Some areas are already showing levels of severe acute malnutrition well above the emergency threshold, like pockets in the outskirts of the city of Shire and in Sheraro. And with the rainy season looming, the outlook for the coming months is grim, as the fighting has left farmers unable to get to their fields.
Well-functioning rural clinics now stand in ruins
Prior to the conflict, Tigray had a well-functioning and well-equipped health system that was among the best in Ethiopia. Health centers and health posts in rural areas covered people’s basic needs and were connected to the main hospitals through a fleet of ambulances that transported patients in need of specialist treatment.
One such rural health center was in the town of Sebeya, near the Eritrean border. From the outside, the complex of buildings, which used to serve a catchment area of around 17,600 people, looks impressive, with its solid, well-spaced concrete buildings and various demarcated areas.
“Services here were good,” said Fatimah*, a 27-year-old woman from Sebeya. “I gave birth to all my four children here. If the health staff didn’t have the capacity to do something, they’d send you to Adigrat. I never had to go, but other patients would be taken there in the health center’s ambulance.”
Currently, the ambulance is missing and Fatimah, who is seven months pregnant, will not be able to deliver her fifth baby at this health center. Just meters from where she was waiting for a prenatal consultation with MSF medics, the health center’s delivery room—where 40 to 50 women used to give birth each month—lay in ruins.
In mid-November, during the fighting, a number of rockets hit the building and an administrative structure. The two delivery beds and a radiant warmer for newborns were now covered in dust, plaster, and splinters of wood, and the floor was a mess of papers, damaged pressure gauges, broken instruments, and dirty clothes. The harsh light of the dry season shone through a big hole in the wall and multiple smaller ones in the ceiling.
“These days women are delivering at home,” said Solomon*, a health worker. “Even if the birth goes well, newborns face the risk of dying. People with chronic conditions such as HIV, tuberculosis, or diabetes are suffering due to the interruption of their medication. Children are dying due to pneumonia and malnutrition.”
Fear and loss of livelihoods
For the residents of Sebeya, the partial resumption of medical services through a mobile clinic is a positive step, but the needs are immense. Most people here have lost their livelihoods and experienced months of harsh conditions, if not direct violence.
“I was a merchant before the crisis,” said Mariam*, as she waited for her prenatal check-up. “I had a shop selling coffee, sugar, and cleaning materials, but now it is closed. It was looted after we fled the town to seek refuge in my in-laws’ village. I was in hiding for four months and, even now, I am not yet back here permanently. I used to have a good life and my only concern was improving the business,” she said. “We never thought the conflict would hit us. I never thought I’d find myself without food and having to hide in the bush.”
Close to 300 medical consultations were carried out in Sebeya and Adiftaw by MSF’s mobile clinic teams. Apart from sexual and reproductive health issues, the most common conditions seen, particularly among children, were malnutrition, pneumonia, diarrheal and skin diseases related to poor living conditions and little access to clean drinking water.
Insufficient aid beyond towns and cities
“We try to prioritize the areas where we should continue responding,” said Santo. “And we try to increase the package on offer: it might be family planning, prenatal consultations, vaccinations, or other services, none of which have been available for months.”
Much remains to be done to expand people’s access to sexual and reproductive health care and other critical support services. While humanitarian organizations have sent teams to Tigray, especially since February, the response on the ground is still extremely limited, and hardly ever extends beyond the larger towns. There are still rural areas in Tigray that neither MSF nor any other organization has been able to reach. We can only assume that people living in these areas are also without access to health care.
“Rural areas are often left without any kind of assistance, and in recent weeks access for humanitarian organizations to various parts of Tigray has been further constrained,” said Santo. “There is an urgent need to scale up humanitarian assistance and to expand its reach.”
MSF currently runs medical projects in the cities and towns of Adigrat, Axum, Adwa, Abi Adi, Shire, Sheraro, Humera, and Dansha. Since early 2021 MSF mobile teams based in these locations have progressively expanded their activities to rural towns, mountainous areas, and villages in parts of the region where the health system is not functioning.
Over recent months, our mobile teams have visited more than a hundred different locations, either to run temporary mobile clinics or to train health staff and resupply looted health centers.
*Names changed to protect anonymity.