Short Wave - The Tigray Medical System Collapse

Episode Date: October 26, 2022

The civil war in Ethiopia is destroying the medical system in the northern Tigray region, which serves nearly 7 million people. Doctors are operating without anesthesia and re-using medical equipment. Sporadic electricity and water are also causing problems for hospitals and clinics. NPR's Ari Daniel talks to host Aaron Scott about how people who need and provide medical care are coping.See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Hello, Shortwavers, Aaron Scott here with Ari Daniel, a reporter on our global health and development team. Hey, there, Ari. Hey, Aaron. So you're here to talk to us about your reporting on the Civil War in Ethiopia. Yes, it's a conflict that U.N. Secretary General Antonio Gutierrez describes as spiraling out of control. Here he is speaking at the U.N. Security Council. Violence and destruction have reached alarming levels.

The social fabric is being ripped apart. Things sound really, really terrible, Ari. How long has this been going on? Well, the conflict in the Tigray region started nearly two years ago, and a recent UN report accused all parties involved of committing war crimes and crimes against humanity. And one of the biggest casualties of this war has been Tigris' health system. For instance, last month I spoke with Fasika Amdislase, a surgeon at Tigris' Ider Comprehensive Specialized Hospital.

Our patients are not getting basic medicines like antibiotics, IV fluids, oxygen. And without these basic kinds of medical supplies, he's watched patients die. Seeing the hopelessness in their eyes and being the one to tell them, to tell them that you can, cannot help them, that they are going to dive soon. As a first-hand witness, as a physician, is very heartbreaking. And you cannot do anything for them and you tell them to pray. Today on the show, the situation in the Tigray region of Ethiopia and how people who need and provide medical care are coping.

You're listening to Shortwave, the Daily Science podcast from NPR. Ari, to start out, will you remind us who's fighting whom in this civil war? Of course. This is basically a power struggle over control of governance between the Tigray People's Liberation Front. That's the party that controls Ethiopia's northern Tigray region and the Ethiopian government forces as well as their allies. So before the war, nearly 7 million people lived in Tigray. And it's a region that's a bit smaller than the state of West Virginia. It's turned into this incredibly bloody war. I talked to researchers in Belgium at Lent University who've been tracking the situation in Tigray and they estimate that there could be up to 600,000 people who've died, millions displaced and those people

who remain face poverty and starvation. Aaron, one person who works at an NGO with partners in Tigray, he told me and I quote, the scale of human suffering has few parallels. Wow. And that suffering, I imagine, is only made worse when medical care isn't available. So you've been looking into the war's impact specifically on health care workers and hospitals, right? Yes. The Ethiopian forces have been targeting them 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. They're pretty much non-operational. And it's really difficult to get information out of Tigray because it's under blockade. But I spoke with Lindsay Green.

She's with Physicians for Human Rights. And PHR is in contact with health workers who are on the ground. We've heard of health care facilities that have been destroyed and looted. There are very few health care facilities within Tigray still able to function. And that is with little to no supply of medicine. So get this, Aaron. doctors are giving patients expired medications, including anesthesia. Here's Fasika, again, the surgeon who I introduced earlier.

There were times where the patient took very long time to wake up, and there were times where even patients awaken and struggle in between surgery because the drug was not working. They're only doing the surgeries that are absolutely essential. Faseca says that without saline solution to wash the skin that's, being cut into, they've used water that's been boiled and then cooled. Sometimes when the power's gone out, they've waited in the dark for hours to resume the surgery until the lights come back on.

