In Shire, a town located within Ethiopia’s Tigray region, a woman endured two harrowing assaults as the war in Tigray drew to a close. Initially, Eritrean soldiers took her to a military camp where they, along with a number of other women, endured gang rape. Just two days later, she was victimized again by local militiamen. The violence left her with severe injuries, including a broken collarbone and wrist, and the added burden of an HIV infection. Now, over two years later, she struggles to access antiretroviral medication, trading parts of her meager wheat rations for drugs which are insufficient to manage her illness.
Once a leader in HIV prevention, Tigray boasted a prevalence rate of just 1.4% due to dedicated awareness efforts. However, the conflict that erupted in 2020 between the Ethiopian government, with Eritrean support, and Tigray’s fighters marked a significant downturn. This devastating war, characterized by extreme violence, widespread sexual assault, famine, and disease, resulted in dramatic increases in sexual violence, with a reported 10% of females aged 15 to 49 experiencing sexual abuse.
The war severely crippled Tigray’s healthcare infrastructure, rendering only 17% of medical facilities operational, facilitating a massive gap in critical medical support for violence survivors. The lack of timely healthcare has exacerbated the HIV crisis in the region, raising post-war prevalence to 3% from the pre-war levels, which is even more serious among the displaced and survivors of sexual violence.
Amanuel Haile, head of Tigray’s health bureau, described the multifaceted crisis where warfare led to widespread destruction not only of homes and hospitals but also of food systems and essential drug supplies. The unavailability of prophylactics during the conflict hastened HIV transmission, as a lack of contraceptives forced some vulnerable populations into riskier actions, including sex work for survival, according to health workers.
The situation is further deteriorated by international funding cuts from the U.S. Agency for International Development, which resulted in the loss of thousands of health workers and the suspension of many vital HIV-related services provided by local charities. These organizations played a crucial role in diagnosing, treating, and supporting HIV patients and their communities.
Aside from the HIV epidemic, Tigray grapples with an increase in other infectious diseases such as malaria, measles, cholera, and tuberculosis, all spurred by ongoing instability, climate change, and budget constraints. These outbreaks stretch the already taxed health infrastructure, with ambulances destroyed in the war and essential facilities like Ayder Referral Hospital operating at half capacity.
Health authorities in Tigray, amidst these numerous health and logistics challenges, are focused on rebuilding essential services. However, ongoing political instability within Tigray threatens further disruptions, deterring potential international aid and donor engagement.
Despite daunting obstacles, regional healthcare leaders are working to restart community-based health insurance schemes, once a cornerstone of Tigray’s health system. This effort is pivotal to restoring healthcare access in a post-conflict scenario, but political tensions pose significant challenges, potentially undermining critical rebuilding efforts.