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.
One of the most devastating injuries in war occurs when vital blood vessels, bones, and/or tendons are injured. The Neurosurgery Department at Mekelle University Ayder Hospital is currently making a special effort to treat patients afflicted with these disabling nerve injuries. Although often on popular televisions heroes are portrayed to recover from such wounds without surgery that is not the case in real life. Hundred of civilians in Tigray have suffered death or injury from air strikes, drone strikes, directed military fire from Eritrean, Amhara militia, or ENDF forces. Sometimes soldiers would intentional shoot an arm or a leg to permanently disable women they raped or farmers they wanted to evict from their homes knowing such injuries would render them unable to work. Being able to perform this surgery for peripheral nerve injuries absolutely requires the continued supply of anesthetics, suture material, and other supplies otherwise these patients will be left with a permanent disability. Too long a delay in availability of materials can result in a potentially treatable condition becoming a permanent disability because the nerve damage is irreversible.
Since I came to Mekelle University’s Ayder Comprehensive Specialized Hospital in Tigray in 2015 we had developed among the staff and the specialists in training the ability to deal with these potentially devastating injuries. Losing the use of a hand or leg can mean a farmer can not farm and that his family could starve. If the nerve is completely severed repair is best done within a few weeks. If there is partial injury then sometimes delayed surgery even many months later can help restore functional use of the extremity. Prior to the onset of war in November 2020 we had dealt with many such injuries mostly from motor vehicle or work accidents with very good outcomes in the vast majority of cases deemed operable candidates. In some cases we even did transplants of non-vital sensory nerves in the leg to restore function in the arm successfully.
Correspondence from Dr. Merhawit Atsbha, internist and faculty member, of Ayder Hospital documents how the lack of medication and services available to treat diabetic patients in Tigray has lead to horrific suffering and loss of life.
Here is his letter to the world:
As to diabetes management we have-not received any medication after June 2021. We have so far been using the stock we had before that and starting from September we have started using expired po anti diabetic drugs. And our treatment has recently focused on preventing acute complications like DKA and HHS. We have stopped being concerned about good glycemic control and preventing chronic complications. We also mostly do not discuss about diet with patients as they have to eat what is available.
From the report we got from our pharmacy head we have learned that we are left with 150 vials of NPH and few strips of glibenclamide. Metformin has been out of stock for two weeks. The sad part is we even have run out of the expired drugs. With the limited amount of drugs that we have we will be able to serve for only 2 to 3 days.
To make things worse we have run out of IV fluids so we are treating even moderate and severe DKA with free water. Thinking about the more than 10,000 patients in Tigray and more than 2500 patients in Ayder we are very sure that we will be flooded with acutely sick patients in the coming weeks but we will not be able to help them.
Therefore, we beg you all to be the voices of the voiceless patients and physicians here. And find a means to help our patients before it is too late. Thank you for the efforts made so far.
The Tigray Regional Health Bureau system and Mekelle University Ayder Hospital had for many years made tremendous progress in the care of Tigrayans with diabetes mellitus. Providing medications, treating complications, providing community health education on self-care and prevention were all important factors in improving life expectancy and quality of life.
The prevalence of diabetes mellitus in Ethiopia is estimated to be somewhere between 14% to 18%. With medication, diet control, and education teaching the patient self-care most diabetic patients can lead productive and near normal lives but without treatment complications like diabetic coma, peripheral vascular disease, and heart disease cause severe disability and early death.
In February 2021, Ethiopian Minister of Health Lia Tadesse lied to Reuters news agency when she said supplies were being sent to Tigray for the care of diabetics in response to news reports that people with diabetes were dying at home. Under the Ethiopian occupation no significant supplies were ever received. It is suspected that many shipments were taken instead to Eritrea.