They routinely wash and reuse gloves. And so it is basically medieval surgery, but modern surgery. Another physician told me that he's seen the invading armies take ambulances and even crush medications under the tires of their military. vehicles. As for those who've been wounded in the fighting or victims of the widespread sexual violence, there's very little, if anything, to help them. Lindsay Green told me the effects could last for a really long time. If they are able to go to a health facility to try to seek care and services after this violence, they are often met with not only a lack of ability

to receive physical care, but also long-term impacts on for and other sexual reproductive health outcomes. And there are also very few of the psychological services that are needed for people to heal from the trauma of sexual violence. Is this devastation affecting all areas of Tigray equally, Ari? Well, nearly. I was able to contact people in Tigris' capital, McKella. Medical care is better there than in the rural areas, but honestly, not by much. One woman I spoke to, she's a physician who's based in McKella. She asked me not to use her name for her own safety

and for fear that her family that's living elsewhere in Ethiopia could be arrested or interrogated. She told me that earlier this year, she was pregnant with her third child. Power in the city was going out constantly, even at the hospital where she planned to give birth. Most of the time, it was running out of light, and it had no enough fuel for the generator to be turned on.

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. If anything happens, it would be difficult to treat because they cannot see where I'm bleeding from. And this is a doctor who's worrying about this. Someone with a lot of experience who's probably seen how quickly these situations can turn deadly. That's right. In fact, a UN-backed study is in the works, and one of the authors told me that their preliminary

results are showing that women in Tigray are dying during pregnancy and after birth at a rate that's five times higher than before the war. Wow. So this war is creating a maternal mortality crisis. Yes. And Ari, even for those who survive, I can only imagine how hard. hard it must be to raise a newborn when you have such limited access to care. Exactly, Aaron. When a health system crumbles, these vast numbers of people, they get lost in its wake.

Diseases that had been under control, like rabies and measles, they flared back up again. I talked with Hilae Abraha Gassizzo, an epidemiologist at Torrance University, Australia. He's originally from To Cry. And he says that many of these deaths are preventable. And he argues that What's needed is... A humanitarian corridor to deliver basic supplies to Tigray, medicine, food, and fertilizer. Is there any chance of that? Well, a temporary ceasefire in March of this year to allow humanitarian aid into Tigray. It didn't achieve much before fizzling in August as the fighting resumed.

And then there's another group of people being impacted who I haven't mentioned yet, Aaron, and they're those who are suffering from chronic diseases. I talked to 52-year-old Burhan Haileu. a woman living in McKella, about her type 2 diabetes. A hospital staff member is translating for her here. My main job now is worrying about my disease because I have children. I fear I may leave to them alone. I may die, so they will be alone.

No one will take care of them. Insulin is so hard to come by Aaron that Burhan says she often goes with. it. Even our physicians, including nurses, are crying in front of us because they don't have something to give for us. What about these nurses and other health care workers, Ari? Did you talk to them about what the experience is like for them? I did.

One of the nurses is At Sede Gidei Déde. She's 35. and she works at Ider Hospital, which is a place that used to see some 5,000 diabetes patients before the war. Now, of course, it's far fewer. She shows up to work these days, and she feels powerless to help her patients. 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. And that's because without sufficient insulin, there can be a loss of bladder control. And ultimately, without treatment, diabetes can be deadly. Ari, this all just sounds so devastating. You've talked to these people over the last couple of months. Do you have any sense of how they're doing now? Well, the pregnant mother, who I mentioned earlier, fortunately, she's doing well.

As her due date grew closer and there was routinely no power at 9. she did the only thing she could think of. She told me that 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 it stayed on. She didn't need her flashlight. And at five in the morning, she gave birth to a healthy baby boy. Baby.

She sent me this recording of her and her new son. I feel blessed, actually. It's a blessing to have a baby, so I'm happy. Ari, thank you for all the work you put in to bring us this story. You're welcome, Erin. Thanks for letting me share it with you. This episode was edited by Rebecca Davis and Giselle Grayson and produced by Rebecca Ramirez. Abi Levine checked the facts. Our audio engineer was Natasha Branch.

Brendan Crump is our podcast coordinator. Beth Donovan is our senior director of programming. And Anya Grundeman is our senior vice president of programming. I'm Aaron Scott. Thanks, as always, for listening. listening to Shortwave from NPR.