Intentional destruction of water supplies in Tigray causes incalculable suffering, disability, and death

Long lines of Tigrayans waiting to fill water containers they will carry for miles to their homes Source: TeleSur

The Eritrean and Ethiopian “law enforcement operation” which occupied Tigray resulted in the destruction of 90% of community water resources. Tigray is an arid land with very few ponds, lakes, or rivers. Much of the water supply was derived from government maintained wells. There is only appreciable rainfall during the summer months. Adult Tigrayans living a hard rural farming life which makes up 90% of a 7 million population generally need at least 2.5 liters of potable water to drink. 

Even before the Ethiopian Tigray conflict water projects by NGOs and government had allowed only 5 liters per person per day supply mostly through neighborhood wells. This was below the 15 liters generally recommended. Now most of these have been destroyed, sabotaged, or looted by Eritrean and Ethiopian forces. Photo source: Netri Foundation

Water is essential for life. Death can occur if there is no water intake in just days. Water borne disease can cause febrile illness, diarrhea, and inability to carry out even the necessary labors of daily life. Without antibiotics or intravenous fluids to treat these conditions normally treatable disease becomes fatal potentially for thousands of people as always been seen in the past. The limited water intake of Tigrayans had already been documented to contribute to high rates of kidney stones and kidney disease which now without medical treatment become fatal. Just about any medical condition is made worse by lack of water. Pregnancy and child development become compromised by the lack of proper intake and disease.

Before the onset of the Ethiopian Tigray conflict in November 2020 most of the urban areas had water plants often with their own generators which provided water several days a week. Many of the modest homes had water storage at a low height that allowed low flow by gravity to dispense the stored water. Sometimes they had an electric pump to push water up to higher storage. The loss of electricity rendered city water supplies inoperative. In the rural countryside traditionally women would carry 5 gallon containers on foot often traveling for hours to government installed manual pump equipped wells. Many women searching for water became targets of violence and violation by Eritrean and Ethiopian soldiers.

In the urban areas the community now receives water delivered to the neighborhoods, kebele, by horse drawn tank carts which collect water from wells or natural resources. This is not purified in any way and may contain bacterial, parasitic, or chemical contaminates. While I was in Mekelle during the occupation we would try to filter the water by pouring it through blankets and then boil it. As there was no electricity we had to search for fire wood which was in short supply. The timing of the fire was key because it was used to keep warm during the often chilly evening hours and used to cook food as well as to kill pathogens in the water.





Starvation in Tigray will cause permanent medical complications even in survivors

This week UN reports over 400,000 are at the famine stage and 2 million are at the brink.

When many people hear about starvation they assume that intervention that is done when many start to die will result in complete reversal of ill health. Unfortunately the reality is that moderately severe starvation for just a few months can lead to permanent disability and premature death even once proper nutrition has been re-established.  The World Food Program and other agencies announcement that 40% of Tigrayans are suffering severe hunger means that even for those that have not yet died they may already have contracted a permanent condition. This  is especially so for children.

Thus the urgency of a rapid and comprehensive response to the growing Tigray famine is absolute. Severe decline in brain function, child growth stunting, diabetes, increased birth maternal and child mortality, birth defects, and lowered resistance to infectious diseases such as tuberculosis (endemic in Ethiopia) have been well recognized since World War II in civilian populations deprived in war.  Children who survived then in adulthood showed increased levels of diabetes and heart disease leading to premature death.

Diplomatic posts for ENDF Generals protects them from prosecution

Addis Standard reports Generals Bacha and Hassen are to be appointed to diplomatic posts

Ethiopian Prime Minister Abiy Ahmed’s appointment of Ethiopian National Defense Force senior leaders, General Bacha Debele and General Hassen Ibrahim, along with a whole new slate of foreign diplomats might seem strange but there is hidden rationale behind this action. One very credible theory behind this action has nothing to do with these appointees diplomatic skills but rather is likely to be an attempt to shield them from international or domestic prosecution for war crimes carried out under their leadership.

