Analysis
More than 180, 000 people with noncommunicable diseases in Tigray are either dying at home or in great risk
People with NCDs are dying at home due to lack of basic health services and medications such as insulin, antihypertensive, asthma and epilepsy treatment due to the ongoing fighting and insecurity in the region. The following actions must be urgently taken to put an end to this.
By Fisaha Tesfay, and Yemane Gebremariam
It has now been over four months since the fighting broke out between the Tigray regional state forces and the Ethiopian government forces (alongside Amhara Special forces, Amhara militia, and Eritrean government Forces). Despite the Ethiopian Government’s denial, active military engagement is still going on in the region and the humanitarian and health situation of the people of Tigray remains deeply alarming.
To document the impact of the War on non-communicable disease (NCD) patients in Tigray, we pull together a range of sources including recent perspective pieces on the impact of the war on the health system in Tigray and the food and health care impact of the war on Tigray, media releases; a report released by the current interim administration of Tigray and other multilateral organisations such as the World Health Organisation (WHO), United Nations International Children’s Emergency Fund (UNICEF), Médecins Sans Frontières (MSF) and Save the Children. Dr Gebremariam also adds firsthand insights and medical field notes from a recent trip to assess the health situation in the region. We both grew up and worked in the public health space (the first as a researcher and the second as a medical doctor) for several years in Tigray and as such understand the health system and health service delivery in the region. Hence, we believe, it is reasonable for us to provide some insights on the impacts of the war on people living with noncommunicable diseases in the region.
The destruction of healthcare in Tigray
There is no denying that every health program in the embattled region is severely affected. For this reason, access to health services including clinical follow up for noncommunicable diseases is barely available in almost all parts of Tigray and many patients are dying at home from these conditions.
Many health system infrastructures such as hospitals, health centres, health posts and ambulances are either destroyed or looted. For instance, out of the 205 health facilities that were assessed by the regional administration, 165 (81%) are out of order because of either looting or destruction. Furthermore, out of the 40 health facilities that are currently functioning, only 28% of them are receiving medicine supplies. On top of the looting and destruction, health providers have either fled the conflict or been killed, ambulances were destroyed or stolen by the Ethiopian or Eritrean defence forces.
No access to lifesaving medications
Prior to the conflict, health service access in Tigray was universal. Hospitals, health centres and other services were within reach for almost all people in Tigray. However, after the fighting commenced, most Tigrayans no longer have access to basic health services, with some exceptions in major cities such as Mekelle, Adigrat, Axum and Shire. Among others, people living with NCDs are suffering the most due to their reliance on health services to collect their life saving medications. Hayelom’s story, (from the diary of Yemnae Gebremariam who recently visited Adigrat hospital in eastern Tigray) is one of the many heart-breaking stories which exemplifies the dire health situation that millions are experiencing in Tigray.
Hayelom Tesfay was a lecturer at Adigrat University with Type I diabetes mellitus (DM) and must regularly collect his insulin supply from the nearest health facility in his neighborhood. On the 4th of November 2020, war broke out in the region where he resides, and he was forced to flee from the city to save his life – just as many others did to escape the indiscriminate bombing and shelling that came with the fighting. Yet for Hayelom, there was another time bomb looming within him and on one unfortunate day, his neighbors recall “he felt the pace of his breath change, got dizzy, and had a pain in his abdomen”.
Hayelom was aware that he had developed the acute complication of DM called diabetic ketoacidosis (DKA) – a life-threatening condition when the blood becomes too acidic. He urged people to get him insulin or take him to Mekelle, the capital. But even while asking, he knew that it was not possible as there was heavy fighting all the way to Mekelle, so neighbors took him to a nearby health centre in a remote village. To the dismay of all, there was no insulin and Hayelom who escaped from bullets succumbed to an insulin-deficit.
Hayelom’s is only one story, with many others who are trapped in the war-torn region suffering the same fate. Several such cases have been on other media outlets and on Social Media, and several others have been included in Tghat’s victim list. Even among those who manage to get insulin, storage is problematic. There was no electricity for more than two consecutive months all over the region (which has not yet fully been restored) and Tigrayans must flee almost daily to safer places and hideouts.
More devastating stories from the field
A paediatrician from Mekelle also recalls her agony due to the escalating adverse DM events all of which are preventable with appropriate medical care: “there were a lot of kids who have established a great bond with me; some of them used to give me a call for greeting but they are not coming to the health facility or giving me a call anymore. Now, I do not know their whereabouts. In recent days, I have to deal a lot with constant exacerbations of DKA, insulin interruptions and all that because many of my patients are deprived of insulin. Even when it becomes available, the regimen varies from time to time and most often it’s mixed insulin which I don’t recommend for kids.”
In our recent systematic review before the war, NCDs such as DM, cardiovascular diseases (hypertension, ischemic heart disease, stroke and rheumatic heart diseases), cancer and chronic obstructive pulmonary diseases were common in Tigray. Before the fighting, there were more than 180, 000 people with NCDs who missed their clinical follow up, of which 24,000 had DM and 20,000 had hypertension. There are mounting reports of people dying from the lack of basic medication for NCDs such as insulin, antihypertensive drugs and lack of regular clinical follow ups. For instance, before the war in Ayder Referral Hospital, one of the biggest hospitals in Tigray, there were 1, 400 children and more than 2, 000 adults with DM on insulin. While there are six confirmed deaths due to the lack of insulin, hundreds are lost to follow up– possibly due to death.
