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Conflict in Tigray has led to a collapse of its public health system


Spiraling out of control - that is how U.N. Secretary-General Antonio Guterres has described the ongoing civil war in Ethiopia. Here he is speaking at the U.N. Security Council.


ANTONIO GUTERRES: Violence and destruction have reached alarming levels. The social fabric is being ripped apart.

CHANG: The conflict in Tigray started nearly two years ago, and a recent U.N. report accused all parties involved of committing war crimes and crimes against humanity. Hundreds of thousands have died, and millions of people have been displaced. NPR's Ari Daniel joins us now to discuss another casualty of this war - Tigray's health system. Hey, Ari.

ARI DANIEL, BYLINE: Thanks for having me, Ailsa.

CHANG: Well, thanks for being with us. Can you just remind us who is fighting whom in this civil war?

DANIEL: Well, this is basically a power struggle between the Tigray People's Liberation Front - that's the party that controls Ethiopia's northern Tigray region - and the Ethiopian government forces and their allies. And it's turned into an incredibly bloody war. I connected with some researchers in Belgium at Ghent University who have been tracking the situation in Tigray, and they estimate there could be up to 600,000 people who've died, millions displaced and that for those who remain, poverty and starvation are rampant. One NGO told me - and I quote - "the scale of human suffering has few parallels."

CHANG: And I imagine that suffering is only made worse when medical care isn't available, right? Like, you've been looking into the war's impact specifically on health workers and hospitals. Can you talk to us more about that?

DANIEL: Yes. Yes. So they've been targeted in this war. And right now, according to the Tigray Health Bureau, more than 80% of the hospitals have been damaged or destroyed. Rural clinics are pretty much nonoperational. I spoke with Lindsey Green, and she's with Physicians for Human Rights. It's not easy getting information out of Tigray because it's under a blockade. But her group is in contact with health workers on the ground.

LINDSEY GREEN: We've heard of health care facilities that have been destroyed and looted. There are very few that are still able to function, and that is with little to no supply of medicine.

DANIEL: So doctors are giving patients expired medications, Ailsa, including anesthesia. One surgeon told me at times it's wearing off mid-surgery.

CHANG: Oh, my God.

DANIEL: He said he feels like he's doing medieval medicine. And those who've been wounded in the fighting or victims of the widespread sexual violence, there's very little, if anything, to help them.

CHANG: Well, I know that you have been able to speak directly to a number of health workers who are in Tigray. What else are they telling you about the situation?

DANIEL: So I was able to contact people in Tigray's capital, Mekelle. Medical care is better there than in the rural areas but not by much. One woman I spoke to is a physician, and she asked me not to use her name for her own safety and for fear that her family might be arrested or interrogated. She told me that earlier this year, she was pregnant with her third child. And as her due date got closer, power in the city was going out constantly, even at the hospital where she planned to give birth.

UNIDENTIFIED PHYSICIAN: Most of the time, it was running out of light. And it had no enough fuel for the generator to be turned on.

DANIEL: She was terrified that she'd end up delivering in the middle of the night, in the dark. She was especially worried because she'd had serious bleeding in the past following childbirth.

UNIDENTIFIED PHYSICIAN: If anything happens, it would be difficult because they cannot see where I'm bleeding from.

CHANG: And if they can't see where she's bleeding, they can't fix the problem.

DANIEL: That's right. In fact, there is a study under review right now. It's got U.N. backing. One of the authors told me they're finding women in Tigray are dying during pregnancy and after birth at a rate that's five times higher than before the war. So you can see that when a health system crumbles, so much gets lost in its wake. Just think about chronic diseases. I spoke with 52-year-old Birhan Hailu. She lives in Mekelle, and she has Type 2 diabetes. A hospital staff member's translating for her here.

BIRHAN HAILU: (Through interpreter) My main job now is worrying about my disease because I have children. I fear I may die. So they will be alone. No one will take care of them.

DANIEL: Insulin is so hard to come by that Birhan says she often goes without it. You can hear in her voice just how upsetting this is.

HAILU: (Through interpreter) Even our physicians, including nurses, are crying in front of us because they don't have something to give for us.

DANIEL: One of those nurses is Atsede Giday. She's 35 and works at Ayder Hospital, a place that used to see some 5,000 diabetes patients before the war.

ATSEDE GIDAY: That's my duty, to come to the hospital to treat my patients. But I am coming here to say there is no drug in the hospital. My patients, when you see them, you see full of urine in their legs.

DANIEL: And that's because without sufficient insulin, there can be a loss of bladder control. And ultimately, without treatment, diabetes can be deadly.

CHANG: This all sounds so incredibly dreadful. I'm almost afraid to ask, Ari, what happened to the pregnant mother you mentioned earlier?

DANIEL: Yes. I was hoping we could come back to that. And don't worry, Ailsa. It's actually good news.


DANIEL: So as her due date grew closer and there was routinely no power at night, she did the only thing she could think of. She charged her solar-powered flashlight in the sun each day. And then this past June, she went into labor. And on that particular night, the power remarkably stayed on. She didn't need that flashlight. And at 5 in the morning, she gave birth to a healthy baby boy.


UNIDENTIFIED PHYSICIAN: (Non-English language spoken).

DANIEL: She sent me this recording of her and her new son.


UNIDENTIFIED PHYSICIAN: It's a blessing to have a baby. So I'm happy.

DANIEL: A glimmer of light.

CHANG: That is NPR's global health reporter, Ari Daniel. Thank you so much, Ari.

DANIEL: You're welcome, Ailsa.

CHANG: While fighting does continue in the Tigray region, the two sides finally sat down in South Africa today for the start of their most formal peace talks to date. The talks are mediated by the African Union. The United Nations and representatives from the U.S. are also there as observers. The negotiations are now taking on new urgency against the backdrop of the humanitarian crisis in the region nearly two years into the conflict. Transcript provided by NPR, Copyright NPR.

Ari Daniel is a reporter for NPR's Science desk where he covers global health and development.
Megan Lim
[Copyright 2024 NPR]
Bridget Kelley
Bridget Kelley is the Supervising Senior Editor of NPR's award-winning afternoon newsmagazine, All Things Considered.
Ailsa Chang is an award-winning journalist who hosts All Things Considered along with Ari Shapiro, Audie Cornish, and Mary Louise Kelly. She landed in public radio after practicing law for a few years.