Mekelle — At midnight in the early days of October 2021 - screaming and shouting would irrupt in our neighborhood in Mekelle. I assumed a fight had broken out - unusual perhaps, but not unlikely - me and my mother walked outside our home to find over half a dozen neighbors with a terrified look on their faces as a woman screamed. Right there, in the bleak of darkness and freezing temperature a woman was giving birth to her first child.
I'm sure many of you are wondering why the sisters, or us - the half a dozen neighbors beside her - failed to just pick up a phone to call an ambulance or get their cars started to get her to the hospital. Well, at that point, Tigray had been under siege for three months. For much of the world - a communication blackout would simply imply an internet shutdown. But for months, Tigrayans had been living without cell service and all other forms of communication not just with the outside world, but within, too. Not only that, fuel, banking services, aid and medical supplies have been blocked from reaching Tigray.
According to a mini Demographic and Health Survey conducted in 2019 by Ethiopia's Central Statistics Agency, 94% of pregnant women in Tigray received at least one visit for antenatal care services, trained health workers assisted 81% of deliveries and 73% of mothers were getting postnatal service within seven days of delivery. The corresponding figure, as provided by Tigray's Bureau of Health, in 2021 shows an astronomical decline to 16 percent, 21 percent and 19 percent respectively.
This is primarily due to the deliberate and systematic destruction of health facilities in Tigrai. An assessment by Médecins Sans Frontiers of 106 health facilities across different parts of Tigray between December 2020 and March 2021 found that 73 percent of health facilities were either damaged or looted, and 65 percent were completely non-functional.
Tigray's health system, like most across the developing world focused on the provision of primary health care, leading to a high dependence on small but numerous health facilities located in rural and remote areas across the state. These facilities, even less accessible to aid organizations and the media, were the primarily targets of destruction and pillaging.
The destruction of health facilities in Tigray also indicates to the deliberate destruction and targeting of a predominantly female driven sector; over 60 % of health workers in Tigray are women. This is in part due to the Tigray state's policy for improving sexual and reproductive health, that includes the Health Extension Program that employees exclusively female health workers with high school diplomas to go house-to-house in rural areas to promote reproductive health amongst pregnant women and lactating mothers.
Tigray's health system today depends on mobile clinics and an in-substation number of health facilities based in urban areas; most of whom have now been rendered useless due to the on-going siege on the region. Most pharmacies have closed, hospitals are being forced to reuse even gloves and many hospitals have discontinued laboratory services because they've run out of essential chemicals and equipment. Remaining laboratories cannot run test for HIV, or other sexually transmitted diseases, not to mention other essential testing such as, haemoglobin levels, or Covid 19.
The impact the destruction of health facilities has had on women's capacity to access sexual and reproductive health care is quite possibly one of the most aggressive in reversing gains for women's reproductive rights in the 21st century.
The communications blackout and discontinuation of banking services
Even before internet service was discontinued in Ukraine - Space X made the decision to provide satellite access to ensure Ukrainians remained connected to the world and each other. Tigray, on the other hand, has been without all forms of telecommunication services for the past nine months and only partially and intermittently had access in the eight months that came before it. While internet has not been available for the most part of the war that is now on its eighteenth month.
The discontinuation of these services has also meant that banks in Tigray are not able to access or update customer information. This is in addition to the federal government's months long blanket suspension of all accounts opened in Tigray.
The Ethiopian government's attempts at suppressing information coming out of Tigray were so intense in fact that government troops raided and dismantled UN communications equipment hours before they withdrew from Tigray's capital, Mekelle on 28 June 2021. Not to mention the destruction they caused to broadcasting outlets based in Tigray - including state owned Tigray Television.
The discontinuation of telecommunication and banking services has a clear implication on women's reproductive health, it's likely that many women are going without medical treatment due to financial reasons or simply because they're not able to reach health professionals in time. It also means that neither aid organizations nor government are able to track, formulate and respond to needs on the ground. Lack of basic services also adds weight on women as primary caretaker's in the home. Failure of Tigray's health system to care for patients will lead to women having more responsibilities in the household; lack of electricity, banking, and unavailability of essential items in markets just means women will have to do more to coup with the needs of the household.
What Remains?
An important aspect in ensuring women's reproductive rights is, of course, the availability of contraceptives. I visited five pharmacies at different locations around the capital: just one had morning after pills, another had injectable contraceptives, nothing else was available, and what ever women could find was being sold at three to four times its usual price. The last batch of pregnancy termination pills available in Tigray were at Asertehade Lekatit Hospital in my neighborhood and expired some two months ago.
Tigray has run out of vital vitamins for prenatal care, health facilities are far from having the capability to provide proper care for women in labor and foods essential for infants are either unavailable or overpriced.
The on-going siege has also increased women's vulnerability to sexual exploitation. Women IDPs are especially at risk, an ethnic cleansing campaign in western Tigray has led to a massive number of displaced persons, of which close to half are women. None of these IDPs are able to access food or other essentials, what little was available many IDP chose to sell in exchange for food in the early days of the siege. Now, women are being forced into prostitution, and child labor is simply the order of the day, while lack or separated sleeping corridors for women and children in these overcrowded IDP camps are sure to increase women's vulnerability to sexual violence.
Tigray is running out of other essentials for women, such as, menstrual pads, soaps and other basic supplies essential for sanitation, too.
To Hope
But despite the extraordinary evidence supporting the grave violation of human rights in Tigray and the very inhuman nature of this siege, which the UN called is a "de facto blockade" - no country or international organization has imposed sanctions on Ethiopia. In fact, the Nobel Committee has publicly announced that it stands by its decision to award the prize to Abiy Ahmed in 2019. The chair for the committee told CNN's Zain Asher she didn't believe there was ' a right or wrong' in the on-going conflict and described it - a conflict which has weaponized food, rape and basic services - as 'complicated.'
But the chairperson's statements were just a reflection of the international community's general reservation towards a clear condemnation that would carry with it a responsibility to act. So instead, statements are shallow and their only clear objective is to sound even handed.
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The international community's response to the crisis in Tigray is especially surprising in light of the COVID 19 pandemic that has thought us all about the far reaching consequence of a health crisis anywhere in the world. Assuming the effects of the health crisis in Tigray can be contained within the region goes against all major scientific findings of the past century. Our faiths are very much bound - an assertive response to the humanitarian catastrophe is not only human and very much long overdue but an investment in the health and well-being of the human kind.
Minutes after me and my mother left our beds to find the young woman laying on our door steps- a neighbor would turn to me and say "could you bring scissors please?" A child had been born, and for a moment we'd feel something other than fear and frustration at the unfortunate faith that had brought us all together that evening, we'd feel hope. The type of hope that comes along with one of the greatest beginnings on earth; hope for a brighter future, hope for peace and most importantly, hope for good health. AS
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Writer's note: I am a journalist living under siege in Tigray. For ten months her own government in collaboration with the Eritrea has blocked all land routs into Tigray and banned commercial flights. No commercial goods have been able to reach Tigray and aid flowing is a trickle, and everyone in Tigray is blocked from accessing banking services. The comprehensive communications blackout in Tigray has also meant that Tigrayans are not able to tell the world their stories and share the horrid impacts of the siege. Which is why I am dedicated to ensuring that more stories are able to come out of Tigray.