Another doctor’s diary below further demonstrates the depth and extent of the suffering and death shared among thousands because of the lack of basic medical services and medications. In the general hospital, he recalls two cases of status epilepticus (i.e. seizures) who succumbed to death. “They came in a coma and when I checked their history both were on Phenobarbitone (anti-epileptic drug) with good control but came with status epilepticus after supply was suddenly cut off. Oxygen was short, no Phenobarbitone and all colleagues and I tried starting them on the only available medications but it was all inadequate and they died. It’s very challenging to be a physician these days in Tigray. The supply and demand gaps are very wide, we must make forced change in regimens and the result is usually poor. We do not have even long-term controllers for asthma and as a result, we manage exacerbations very frequently. There are a lot of missing patients, but I can’t enumerate them as we are currently doing only simple life saving measures”, he says in anguish.
An official of the regional health bureau within the interim administration also reflects on the deteriorating condition. “Currently, we are only mobilizing the available limited resources to run mobile clinics. We don’t know how many cases of chronic illnesses were nor do we have current assessment. We are in no position to furnish hospitals because there is ongoing looting by the Eritrean forces and resources are scarce.”
The way forward
In conclusion people with NCDs are dying at home due to lack of basic health services and medications such as insulin, antihypertensive, asthma and epilepsy treatment due to the ongoing fighting and insecurity in the region. The following actions must be urgently taken to put an end to this.
- International and regional governments and organisations must enhance their efforts to stop the fighting.
- Aid agencies should be urged to support the supply of insulin, antihypertensive and epilepsy drugs.
- The Ethiopian Ministry of Health should scale up its efforts to address the medicine supply chain challenges.
- It is highly recommended to redesign the delivery of health services to a vertical and targeted program (e.g., NCD, TB, HIV and malaria program) to address the need for treatment of NCDs and other conditions.
About the authors
- Dr Fisaha Haile Tesfay is a postdoctoral research fellow at Deakin University, Institute of Health Transformation. The views expressed in this opinion piece are only the author’s, not necessarily the funders.
- Dr Yemane Geberemariam is a Paediatrician at Adigrat University. The views expressed in this piece are only the author’s, not necessarily the funders.
Fisaha
April 7, 2021 at 3:01 am
Many thanks for your encouraging comments
Mezgebe
March 29, 2021 at 2:42 pm
The Last solid five months In Tigriay.
For the last five solid months in t Tigriay the only sun is rising and setting regularly. War planes, Destroyer Rockets and Drones are disturbing the air to distract infrastructures, churches, mosques, factories, Hospitals, Bridges, micro dams, Sub stations, School buildings etc.
Artillery, tanks and heavy duty military machines to demolish the Tigriay land. Launchers and explosives are burning Homes, uncollected crops, Bushes reforested within the last thirty years. Bullets are killing innocent civilians, innocent animals used as life stock,
Ethiopia, Eritrean and Somalian combined Troops, to loot individual properties, including grain and cattle from individual farmers, ornaments from each girls neck, To collect church and Mosque treasuries, Books, etc. To rape Women and under age girls, To Kill religious leaders from mosques and churches.
All roads leading to Tigriay are closed for more than three years to stop any supply to the region including journalists and visitors, but open with in the last five months only for the military service and supply. Telephone and Intern ate are blackout. No power to light, to cook, to mill grain. No banking service to get money to buy food. No water supply to drink, to be sanitized. There is no any medical service to get birth, to get medicine, The only medical service is given for the military members of the combined forces from the battle fields.
The copied 19 pandemic is the biggest world issue of the time. But in Tigriay, nobody is speaking of its origin, way of transmission, prevention method, and so on.
The only sun is rising and setting regularly with in the last 100 solid days. Nothing is in its former position. Husbands killed in front of their wife’s, Mothers abused in front of their children, Millions are out of their home. Millions of children are out of school, Believers do not go to churches nor to Mosques. They tried to hide themselves in distant caves and bushes. Which did not save them from the distilleries launched from distant.
In the Tigriay land , Hunger, death, fear, Harassment, Terror, Rape, looting, etc are activities done without limit for the last solid five months.
Anybody to stop such a disastrous act?
Tigray ትስዕር
March 29, 2021 at 2:33 pm
Sadly speaking, the On going war in Tigray is characterized by “multiple acts of large-scale violence,rape, robbery, mutilation of human body , treating humanity like a vessel for Vector-borne & blood-born deaseas ,carried out in an organised fashion(involving foreign and domestic actors of genocide) and resulting in numerous victims in an unimaginable manner.
We plead for actions for over 4 months and al the past actions taken so far are not comparable to the required measure that could result in the culmination of the carnage in Tigray. As opposed to our expecations, we are witnessing heart-wrenching stories on a daily basis.