Remember that in August 2021  the Office of the United Nations High Commissioner for Human Rights and the Ethiopian Human Rights Commission had completed a report that human rights violations had been committed in Ethiopian Tigray conflict ostensibly by all parties. This report was criticized for not including all the potential war crimes especially the massacre of church goers in Axum. The former Ethiopian Minister of Women, Youth, and Children Filsan Abdi who went to Mekelle in July 2021 has stated repeatedly that she found credible evidence for widespread violation of women from ENDF and Eritrean forces which were downplayed by Abiy Ahmed leading to her resignation. In December 2021 after examining what evidence was available the UN Human Rights Commission voted to sponsor an international investigation.

There is good legal precedent that personal immunity (immunity ratione personae) and functional immunity relating to the office held (immunity ratione materiae) given to diplomats may offer protection from international prosecution. Legal scholars who study the history of prosecution of war crimes note that there is a “culture of impunity which contributes to a climate in which human rights violations persist and are not deterred”. Thus mechanisms of enforcement are often not available because of these loopholes in prosecution.

The Ethiopian medical blockade of Tigray has caused thousands of birth related deaths

The United Nations Population Fund reports pregnant Tigray women have problems finding support

The Ethiopian complete medical supply blockade has turned  the normally happiest time in family life, the arrival of a new baby to a young married couple, into a nightmare . For Tigray’s population it is estimated that there are 36 births per 1000 population giving an estimate of 252,000 births per year. Prior to the onset of the Ethiopian occupation with its subsequent medical blockade of Tigray we know that maternal mortality from births in Tigray averaged 266 per 100,000 live births. Of those deaths the most common cause was hemorrhage accounting for 34%. Ethiopia already had one of the highest rates of post-partum hemorrhage with some areas reporting 676 per 100,000 the highest in the world.  In the best of conditions another twenty infant deaths occur per 100,000 births due to maternal complications of pregnancy. Of course these numbers were estimates because many women still delivered outside of medical attendance and births are often not registered. Estimates are that 19% of women delivered in medical attendance in Tigray.

The Ethiopian blockade of medical supplies has made it impossible to run a blood bank and treat complications of delivery. There are no drugs, medical equipment, or even the capability to do surgery to stop a dangerous post partum hemorrhage. I can tell you from my experience at Ayder Comprehensive Specialized Hospital in Mekelle that everyday many young women giving birth had their lives saved by blood transfusion. Now these women die. 

If we take into account that the there is no treatment now for post-partum hemorrhage, neonatal respiratory failure (no oxygen, suction, intubation supplies), sepsis from infection (no antibiotics or intravenous lines), and no caesarian section for breech presentation, cephalopelvic disproportion or even fetal distress the severe complication and death rate will climb exponentially . Maternal and infant mortality for Tigray has no doubt soared to that seen in previous centuries.

The brave nonviolent defense of Ayder Hospital by Mekelle citizens in November 2020

Men and women Mekelle citizens of all faiths put up roadblocks to prevent looting of Ayder Hospital in November 2020 (Photo from Eritrea Hub)

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 about 3 months later 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.

The 24 hour constant barrage of Mekelle killed thousands of civilians. This image was created from the author’s memory of this event.

The day before the occupation of Mekelle we knew that the Tigray Defense Force had left the city in hopes to avoid civilian causalities. Yet early in the morning an artillery barrage started which targeted essentially the whole city. Rounds were landing about every 5 seconds. This lasted until the early morning hours of next day. Stopped for a while and then was restarted for several hours. 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.

As the invading forces approached we saw many women with vulgar mutilations of their vagina, amputations, facial injuries, and mortal wounds from gunshot and blades. There were women shot in back apparently running from invading Eritrean and Ethiopian forces. Sometimes their small children were brought in with partial decapitation.

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. These fighters would be in every room watching everything done by nurses and doctors. They told us to write in the medical records that any civilian injuries were caused by Tigray fighters and not by Ethiopian or Eritrean forces. 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. 

