In an emergency international zoom conference today Drs. Amanuel Haile, Tigray Health Bureau Director,and Kibrom Gebreselassie, CEO of Mekelle’s Ayder Hospital, the continuing catastrophic health care crisis in the Tigray region suffered under the Ethiopian siege was reported.
Less then fifty percent of health care facilities have any staffing at all. Even those that are open have no electricity or supplies. There are no antibiotics to treat infection, no surgical supplies, and even simple things such as bed sheets and soap are scarce. No electricity is present to run medical equipment except for occasional runs at the tertiary Ayder Hospital on a rare basis.
During the so called truce following the exit of occupying forces of Ethiopia from Eastern Tigray but not Western Tigray there has been a strangulating blockade of food, medicine, and fuel. Only 5% of necessary medical supplies were coming through the blockade. The Ethiopian military as well as the Ethiopian Ministry of Health under Lia Tadesse continue to limit what will be cleared for transport into Tigray from Ethiopia so that the people of Tigray would be “punished”.
Immunizations for children, oxytocin to help in childbirth, HIV testing, antibiotics, cancer drugs, tuberculosis drugs, anti-malarials, oxygen and surgical equipment are a few of the many banned items. Even while Ethiopia claimed to be assisting in medical supply the reality is that not a single item was donated by Ethiopia itself. Only donated supplies from foreign countries in miniscule quantities are transported.
The medical crisis extends beyond just humans as there have been outbreaks of rabies in some cities from infected dogs spreading to humans. Feed for livestock is sparse and many animals have become infected with anthrax which has spread to humans as sick animals are desperately consumed.
While fifty thousand health care workers have attempted to remain on station to help the population they have gone unpaid essentially since November 2020. There is no fuel or parts to allow transportation of patients to health care facilities.
Examination of the claims by Ethiopian Defense Minister Abreham Belay that Tigray youth fighters captured were given drugs is a bizarre and hypocritical statement. He no doubt is aware that there is a potent stimulant, Khat, commonly used in the Amhara, Oromo, and southern areas of Ethiopia which is not common in Tigray. It seems he wants to claim the Tigray forces are just youths coming in undisciplined waves often defeating superior numbered Ethiopian forces which have “superior weaponry and training”. So he came up with the idea that the Tigray have magic drugs that turn this innocent youth into supermen. There is a great irony in that there is high if not certain likelihood that his own fighters which often include youth are likely using Khat to greater extent then the Tigray. Not only do the Tigray culturally not favor its use but the availability of Khat would be almost impossible. It does not grow in Tigray and is perishable within a short time. The Tigray siege would make it difficult to import in great quantities.
The second largest export of Ethiopia are leaves of the plant, Khat (Catha Edulis)which contains the amphetamine-like substances cathine, cathinone, and methcathinone. Traditionally it is chewed slowly for hours to increase alertness, improve the mood, and increase mental focus. Its use is very common throughout much of Africa and the Arab regions. Public health studies have shown its greatest use in the the Southern Nations, Nationalities, and Peoples’ Region, Oromia, and Amhara regions of Ethiopia.
When I lived in the Amhara region one could find a Khat vendor on almost every block of a town whereas in Tigray the cultural use of Khat has been much less accepting. Often times taxi drivers, security guards, young men college students, policemen, and soldiers in the regions mentioned in the areas above partake of Khat as documented in public health research. There is little research on its effects on physical activity although in Olympic competition it is banned as happened to a Kenyan boxer in 2004.
Although in these regions the popularity of Khat use is high little is known about any deleterious effects. Some clinicians involved in stroke care like myself have wondered whether it creates a greater risk of hemorrhagic stroke but to date no definitive evidence has been demonstrated.
Finally, Ethiopia has very poor resources for drug testing. I cannot believe that the Ethiopian Defense Forces is drawing blood, urine, and hair samples from its prisoners and sending them to foreign countries for testing which is what would be required.
The following is a copy of the account given by Dr. Kibrom Gebreselassie Desta, Medical Director of Mekelle University Ayder Hospital of the bombing of the kindergarten in downtown Mekelle as documented on his Facebook. The horror of injuries and death was magnified further by the Ethiopian government’s siege of medical supplies which rendered severely limited what medical care could be given to survivors.
It was noon.
Staff were leaving the hospital for the midday break.
