Tigray crisis: “We suffer from a lack of medical care” | Doctors Without Borders

Stigma around sexual violence

Dr Tesfamichael is particularly concerned that few survivors of sexual violence seek help. “Many women are raped but they don’t ask for help. They want to go to the hospital, but stigma and social norms prevent them from doing so. We have emergency contraceptives, prophylaxis, the problem is that we cannot reach the patients. We need to increase health education, community mobilization and home visits.

MSF first faced a similar situation in our on-site clinics. Our staff hears many stories of sexual violence in the community, but very few women come for treatment. The number of survivors seeking care is now increasing, perhaps because more people know 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 psychoeducation sessions at the sites. Many people have been deeply traumatized by the violence they have suffered, by their displacement and poor living conditions, and by being separated from family members, often without knowing where they are.

“We all have trouble sleeping,” says Tesfaye*, 43, who lives on the school site with his family. “We all think about our homes, our businesses, our children who don’t go to school. My eldest daughter, who is 14, was one of the top students in her class. She hasn’t been to school for about a year, first because of COVID-19 and then because of the fighting. She is very upset.

The health system in rural areas has collapsed

While the situation for displaced people in the Shire is difficult, it is even worse for people living in areas outside Tigray’s main towns. Birhane* is a 58-year-old farmer who visited MSF’s primary health clinic at the university site. With his weathered face, traditional white headscarf, and lean, arched body perched on a cane, he looks much older. He walked two and a half hours from his village to seek treatment.

Birhane says the health center that served her farming community of 2,500 people has been closed since November and all six staff members have left. “We suffer from a lack of medical care. We have no medicine; the two village ambulances were taken. Many people are sick. Three pregnant women have died during childbirth in the last three months,” he says. “There is no food in the village. Our fields have been plundered. Some of our wives have been raped. We stayed two months in the forest and we are still afraid.

Berhe*, a health professional working with MSF, says the area had a functioning health system long before the fighting started. Villages had health posts and there were health centers in small towns and hospitals in big towns. Health extension workers visited the 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 yet been vaccinated. Maternal and child health is very difficult right now. During one of our mobile clinics, we learned that a mother who was giving birth had died because she could not get help from health professionals. In rural areas, there are no health facilities, no ambulances.

Since the end of January, MSF has been sending mobile medical teams to treat people in villages and towns to the north, east and south-east of Shire. We are also supporting some health facilities with medical supplies and recently opened a base in the northwest town of Sheraro from which we provide care to people in the surrounding rural areas.

Most of the health facilities visited by our teams are not functional. Many have been vandalized and looted and most staff have left. Most people in the area have not received any medical treatment since November.

As access to towns and villages along the main roads in northern Tigray becomes easier, we are now trying to reach people who live in the bush, says Gordon. “These are the people who really can’t access any type of health care. We try to make it happen and give a minimum of care and see their condition. We hear of people who have been in the bush for months and still do not feel safe enough to come to the clinic.

*Names changed to protect anonymity.