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  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.

Overhead view of Ayder Hospital in Mekelle which occupies a large city block

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.

Thousands of unarmed families totally surrounded the Ayder Medical Campus constantly for several days to prevent the pillage of the hospital

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. 

Panic and the fog of war are undeniable in Addis Ababa

Addis Ababa is clearly moving into a panic with all foreign governments evacuating their citizens, wanton capture of Tigrayans, and a marshal state of law

Clearly those who stated Addis Ababa was living day to day business as usual were wrong. To describe the situation as panic based upon contacts I have spoken in the past few days is a conservative appraisal.  Conflicting reports on the status of various government officials and which government agencies are still functioning abound. 

At this time many sources including Ethiopian government report that Abiy Ahmed has given the role of day to day government administration to Demeke Mekonnen whereas before it was Demeke Mekonnen who was visiting the troops in the field. If Abiy Ahmed is truly commanding the armed forces of Ethiopia then how can he be incommunicado? Additionally he has ordered all members of his Prosperity Party and all government staffers to fight. So is the government apart from the military shutting down?

Abiy Ahmed tells Jeffrey Feltman and others in the diplomatic community he can negotiate successfully while in the same breath says he can get an easy military victory. The Tigray leadership as usual does not make clear its immediate military intention. One wonders is their goal when they reach proximity to Addis Ababa will be to impose a siege as they have done before?


President Sahle-Work Zewde belatedly claims she was against Abiy Ahmed “war mongering”

Great hope was placed when Sahle-Work Sahle as Ethiopia’s President.

Sahle-Work Zewde the President of Ethiopia who was widely hailed as a sign of reform of Abiy Ahmed has come out now saying that she was against the “war mongering” of Abiy Ahmed and his Prosperity Party supporters but could do nothing because her position was ceremonial only. Where was she when children were being starved, women being violated, and innocent villagers being executed?

Previously in February 2021 after being silent for three months she did utter the words that the humanitarian needs in Tigray were “enormous” but nothing else. Her words now claiming that “Abiy was dragging his country into a sort of downward spiral” to me seem mostly self serving to escape blame. If she is really sincere then she most immediately go public and convince Ethiopians to stop supporting Abiy Ahmed and seek an end to more killing, detainment, starvation, and suffering.

Awaiting findings of the ACHPR ongoing investigation into Tigray atrocities

Ethiopia’s Ministry of Foreign Affairs said it is “regrettable to note that the African Commission on Human and Peoples’ Rights made a unilateral announcement on the establishment of a “Commission of Inquiry” and said it was “completely outside the scope of the invitation by the government and lacks legal basis.”

The report of the African Commission on Human and People’s Rights regarding Tigray which has been underway for some time now has not yet been released but their severe concerns have been well communicated. On May 12, 2021 the whole body of the ACHPR agreed there was need to investigate potential human rights violations in Tigray.

Even though Ethiopia is a charter member of the ACHPR and its associated African Court in June 2021 it refused the jurisdiction of the ACHPR to investigate Tigray.  Subsequently the ACHPR has continued investigations and updates. This body has sought out input from first hand witnesses to the events in Tigray which Ethiopian lead bodies have sought to avoid.

The government of Ethiopia has sent written statements opining that they have not committed atrocities but so far this has not convinced the ACHPR to conclude their ongoing search for the truth. They have asked all parties to cease military action and reminded the Ethiopian government of its obligations to protect human rights.

Unlike the joint United Nations and Ethiopian Human Right Commission investigations which absolutely neglected and in fact intentionally avoided certain indicated sources of investigation, the ACHPR has taken testimony for first hand witnesses in Tigray including health care providers who personally lived the war and cared for the victims. Clearly one of the reasons of the destruction of hospitals and  clinics by Ethiopian and Eritrean forces was to eliminate evidence of atrocity. Additionally as I and others have discussed at Ayder Comprehensive Specialized Hospital there was intimidation of nurses and doctors to falsely write into medical records that civilian injuries were due to Tigray fighters. The AHCPR has obtained testimony from many of those involved even if they were now out of region.