I locked my door and sat in the couch. I didn’t want to go home for lunch. I know I have no prepared lunch at home. It has been more than a year since I got my salary, like any Tigrea government employee. Every commodity that you can get in the market is at least 10 times more expensive than its pre war value. But this too is if that commodity is available. Eating once a day is a routine thing for someone who can afford it. For someone who is the director of the biggest referral hospital in the entire region. For someone who had spent two decades in medical school, a subspecialist in Cardiovascular and Thoracic Surgery like myself. For the common people imagine how hard life is.
Our friends and family members who live abroad send us money sometime when the have means to do it. Dealers will cut a minimum of 35% of the cash and they give you at an exchange rate which is too low than the bank rate. You should be grateful as this is your only hope to see the sun rising the next day.
While dozing in silence I was started by the sharp noise of an Ethiopian military jet. It was followed by a deafening explosion. I thought my hospital was the target. I run to the emergency room. Everyone was alert and ready to receive the victims. The head nurse told me he saw smoke in the neighbourhood which was at least one kilometre away from our hospital.
We heard the siren of an approaching Red Cross ambulance. It brought an injured elderly woman and a dead boy, at least 17 years old. He had a big hole in his chest. His heart was blown out. An instant death for the kid, but a lifetime horror for the woman who had to endure the scene in the entire trip. Soon more ambulances brought dead and injured children of the air strike. The target this time was a kindergarten. The children’s Amusement Park was completely destroyed. The area is a quite neighbourhood with no military installation or camp. Ethiopians, like their Eritrean allies are known to target market places and schools. They did hit their target once again. We in the receiving end of their two year long atrocities, it is another day of sorrow and bitter sadness.
In a hospital which has no budget in a year, with a staff who haven’t received their salary in 16 months, with no electricity (our sterilisation department, the operation theater, imaging department are not functioning because there is no fuel for generators. NGOs like WFP, USAID, UNICEF, WHO and OCHA were asked for help, none of them could help us. The treatment we got from UNICEF was the most painful. The guy there laughed at us when he heard neonates are dying of hypothermia. USAID and WFP opted not to respond to our quest. The others at least shared our pain.) or telecommunications services, here we are to treat our wounded. The emergency physician approached me and asked for more intravenous fluids. Her tears were visible. She knew the hospital has no fluids nor antibiotics. All I can do is shed my tears with her.
My prospective as a long time researcher, teacher, and physician at Mekelle University on the effect of the Tigray war and subsequent siege on women’s health
Just prior to the invasion of Tigray by Ethiopian and Eritrean forces we know that Tigray had one of the highest rates of medically assisted childbirth in Ethiopia likely to be close to 20%. This low number reflected that it also included a high number of women who were recognized in screening by local health authorities as at risk for a problem pregnancy which lead them to seek closer follow up and care.
Now the health care extension worker network and local clinic systems staffed by public health officers, nurse, and general practitioners have been eliminated. There is no communication system or reliable transportation system even if there was functioning health facilities to visit.
Tigray already had high levels of birth defects including neural tube defects which require close pre-natal care and surgery immediately after birth to improve the health of mothers and children not only for their survival but to promote prevention. The medical and prevention services for these defects in which Tigray was a leader in Africa recognized for the leading research work done by Mekelle University by the World Health Organization and Ministry of Health which has abandoned Tigray now have essentially ceased.
Vaginal bladder and rectal fistulas which are preventable by pre-natal and appropriate birth care management have already skyrocketed. Additional many horrendous mutilations by invading armed forces further added to this burden. Women with these preventable and treatable conditions require sophisticated counseling and specialized surgical care units to avoid a life of social rejection and isolation. These services minimally exist now.
Female reproductive system, breast, thyroid and other malignancies affecting not just the elderly but often women as young as the second decade were in the pre-war era being addressed by preventive screening and the development of comprehensive cancer treatment at Ayder Hospital in Mekelle. A three hundred bed cancer center which included surgical suites and a radiation therapy installation remains unfinished and somewhat vandalized by the occupation of Mekelle.
Before the war about 25% of Tigrayans required food aid. Most of the rural population of women have to carry out the duties of contributing to farming and raising animals, caring for elderly relatives, collecting daily water, and child care. Poor health compromises their abilities to function in society causing higher levels of birth defects, maternal and child perinatal mortality, and retards the goals of elevating women’s status in society.
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.
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 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.
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.
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.
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.