Poor planning causes Ethiopian public hospitals to severely lack medical devices

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

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

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

A Statement and Plea from the Doctors at Tigray’s Ayder Hospital

The following statement and plea is from the medical staff and other health care professionals from Mekelle University Ayder Comprehensive Specialized Hospital in Tigray. Normally this is a tertiary hospital serving over 10 million population of Tigray, Afar, northern Amhara, and refugees from Eritrea. The complete blockade of supplies, power, internet, telephone, and travel has rendered the hospital essentially inoperative.

Hoping Against Hope!

Jan. 4/ 2022: Position Statement of Doctors and other health professionals of Ayder Comprehensive Specialized Hospital – College of Health Sciences, Mekelle University
We, the Doctors and other health professionals of Ayder Comprehensive Specialized Hospital – College of Health Sciences, at Mekelle University, hear and experience firsthand the daily suffering our patients are enduring. As we had solemnly sworn an oath to protect and save our patients from suffering, the least we could do on difficult days like these ones is to become their voice and ventilate their sufferings for the world to hear.
The statement below, therefore, is the collective voice of all of us working in the hospital and the college to echoing our patients’ plea that we hear every day for the last six months.
We have no doubt that anyone listening or reading this position statement will be cognizant of the fact that meeting the health needs of a community in low-resource settings such as ours is a very daunting endeavor, even in times of peace and stability.
To substantiate this, we wish to put some historical milestones of our college into perspective:
• We, the Doctors and other Health Professionals of Ayder Comprehensive Specialized Hospital – College of Health Sciences, remember our humble beginnings 14 years ago. We remember that, back then, our 500 – bed hospital had stood empty and idle for nearly a decade because of the severe shortage of health professionals, medical instruments, and financial resources.
• We also remember how this once empty hospital had grown fast through the hard work and perseverance of all of us, the unwavering support of our university, national and international partners.
A hospital that was barely better than a countryside health post in the early days of its establishment, grew to be a specialized referral center a decade later serving a catchment area of 9 million people from Tigray, neighboring districts of the Afar and Amhara regions.
It won’t be forgotten that our hospital had been also serving Eritrean refugees staying in the camps in Northern Ethiopia for quite a while. It is also to be well remembered that patients from Eritrea were well taken care of in our hospital during the brief period of border normalization between our two countries in 2018.
Our hospital’s annual patient visit had risen to nearly 300,000 and thousands of major surgeries, deliveries, and a wide variety of interventions and treatments used to be given.
We all took those positive developments for granted and it was customary for us to focus on future progress rather than dwell on past achievements.
However, while mentally unprepared, we have found ourselves, in such a short period of time, in a situation that we would never ever have considered possible in our wildest imaginations. How could we ever have expected to cancel surgeries for lack of intravenous fluids, anesthesia drugs, or tell patients or their relatives to find intravenous fluids somewhere in the city while the patient needed quick support?
But, we have been forced to work in a hospital without intravenous fluids, gloves, even the most commonly used antibiotics, anti-pain medications, drugs vital for women undergoing labor and delivery, drugs for various kinds of mental illnesses, basic laboratory tests, and a lot more other essential drugs.
• The availability of essential drugs, which was 79.3% a couple of years ago and 82% a year ago has now gone down to 17.5%.
• The availability of laboratory tests which was 93.7%, a couple of years ago and 84.2% a year ago, has now gone down to 42.1%.
The numbers are going down rapidly every week. The oxygen supply to our hospital has become very unreliable and resulted in the death of patients because of the frequent breaking down of the machines that could have been easily repaired if we got spare parts from the manufacturer through Addis Ababa to Mekelle which is now completely impossible.