The ACHPR has expressed concern over the following in it’s resolution

Deeply concerned about allegations of gross violations in the ongoing conflict in the Tigray region, including sexual violence against women and girls, gang rapes used as weapons of war, killings of civilians by belligerents and extrajudicial killings;

Also noting, and with concern, the situation of Eritrean refugees living in camps in Tigray region, and allegations of abductions, extrajudicial killings and forced repatriation to Eritrea of refugees and asylum seekers;

Deeply concerned about reports of the large-scale movement of Tigrayan refugees fleeing the conflict to Sudan and neighboring countries;

Further concerned about reports of massive and forced internal displacement of thousands of people in the Tigray region who find themselves in situations of isolation;

Expressing its deep concern at reports about the intensity of hostilities which have led to an increased number of victims and casualties in the ongoing conflict, and which have resulted in serious and gross violations of human rights, breaches of international humanitarian and human rights law, refugee rights and the provisions of the Kampala Convention;

Noting with concern the humanitarian crisis in Tigray, the challenges to the population’s access to humanitarian assistance, and reports of the use of starvation as a weapon of war;

Recalling reports with allegations of human rights violations against the civilian population, including attacks against civilian infrastructure, destruction of property, looting, destruction of refugee camps, which may constitute war crimes and crimes against humanity;

Further concerned about the threats to the safety, security, well-being and livelihood of the people of the Tigray region, as well as the loss of lives, destruction of public and private infrastructure, as the military conflict continues;

Conscious of the need to act as soon as possible to contribute to the resolution of the conflict, including the determination of accountability, in order to bring the perpetrators to justice and provide reparation and restoration to the victims, as well as bring about national reconciliation, with a view to enhancing stability, security and peace in the Federal Democratic Republic of Ethiopia;

Noting the report of the Ethiopian Human Rights Commission of 24 March 2021 confirming the killings by Eritrean troops in the town of Aksum and the statement of the Ethiopian Prime Minister acknowledging the violation of human rights in the Tigray region;

At the last sessions in August 2021 resolutions where passed to obtain opinions of experts to further investigation.

On October 23, 2021 the ACHPR issued a press statement about Ethiopian airstrikes in the Tigray region saying


The Commission has since been closely monitoring the crisis in the Federal Democratic Republic of Ethiopia (Ethiopia) and is deeply saddened by the alarming reports of the recent resurgence of   military offensive   between the Federal Government and the Tigray People’s Liberation Front (TPLF) in the Tigray Region of Ethiopia.

Reports indicate that Ethiopia’s Military have carried out airstrikes, the fourth in a week in the capital city of Mekele, as fighting intensified between the Federal Government and Regional Forces.

The Commission is deeply concerned about the escalation of the conflict in the Tigray Region of Ethiopia and its impact on the civilian population amidst widespread allegations of human rights abuses including, the killings of thousands of people; disruption of livelihoods; and displacement of more than two million people since the beginning of the conflict in November 2021.

The Commission is also concerned about the increasing humanitarian needs in the region where millions of people are reported to be in dire need of food and aid relief assistance, with hindered access to the necessary humanitarian aid.

The Commission would once again like to remind the Federal Government of Ethiopia of its commitments and obligations under the African Charter on Human and Peoples Rights; International Human Rights and International Humanitarian Law.

The Commission reiterates its call on all the parties to the conflict to halt all military offensive and end hostilities; prioritize the welfare of the people of Tigray; protect its civilians; and engage in a dialogue with a view to finding lasting, peaceful and mutually acceptable solutions to the crisis.

The Commission urges the Federal Government of Ethiopia to take all necessary measures to restore and facilitate the speedy and unhindered access of humanitarian aid and relief, particularity food and nutrition supplies, medicine and other assistance to the region, to avoid famine   and increased hunger related deaths; as well as restore essential services including essential commercial commodities, electricity, communications and banking services in the Tigray Region.

