Health facilities across Ethiopia's Tigray region have been looted, vandalised and destroyed in a deliberate and widespread attack on healthcare, according to teams from Médecins Sans Frontières (MSF). Of 106 health facilities visited by MSF teams between mid-December 2020 and early March 2021, nearly 70% had been looted, and more than 30% had been damaged; just 13% were functioning normally.
In some health facilities across Tigray, the looting of health facilities continues, according to MSF teams. While some looting may have been opportunistic, health facilities in most areas appear to have been deliberately vandalised to make them non-functional. In many health centres, such as in Debre Abay and May Kuhli in North-West Tigray, teams found destroyed equipment, smashed doors and windows, and medicine and patient files scattered across floors.
In Adwa hospital in central Tigray, medical equipment, including ultrasound machines and monitors, had been deliberately smashed. In the same region, the health facility in Semema was reportedly looted twice by soldiers before being set on fire, while the health centre in Sebeya was hit by rockets, destroying the delivery room.
Hospitals occupied by soldiers
Every fifth health facility visited by MSF teams was occupied by soldiers. In some instances, this was temporary; in others the armed occupation continues. In Mugulat in east Tigray, Eritrean soldiers are still using the health facility as their base. The hospital in Abiy Addi in central Tigray, which serves a population of half a million, was occupied by Ethiopian forces until early March.
"The army used Abiy Addi hospital as a military base and to stabilise their injured soldiers," says Kate Nolan, MSF emergency coordinator. "During that time, it was not accessible to the general population."
"They had to go to the town's health centre, which was not equipped to provide secondary medical care - they can't do blood transfusions, for example, or treat gunshot wounds," says Nolan.
Health facilities and health staff need to be protected during a conflict, in accordance with international humanitarian law. This is clearly not happening in Tigray. Oliver Behn, MSF general director
Few health facilities in Tigray now have ambulances, as most have been seized by armed groups. In and around the city of Adigrat in east Tigray, for example, some 20 ambulances were taken from the hospital and nearby health centres.
Later, MSF teams saw some of these vehicles being used by soldiers near the Eritrean border, to transport goods. As a result, the referral system in Tigray for transporting sick patients is almost non-existent. Patients travel long distances, sometimes walking for days, to reach essential health services.
Many health facilities have few - or no - remaining staff. Some have fled in fear; others no longer come to work because they have not been paid in months.
Devastating impact on people
"The attacks on Tigray's health facilities are having a devastating impact on people," says Oliver Behn, MSF general director. "Health facilities and health staff need to be protected during a conflict, in accordance with international humanitarian law. This is clearly not happening in Tigray."
Before the conflict began in November 2020, Tigray had one of the best health systems in Ethiopia, with health posts in villages, health centres and hospitals in towns, and a functioning referral system with ambulances transporting sick patients to hospital. This health system has now almost completely collapsed.
Attacks on medical facilities in Tigray
MSF staff conducting mobile clinics in rural areas of Tigray hear of women who have died in childbirth, because they were unable to get to a hospital due to the lack of ambulances, rampant insecurity on the roads and a night-time curfew. Meanwhile, many women are giving birth in unhygienic conditions in informal displacement camps.
In the past four months, few pregnant women have received antenatal or postnatal care, and children have gone unvaccinated, raising the risk of future outbreaks of infectious diseases. Patients with chronic diseases such as diabetes, hypertension and HIV, as well as psychiatric patients, are going without lifesaving drugs. Victims of sexual violence are often unable to get medical and psychological care.
"The health system needs to be restored as soon as possible," says Behn. "Health facilities need to be rehabilitated and receive more supplies and ambulances, and staff need to receive salaries and the opportunity to work in a safe environment. Most importantly, all armed groups in this conflict need to respect and protect health facilities and medical staff."
MSF teams are rehabilitating a number of health facilities across the region and providing them with drugs and other medical supplies, as well as providing hands-on medical support in emergency rooms, maternity wards and outpatient departments. MSF teams are also running mobile clinics in rural towns and villages where the health system is not functioning, and in informal sites where displaced people are staying. However, there are still rural areas in Tigray that neither MSF, nor any other organisation, has been able to reach; MSF can only assume that people living in these areas are also without access to healthcare.