To make matters worse, electricity blackouts have become more common and prolonged for days at times. There is no means of communication within the hospital and beyond. Thus, we have to walk and find the person we need, even to do something trivial.
We, the staff of the hospital and the college haven’t lost hope despite the huge psychological burden that we have to deal with as a result of witnessing what is happening to our patients on a daily basis.
As you might all be aware of:
• We haven’t been paid our well-deserved salaries for the last seven months, our extra–time payments for nearly 13 months,
• We are unable to withdraw whatever amount of money we have had in governmental and private banks because of the complete shutdown of banking service
• We have nothing to feed our families and ourselves
Against all odds, however, we have continued to serve our patients with whatever supplies are at our disposal!
We have:
• tried to produce fluids locally to clean infected wounds,
• beg business people or residents in the city to give us detergents, soap, bed sheets, and other linen for free or on credit to be able to keep the hospital running.
We have used and are still using expired drugs when that is the only option left. We have tried to give care to those in the most urgent need and ask others to wait to know that those who are waiting are also getting closer to hapless conditions.
Our neurosurgery team has decided to operate on patients with problems in the brain just based on clinical examinations, without having the support of CT scan and/or MRI images which have both been not functional for many months because spare parts could not reach our city due to the complete blockage.
Supplies that we used to get for free from donors and partners, as well as business counterparts, have not reached our hospital for the last six months.
As a result, children who needed shunt surgeries are left to die, those with treatable cancers are denied their rights and those with fractures are forced to wait while being immobilized.
Those who could easily have been saved with hemodialysis are dying. Patients who have had dialysis for years at our hospital are forced to die just because the supplies that could have been brought are not allowed to reach us.
The world is tested with COVID19. Add a large-scale, full-fledged War on it. Then add a siege on it. Imagine this three combined in a poor region that struggles for survival even in times of peace and stability.
We earnestly believe that there are very good people out there in Ethiopia, the horn of Arica, Africa, and the rest of the world who could be the advocates of our patients, our health professionals, and our people. We wonder how the world lets this man-made crisis continue unabated while it has all the capacity and the means it needs to stop it.
We, therefore, humbly and respectfully request all health professionals in Ethiopia, Africa, and the world to be the voice of our patients and stand with us in our effort to end the crisis. We also request the Ministry of Health of Ethiopia, different UN and other international organizations, all the other local partners, NGOs as well as international partners to intervene and bring the misery of several months to an end.
Whatever the cause of the war is, it cannot be right or ethical to deny patients lifesaving health care. Neither can it be justified to completely withhold a hospital budget for several months as if it is never the responsibility of the government of Ethiopia to let a hospital carry on its activities and deliver health to innocent civilians in urgent need of care.
We, people in the world, live on a tiny planet and our destinies are intertwined. It would be very heartbreaking to see those with the power and capacity do nothing except viciously say that they are “concerned”, “very concerned”, and “gravely concerned.”
It is already very late but those national, continental, and global authorities in health, as well as governments and organizations responsible for solving such problems, can still avert a catastrophe.
We have seen the world do that before and we, your fellow brothers and sisters, believe and hope against hope that you will do the same this time around as well.
Truly yours,
Doctors and other Health Professionals of Ayder Comprehensive Specialized Hospital – College of Health Sciences, at Mekelle University
January 4, 2022