The Commission also associates itself with the various condemnations concerning the situation in the Ethiopia, and calls on all stakeholders within the International Community to combine their efforts in order to take appropriate measures needed to restore peace and security in Ethiopia.

Abiy Ahmed’s deteriorating status with Ethiopian performing artists

Singer Tariku Ganiski calls for youth not to go to war but for elders to make peace at Addis Ababa rally. See the Amharic speech he made here.

Popular Ethiopian singer, Tariku Gankisi, who is known for promoting Ethiopian unity in his works was invited to perform at a Addis Ababa rally to support the Federal governments fight against the Tigray and their allies but it did not go as organizers had planned. Instead Tariku told the crowd “Let no youth go to the front lines to fight, let the elders go holding the fresh grass and ask for reconciliation,” before his microphone was switched off by party unknown.

President John F. Kennedy said at the Alliance for Progress in 1962 that “Those who make peaceful revolution impossible will make violent revolution inevitable”. He recognized that dictators oppression of nonviolent protest and dissent can ultimately inflame the cause for war.

In 2018 Abiy Ahmed praised the art community of Ethiopia saying “art has indispensable role in nourishing our cultural life, love, forgiveness and togetherness. The role of the artist is to be a guardian of truth and justice and creatively reveal the richness of our national life”.  However as his ever attempt to tighten controls over everything in Ethiopian life including culture has increased his appreciation for performing artists seems to have changed as have theirs towards him.

On June 29, 2020 the popular Oromo singer, Hachalu Hundessa, was murdered most likely by supporters of Abiy Ahmed. In his quest to consolidate power over the Oromo population the Ethiopian Prime Minister had already imprisoned over 7000 Oromia and overseen the extrajudicial killing of over almost 300 since coming to power in 2018. This singer’s style and message appealed to multiple generations in ballads discussing the subjugation of the Oromo people historically and more recently the expansion of the nation’s capital, Addis Ababa generally considered Amhara territory, into the Oromo national state.  Although Abiy Ahmed was initially seen as a champion of these causes he eventually dropped them preferring his Ahmara identity.

Making media the message and avoiding real issues hastens Abiy Ahmed’s fall

Even though Ethiopia has been thought of a religious country filled with pious Christians and Muslims activists now promote blasphemous suspension of morality

Twitter has seen so many posts advocating escalation of ethnic violence against the Tigray in Ethiopia that they shut down their mechanism for collecting posts with similar topics for readership. In the face of a great epic tragedy occurring in Ethiopia the supporters of Abiy Ahmed have decided that their best strategy in midst of a military debacle is to attempt to deflect the real issues and realign them to emotional ones unrelated to the current reality.

Amhara activist promotes savage behavior

Over the past few years I have had an interest in the use of language and neuroscience related to how it functions to establish human interactions. We have been using this to help develop teaching methods for students training for futures as executives in business in Africa in how they relate to clients. This neurobehavioral science gives some insight to what we are seeing in Twitter and Facebook.

Modern media is about the short sound bit or 125 character phrase that creates a “Wow” visceral response without contemplating the whys? Hows? Where is it going? Where did it come from?

Whereas decades ago all massively distributed media was created by professionals with supervisory editing dictated by agreed norms of civility today we see a change to media made for sensationalistic emotional immediate response.   In the 1960s Marshal McLuhan, a Canadian philosopher, coined the phrase “the media is the message”. The concept is a bit complex but importantly relates to the idea that sensational content in its presentation draws the observer away from thinking about things like why is it presented, what were the circumstances that lead to it, etc. In his work Understanding Media:The Extensions of Man he gave the example of a “burglar carrying meat for the watchdog of the mind”.

The problems of starvation, deprivation, imprisonment, and violation will not be solved by sound bits or catchy phrases. History is replete with many instances of times when leaders let personal glory drive them to make decisions prolonging suffering of those in their charge with avoidable predictable catastrophe.