January 29, 2021 — Since early November, a military escalation in the Tigray region of Ethiopia has caused widespread violence and displaced hundreds of thousands of people. Albert Viñas, emergency coordinator for Doctors Without Borders/Médecins Sans Frontières (MSF), provided the following account today:*
Almost three months after the start of the conflict, I am struck by how difficult it has been—and continues to be—to access a community with such acute needs in such a densely populated area. Considering the means and capacity of international organizations and the UN, the fact that this is happening is a failure of the humanitarian world.
Supporting hospitals affected by the violence
After several attempts, I finally entered the capital of Tigray, Mekele, with the first MSF team on December 16, more than a month after the violence started. The city was quiet. There was electricity, but no basic supplies. The local hospital was running at 30 to 40 percent of its capacity, with very little medication [supplies]. Most significantly, there were almost no patients, which is always a very bad sign. We evaluated the hospital, with the idea of referring patients there as soon as possible from Adigrat, 120 kilometers to the north.
We arrived in Adigrat, the second most populous city in Tigray, on December 19. The situation was very tense, and the hospital was in terrible condition. Most of the health staff had left, and there were hardly any medicines. There was no food, no water, and no money. Some patients who had been admitted with traumatic injuries were malnourished.
We supplied the hospital with medicines and bought an emergency supply of food from the markets that were still open. Together with the remaining hospital staff, we cleaned the building and organized the collection of waste. Little by little, we rehabilitated the hospital so that it could function as a medical referral center.
On December 27 we entered the towns of Adwa and Axum, to the west of Adigrat, in central Tigray. There we found a similar situation: no electricity and no water. All the medicines had been stolen from Adwa general hospital, and the hospital furniture and equipment were broken. Fortunately, the Don Bosco institution in Adwa had converted its clinic into an emergency hospital with a small operating theater. In Axum, the 200-bed university hospital had not been attacked, but it was only operating at 10 percent capacity.
On roads where the security situation remained uncertain, we trucked food, medicine, and oxygen to these hospitals and began to support the most essential medical departments, such as the operating theaters, maternity units, and emergency rooms, and to refer critical patients.
Medical needs going unseen and unmet
Beyond the hospitals, around 80 or 90 percent of the health centers that we visited between Mekele and Axum were not functional, either due to a lack of staff or because they had suffered robberies. When primary care services do not exist, people can't access or be referred to hospitals.
For example, before the crisis, [on average] two appendicitis operations were performed per day at Adigrat hospital. In the past two months, they haven't done a single one. In every place, we saw patients arriving late. One woman had been in labor for seven days without being able to give birth. Her life was saved because we were able to transport her to Mekele. I saw people arrive at the hospital on bicycles carrying a patient from 30 kilometers away. And those were the ones who managed to get to the hospital.
If women with complicated deliveries, seriously ill patients, and people with appendicitis and trauma injuries can't get to hospital, you can imagine the consequences. There is a large population suffering, surely with fatal consequences. Adigrat hospital serves an area with more than one million people, and the hospital in Axum serves an area with more than three million people. If these hospitals don't function properly and can't be accessed, then people die at home.
When the health system is broken, vaccinations, disease detection, and nutritional programs don't function either. There have been no vaccinations in almost three months, so we fear there will be epidemics soon.
In recent weeks, our mobile medical teams have started visiting areas outside the main cities, and we are reopening some health centers. We believe our presence brings a certain feeling of protection. We have seen some health staff returning to work. Only five people attended the first meeting we organized in Adwa hospital, but the second was attended by 15, and more than 40 people came to the third. Beyond medical activities, you feel that you offer people some hope: the feeling that things can improve after two months without good news.
People fleeing violence, living in fear
In eastern and central Tigray, we did not see large settlements of displaced people. Instead, most have taken refuge with relatives and friends, so many homes now have 20 or 25 people living together. The impact of the violence is visible in the buildings and in the cars with bullet holes.
Especially at the beginning, we saw a population locked in their homes and living in great fear. Everyone gave us pieces of paper with phone numbers written on them and asked us to convey messages to their families. People don't even know if their relatives and loved ones are okay, because in many places there are still no telephones or telecommunications.
When we arrived in Adigrat, we saw lines of 500 people next to a water truck waiting to get 20 liters of water per family at most. The telephone line was restored in Adigrat just a few days ago. The situation is improving little by little, but as we moved westward to new places we found the same scenario: fewer services, less transport.
We are very concerned about what may be happening in rural areas. We still haven't been able to go to many places, either because of insecurity or because it is hard to obtain authorization. But we know, because community elders and traditional authorities have told us, that the situation in these places is very bad.
Large areas of Tigray have very mountainous terrain, with winding roads that climb from 2,000 meters above sea level to 3,000 meters. Cities like Adwa and Axum are built on the fertile highlands, but a large part of the population lives in the mountains. We have heard that there are people who have fled to these more remote areas because of the violence.
Logistical challenges, late response
The efforts of our teams have been enormous at all levels—medical, financial, logistical, and human resources. It's an incredible challenge without telephone or internet. At first there were no flights to Mekele and we had to move everything nearly 1,000 kilometers by road from the Ethiopian capital, Addis Ababa. You couldn't make money transfers because the banks were all closed. Yet we managed to start our operations.
Now other aid organizations are beginning to appear, little by little, in some areas. We still don't know the real impact of this crisis, but we have to keep working to find out as soon as possible.
Other MSF teams are currently delivering medical care in different areas of central, south, and northwestern Tigray. MSF teams are also responding to the health needs of displaced people at the border of the Amhara region and in Sudan.