Intentional civilian deaths in Tigray war is probably at least 1 million

A well documented airstrike by Ethiopia in June 2021 on the Togoga Market killed scores of civilians. Ethiopian and Eritrea occupying soldiers blocked local health authorities and concerned relatives from rendering aid adding to the deaths of dozens including women and children

The total civilian deaths  in Tigray since November 2020 as a result of the genocidal war by Eritrea and Ethiopia is probably nearing 1 million. Which equals %14 of the civilian population. Starvation, complete absence of health care, and continued bombing of civilians in Tigray by Eritrea and Ethiopia combine for this holocaust.

In August 2021 I rendered a report based upon published public health data on the history of Ethiopian healthcare what the effect of having no health care in Tigray would be Tigray. We know that before the Ethiopia Tigray conflict the crude death rate within the population was 6.29 per 1000 per year with the normal level of available healthcare. Using the known crude death rate from 1950 of 32 deaths per 1000 per year when there was only one partially working hospital in Addis Ababa and no health care system this we could reasonably apply to current situation. As of today there remains essentially no functioning healthcare in Tigray. For the 7, 070,260 population of Tigray measured in the last census that means this lack of health care will bring about 226,248.32 deaths annually in Tigray. 

Additionally the “de facto” blockade of Tigray officially recognized and discouraged by the United Nations carried out by Ethiopia and Eritrea remains blocking not just medical supplies but essentially 99% of food supplies. Locusts, abnormal rain patterns, lack of seeds to plant, lack of pasture to feed livestock due to abnormal rain patterns, and the locust plagues as well as theft or destruction of farm work animals and equipment by Eritreans have also significantly reduced what food production is possible in Tigray. Abraha Desta, the head of Social Services during the Interim Administration of the Tigray occupation which lasted until July 2021 publicly admitted to France 24 News that the Ethiopian and Tigray government conspired and acted to stop food production in Tigray despite falsely claiming it was encouraging planting.

Currently it is difficult to say how many are dying from starvation. When you combine starvation with untreated disease their combined effect is magnified. Minor illnesses that normally heal become deadly. At health care facilities in Tigray which can do little but watch children and adults die so that very few probably make the trip such that thousands are now perishing unseen in their village and rural homes unattended . As of June 2021 the UN estimated more than 350,000 would die from lack of food. Now months later the situation has only worsened with UN saying if no action was taken to relief starvation the number of deaths would increase to millions of deaths.

Air attacks by Ethiopia and shelling by Eritrea on Tigray’s borders are killing scores of civilians everyday. Especially because their wounds cannot be treated. Extrajudicial killings in Western Tigray continue in secret under Amhara militia and Eritrean direction.


A year without healthcare has cost over 200,000 lives in Tigray

Once a highly specialized tertiary hospital Ayder has now been rendered a place where the sick and their families wait for death

A year has passed since the onset of the Ethiopian and Eritrean war on Tigray including its subtotal blockade beginning even before November 2021 and the complete closing of all but a trickle of food aid since July 2021.

In August 2021 I wrote the concept of the crude death rate which relates to expected deaths per thousand population in Tigray. We knew that in 1950 for Ethiopia as a whole which was without any significant medical care the crude death rate was 32 per 1000 population. By 1971 it had fallen to 21.1 and then by 2020 before the war was only 6.4 per 1000. 

Tigray before the war was leading not only Ethiopia but much of Africa in increasing percentages of medically attended births, lowering maternal and child deaths, providing tertiary care for adults and children including surgical specialty services for not only Tigray but Afar, upper Amhara, and even Eritrea.  We served a total catchment area of over 10 million population.  Mekelle University’s Ayder Comprehensive Specialized Hospital where I was Head of Neurosurgery working closely with the Tigray Regional Health Bureau was a model of developing health care for Africa.

Now 80% of hospitals and clinics in Tigray are basically nonfunctional because of intentional destruction and ransacking by Amhara militia, Ethiopian National Defense Forces, and Eritrean forces.  Medical equipment not wrecked was taken to Eritrea. Many doctors, nurses, and other health care workers such as health extension workers and health officers are displaced, have been abused or even killed. Although Ayder Hospital through a nonviolent civil action of the cities residents avoided gross destruction it has received no supplies in over a year. All health care workers have not been paid for essentially a year yet many remain trying to help without resources.

Now that a year has gone by with the medical resources of Tigray regressed to the standards of 1950 there is absolutely no doubt that the prediction that out of  7, 070,260 population of Tigray measured in the last census the Ethiopian blockade has brought about at least 226,248.32 deaths since the onset of the war in Tigray. This of course does not include deaths from intentional civilian mass genocide and execution.

To replenish the supplies, replace the lost and broken equipment, re-station the workforce, and re-establish the working society of transportation as well communication to stop this increasing death spiral will take months at best. It will take more than sending a few aid trucks. The absolute security of the Tigray Nation State functioning in an environment of growth  and freedom not destruction is the only way of recovery.