The world is watching reluctantly and doing nothing significant when it comes to halting the crisis so far apart from politicizing it .
Ethiopia will not be disintegrated ,and will not be left to suffer a total collapse, argued Amhara elites and their fans. For these traitors, Ethiopia and Ethiopianism are dens and caves where they could find security and do stuffs that their anscestors were practicing. Matthew 21:13
As a teenager, I made to think and beleive Minilik is a righteous man and was curious to visit Adowa and Ankober upon hearing those fairy tales in the church yard. Since I was told Minilik II defeated the Italian invading forces with the help of Saint George and people the church made me to feel that he was a Godly man for whom God sent His messengers to render him and his infantries save and sound. The kind of the story the church men , mostly dominated by amhara gonna treacherously instill an affacetion to an imeprial regime, a royal family of amhara dynasty.
Most Eritreans have collectively developed a malignity against Tigray and Tegarus. For them, they can only satisfy their ego of inferiority complex, resulted from low quality of life both an individual and national level, by destroying our public and private infrastructure and being invloving in dehumanizing and defaming Tigray and Tegarus in an effort to stand out and surpass Tigray. Eritreans are not capable to change their country for the past 30 years despite the fact that they are scattered all over the world like the sand in the sea/Ocean. They could rise up when Tigray goes downhill, as per thier motto. Time will tell, their dreams will never ever come true, mark my words!
They are mostly suffering a materialistic ego and these two dictators (Abiy and Isayas) suffer a compensatory ego. Abiy has grasped this culture of revenge translated it into action in national and international level.
This culture of envy, is malignity and striving to destroy one’s neighbour, classmate or colleague are predemoniantly prevalent in the so-called amhara region. We see many people who have been doped by the people whose ego is exremely high manifesting itself with low self-esteem, terms uncovering jealousy etc . People developped these evil sentiments in an individual level and they bring this demostic values to the national level. These demonic acts are practiced by Amhara ecclesiastical elites who claim they own wisdom (witchcraft) fasley attributed to King Solomon in a bid to justify and sanctify it. I would like to remind you the fcat we must throw and abandon all these bad practices along with ethiopianism . And We must cultivate and encourage helping with another and avoid practicing superstious actions against fellow men.
N.B People who suffer from compensatory ego do demonstrate the foll. traits : They act as experts, deliver false information in a superior manner, they lie and seek admiration from vulnerable types. They are often highly insecure and are trying to emulate a role model who impressed them in their earlier life. They actually do not possess the ability to become them, so instead they pretend. These types can be dangerous. When they are outed they can react badly just as Colonel Abiy and his mentor, Isayas.
“Ego=1/Knowledge. ” More the knowledge lesser the ego, lesser the knowledge more the ego.”. ― Albert Einstein.
Tigray ትስዕር ትስዕርትስዕርትስዕርትስዕርትስዕርትስዕርትስዕርትስዕርትስዕርትስዕርትስዕር
March 29, 2021 at 1:00 pm
Baki or bakit are you from Eritrea, den where the modern day Askaris(sold for 500 mln USD) lives ?
Are you unhappy because you are unable to control the whole Tigray in 3 days and kill all Tegarus ? Coward, why donot say your feeling straight forward. I do myself hated TPLF and supported the so-called Ginigit in my salad days , but as it turns out all these amhara leaders donot even care for their own people let alone for Tegaru. Did you expressed your affection for Tigray by killing Kids, Mothers , nuns, hermits, and priests ?
I donot bother and care for political leaders , I am hear only to plead for actions in an effort to save the lives of my people. The current TPLF is fighting its enemies along with the young generations . They are not like your masters who order their subjects to rape and kill all men and women in the streets and those hiding at home to feel safe.
Tigray ትስዕር ትስዕርትስዕርትስዕርትስዕርትስዕርትስዕርትስዕርትስዕርትስዕርትስዕርትስዕር
March 29, 2021 at 12:54 pm
Your Peope ?? who are you mister Baki or bakit ?
Are you unhappy because you are unable to control the whole Tigray in 3 days and kill all Tegarus ? Coward, why donot say your felling straight forward. I do myself hated TPLF and support socalled Ginigit , but as it turns out all these amhara leaders donot even care for their own people let alon for Tegaru. Did you expressed your affection for Tigray by killing nuns, hermits, priests and kids ?
I donot bother and care for political leaders , I am hear only to plead fo actions of my people. The current TPLF is fighting its enemies along with the young generations . they are not like your masters who order their subjects to rape and kill all men and women in the streets and hiding at home to feel safe.
Baki
March 29, 2021 at 11:56 am
Thank you TPLF for punishing our people with war. Tplf took the people of Tigray to war for what— To protect the lifestyle of Debretsion and Sebhat while the people of Tigray and Ethiopia are engulfed in fire and bullets.
Thank you tplf.
Teklay W
March 29, 2021 at 8:44 am
Interesting but painful story. Thank you Drs Yemane and Fiseha for the echoing the pain of your people. You have tried to grasp the reality at the ground and is necessary to further circulate such evidences to the wider audiences.