Stigma around sexual violence
Dr. Tesfamichael is particularly concerned that few survivors of sexual violence are seeking help. “Many women get raped but they don’t seek help. They want to go to the hospital, but the stigma and social norms prevent them. We have emergency contraceptives, prophylaxis—the problem is, we can’t get to the patients. We need to increase health education, community mobilization, and home visits.”
MSF initially faced a similar situation in our clinics in the sites. Our staff hear many stories about sexual violence from the community, but very few women were coming for care. The number of survivors seeking care is now increasing, possibly because more people are now aware of and trust MSF’s services. From February 15 to 22, 10 survivors of sexual violence received treatment and psychosocial support from our teams.
We offer counseling and psycho-education sessions in the sites. Many people have been deeply traumatized by the violence they have experienced, by their displacement and poor living conditions, and by being separated from family members, often without knowing their whereabouts.
“We all have trouble sleeping,” says 43-year-old Tesfaye*, who lives at the high school site with his family. “We are all thinking about our houses, our businesses, our children who are not going to school. My eldest daughter, who is 14, was one of the best students in her class. She has not been in school for about a year, first because of COVID-19, then because of the fighting. She is very upset.”
The health system in rural areas has collapsed
While the situation for displaced people in Shire is difficult, it is even worse for people living in areas outside of Tigray’s main towns. Birhane* is a 58-year-old farmer who came to MSF’s primary health clinic at the University site. With his weathered face, traditional white headscarf and stooped, thin body perched on a walking stick, he looks much older. He walked two-and-a-half hours from his village to get medical care.
Birhane says that the health center that served his farming community of 2,500 people has been closed since November, and that all six staff have left. “We are suffering from a lack of medical care. We don’t have any medication; the village’s two ambulances were taken. Many people are sick. Three pregnant women have died during childbirth in the past three months,” he says. “There is no food in the village. Our fields have been looted. Some of our women have been raped. We stayed for two months in the forest and we are still scared.”
Berhe*, a health professional working with MSF, says that the region used to have a well-functioning health system before the fighting started. Villages had health posts and there were health centers in smaller and hospitals in bigger towns. Health extension workers visited communities and there was a referral system equipped with ambulances.
“Now, the health structure is completely destroyed,” he says. “When we visit rural areas, mothers say: ‘My child is three months old. He has not been vaccinated yet.’ Maternal and child health is very difficult now. During one of our mobile clinics, we heard that a delivering mother died because she could not get assistance from health professionals. In the rural areas there are no health structures, no ambulances.”
Since the end of January, MSF has been sending mobile medical teams to care for people in villages and towns north, east, and southeast of Shire. We also support some health facilities with medical supplies and recently opened a base in the northwestern town of Sheraro, from which we provide care for people from the surrounding rural areas.
Most of the health facilities our teams have visited are not functional. Many were vandalized and looted and most staff have left. Most people in the region have not received any medical care since November.
As access to towns and villages along the main roads in northern Tigray is getting easier, we are now trying to reach people who are living in the bush, says Gordon. “These are the people who really cannot access any kind of health care. We try to get there and give a bare minimum of care and see their condition. We hear of people who have been in the bush for months and still don’t feel safe enough to go to the clinic.”
*Names changed to protect anonymity.