Geographical distribution of the health crisis of war in the Tigray region of Ethiopia

Abstract

War destroys health facilities and displaces health workers. It has a devastating impact on population health, especially in vulnerable populations. We assess the geographical distribution of the impact of war on healthcare delivery by comparing the pre-November 2020 and the November to June 2021 status of health facilities in the Tigray region of Ethiopia. Data were collected from February 2021 to June 2021, during an active civil war and an imposed communication blackout in Tigray. Primary data were collected and verified by multiple sources. Data include information on health facility type, geocoding and health facility status (fully functional (FF), partially functional (PF), not functional, no communication). Only 3.6% of all health facilities (n=1007), 13.5% of all hospitals and health centres (n=266), and none of the health posts (n=741), are functional. Destruction varies by geographic location; only 3.3% in Western, 3.3% in South Eastern, 6.5% in North Western, 8% in Central, 14.6% in Southern, 16% in Eastern and 78.6% in Mekelle are FF. Only 9.7% of health centres, 43.8% of general hospitals and 21.7% of primary hospitals are FF. None of the health facilities are operating at prewar level even when classified as FF or PF due to lack of power and water or essential devices looted or destroyed, while they still continue operating. The war in Tigray has clearly had a direct and devastating impact on healthcare delivery. Restoration of the destroyed health facilities needs to be a priority agenda of the international community.

Keywords: Armed conflict; Ethiopia; Tigray; health crisis; healthcare; social determinants of health; war.

Figure 1

Structure of the Tigray Health Care System, which had three tiers: primary healthcare unit that includes health posts, health centres and primary hospitals; secondary care provided by general hospitals; and tertiary care provided by specialised referral hospitals. In 2015, there were 39 hospitals (2 referral, 15 general, 22 primary), 204 health centres and 712 health posts. As of November 2020, 40 hospitals (2 referral, 14 general, 24 primary), 226 health centres and 741 health posts.

Figure 2

Map of the Tigray region of Ethiopia.

Figure 3

Geo-map of the status of health facilities in Tigray (as of June 2021). Due to sparseness of data (since there were only two referral hospitals with one in central and one in Mekelle), online supplemental appendix is based on combined count of referral and general hospitals labelled as general hospitals.