Ethiopia’s health care system was once considered a model in the region. But in the northern Tigray region, ongoing conflict has left health facilities and medical workers vulnerable to attacks.

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Ethiopia once had a health system considered a model for Africa. Then, in 2020, civil war broke out in the northern Tigray Region. Combatants occupied and looted hospitals. They attacked health workers. They destroyed medical equipment. A 2022 peace deal ended the major phase of the war. Now renewed fighting in northern Ethiopia threatens that agreement and is putting further strains on an already fragile health system. NPR’s Durrie Bouscaren reports.

DURRIE BOUSCAREN, BYLINE: On September 24, a surgeon went to work at a hospital in Mekelle. It’s the capital city of Tigray, a region in the north of Ethiopia. A 2022 peace agreement between rebels and the Ethiopian government had just broken down, and injured patients were streaming in from the countryside.

UNIDENTIFIED SURGEON: Waking up in the morning, when we go to the hospital, the whole emergency was overflooded with war trauma patients, you know? Like, I’m telling you about the floors were all, like, filled up with no place to sleep.

BOUSCAREN: NPR is granting him anonymity due to fears he’ll face repercussions for treating rebel fighters. He says cell service and the internet were cut off, so there was no way to know how many patients were coming.

UNIDENTIFIED SURGEON: It was just a mess. It was a chaos. And then that continued for almost seven, eight days without network, without electricity.

BOUSCAREN: He spent days in surgery, one patient after the other. There were victims of gunfire, drone attacks, mortar shells – civilians and fighters in uniform.

UNIDENTIFIED SURGEON: We don’t know from where they were really, but you just go ahead and do whatever you can, you know?

BOUSCAREN: There had been signs that the war between Ethiopia’s federal government and rebel groups could reopen. In May, Tigrayan rebels ousted regional leaders and installed their own. In response, Ethiopia’s federal government cut funds to Tigray, including to hospitals run by the regional administration. Doctors haven’t been paid in months.

UNIDENTIFIED SURGEON: In medicine or in surgery, there is a thing we say. It’s an open wound which was never closed, you know, left for healing and then never healed.

BOUSCAREN: In 2022, Tigrayan rebels struck a peace accord with the Ethiopian government, but attacks on healthcare facilities continued. This was not a safe time to rebuild, and resources to try dried up too. When the United States elected Donald Trump, his administration put a halt to foreign aid and dismantled USAID, which had a major presence in Ethiopia. Lindsey Green is a research director for Physicians for Human Rights.

LINDSEY GREEN: The continual attack against healthcare is eroding the norm of healthcare being a protected part of conflict.

BOUSCAREN: She says more than half of health workers surveyed by her group in northern Ethiopia experienced an armed takeover of their hospital or clinic between 2020 and 2024.

GREEN: Armed groups were occupying facilities to take resources or to destroy resources, to destroy machines and equipment, really with the goal of making healthcare harder to access.

BOUSCAREN: Researchers confirmed attacks on healthcare workers perpetrated by both rebels and government forces. Often, they were considered retribution for a community’s perceived alliances or against doctors who treated an enemy.

GREEN: It’s very clear that this ongoing pattern of attacks on healthcare links back to impunity for these violations.

BOUSCAREN: NPR reached out to several parts of the Ethiopian government for comment but did not receive a response. The director of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, wrote on X that the renewed violence in the North is, quote, “pushing an already fragile healthcare system closer to collapse,” with hospitals facing shortages of healthcare workers, medicine and ambulances. Ayoda Werede, a California-based doctor with the nonprofit Health Professionals for Tigray (ph), says over the past two months, the Ethiopian military has not targeted health centers, but other unidentified groups have stolen supplies.

AYODA WEREDE: Including medications, equipments, even mattresses off of patients’ beds that were taken during this time, and this was just this opportunistic vacuum space that was created because of this conflict.

BOUSCAREN: Her fear is that Ethiopia’s healthcare system is already stretched beyond its capacity, and as the conflict heats up again, injured people will have nowhere to go. Durrie Bouscaren, NPR News.

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