.

Throughout the occupation young men volunteered to patrol the streets around the hospital in defiance of the night time curfew pronounced by the ENDF and the Eritreans. Unfortunately some were shot and killed on sight. How many we do not know yet. Sometimes the body was just taken away so that relatives do not know what happened to them.

Mekelle Unarmed Civilians Brave Defense of Their Beloved Hospital-Ayder Comprehensive Specialized Hospital

This is the story I witnessed of the brave unarmed civilians peacefully protesting and blocking invading forces from ransacking Ayder Comprehensive Specialized Hospital in Mekelle, Ethiopia in November of 2020. I had been performing neurosurgery, teaching fellows, and medical students at Mekelle University in the Tigray region of Ethiopia since 2015 in a federal university and hospital. As such I was present in Mekelle from the onset of the war between the Tigray Defense Force and the Ethiopian/Eritrean forces from the onset until my evacuation near the end of December 2020 at the behest of international influence and my family which was three days of driving through multiple checkpoints and unstable areas until we finally arrived in Addis Ababa.

Following the retaking of Mekelle by the Tigray Defense on June 28, 2021 there has been a mixture of sadness and joy. For sometime I have wanted to tell the story of what I think was the most heroic thing I have ever seen in my life which was the unarmed defense of Ayder Comprehensive Specialized Hospital in Mekelle. Prior to this time I felt telling it would result in reprisal to the citizens of Mekelle. Now that Mekelle is free it is important to tell it.

For almost 24 hours on November 25, 2020 the city of Mekelle was attacked constantly by artillery, rocket attack, and airstrikes even though the Tigray Defense Forces had left the city to only civilians. In my own immediate neighborhood just a few blocks from the Mekelle University hospital, Ayder Comprehensive Specialized Hospital many homes and buildings were destroyed and many killed. A market and home for elders was directly hit killing and wounding many.

About 200 yards from my house, a home that housed a large extended family suffered a direct hit that sent shrapnel breaking my windows at about 6:30 in the morning. I ran over there to find a young woman in the street with a severe bleeding wound in upper leg but that was just the beginning of the horror. The walls of the house had been destroyed on two sides and the rest looked like a Swiss cheese with many perforations. On the ground was a motionless young woman who had only a red spot on the ground where her chest was supposed to be. Her lifeless arms were extended with each one holding toddlers. The children where crying. When I pulled back their hair I found that hundreds of small munitions fragments had penetrated the scalp of both children although the eyes seemed okay. There was nothing we could do for the mother nor her mother who lay beside her dead as well from penetrating shrapnel. Remaining family members rushed the sister with the injured leg and the children to Ayder Comprehensive Specialized Hospital.

At the hospital emergency room there was wave after wave of ambulances and private vehicles bringing those hit by the attack who were all civilians. Some could be helped but many were beyond hope. We were able to save the children and their aunt from the attack near my house. Although we would sometimes previously do mass casualty from bus accidents in the past this was a much greater magnitude as we saw more then 120 patients in the first few hours.

Before the invasion of the city, we had been receiving civilian causalities, Tigray Defense Force causalities, and also Federal/Eritrean causalities. We treated them all the same. The local people even brought food and blankets for the all the groups. However after the invasion the tenor of the invading force changed. Many patients were just suddenly whisked away to parts unknown and we were not allowed to inquire.

The next day on November 26, 2020 at which time Federal Ethiopian armed forces and Eritrean forces invaded unopposed the city of Mekelle. For the next few days in Mekelle there were Ethiopian and Eritrean forces looting, shooting, robbing, and harassing civilians all around the Ayder area where I lived and the hospital was located. The hospital was occupied by Ethiopian army regulars, then Special Forces from Oromia, and so-called Federal Police. Then suddenly for about half a day they disappeared.

Rumors where flying in the city that Eritreans where ransacking public utilities, schools, etc. The hospital had always been a source of pride and necessity for not only Mekelle but all of Tigray. The local population of civilians began to put tires, logs, and stones to block trucks or other vehicles in the streets surrounding around Ayder Comprehensive Specialized Hospital, the main teaching and tertiary hospital for Tigray, fearing that the hospital which was highly valued by the city would be destroyed or looted. Special Red caped soldiers showed up and began harassing the locals more and more.

The locals did not back off. They gathered by the thousands and began to surround the hospital 24 hours a day. Many times semitrucks and smaller trucks driven by Eritreans which were empty tried to make it to the hospital to loot it but where physically blocked by protestors standing in their way. At one point a group of young men were shouting about ten feet in front me to the soldiers. Suddenly the soldiers fired at them killed one and injuring two others. At that time there were tires burning all around the hospital with thousands of protesters. The soldiers were scared and I feared the worst was going to happen. It was tense until morning. Finally the lined up trucks driven by plain clothed Eritreans were told to leave by the invading forces. The two that survived to be treated were hauled off from the hospital by the invading forces and have not been seen again as far as I know.

Pictures I had of the event were erased by Eritrean patrols that would search me everyday I went to the hospital but I will never forget the bravery of the people in Mekelle who unarmed defended their hospital.