Tigray conflict decimates maternal health services, overwhelms health workers

SHIRE, Tigray, Ethiopia – “When the conflict broke out, I was two months pregnant. We were forced to flee and walk for days under the blazing sun to reach safety and protection,” said Merhawit Gebremedhin, who is from the town of Dansha in Western Tigray, the Ethiopian region that has been embattled since November 2020. 

Ms. Merhawit had been an accountant, and had saved up to give her baby a safe, loving home and a promising start. But then the conflict mowed through her town, shuttering access to critical health services.

“You never know when life is going to turn its back on you. I left everything I worked so hard for behind to save my life and that of my baby. This is all I have,” she told UNFPA, pointing to a few belongings in a bag. 

Today, the 23-year-old lives with her husband in a school in the town of Shire. It is one of the many temporary shelters established to host people and families displaced by the crisis. Across Tigray, there are an estimated 1,918,220 internally displaced people, living in congested and sub-standard collective centres, including schools and churches. 

With her baby due any day now, she is preoccupied with one thought: What will become of her child? 

“I think about my situation day and night. How am I going to keep my baby alive with no income and living in such gruelling conditions?” 

Maternal health at risk

Nearly eight months of conflict have taken a serious toll on health facilities across the region. Today, only 59 per cent are functional, and only four are able to perform surgical procedures for pregnant women experiencing complications, such as Caesarean sections, blood transfusions and other emergency obstetric care.

“I was really scared to give birth in Dansha. What if I got sick, or I needed an operation? What would I do then?” Ms. Merhawit recalled. 

Many facilities have seen extensive infrastructure damage, and others have been looted for medical equipment and supplies. 

“Before the conflict, there were five primary hospitals around this area and now all of them have collapsed,” said Dr. Berhane Tesfay, the medical director of Suhul Hospital in Shire.  Those hospitals that are still operational, like Suhul, are overwhelmed. “We are saturated. The service demand, especially in maternal health, is appalling.” 

“We have gone from 260 to 600 deliveries per month. Complications have doubled. Our C-section procedures have increased from two to four or five per day since the conflict erupted,” said Berhe Weldu, a UNFPA-supported midwife providing support at Suhul Hospital. 

Many of his clients are like Ms. Merhawit – pregnant women who have undertaken long and dangerous journeys to seek care. For those who experience complications, the risks are grave. 

“We are losing all the gains on reducing maternal mortality. In this hospital, we have gone from losing six women per year to 15 in just seven months of conflict. And we don’t know how many have died in their homes or on their way to a health centre,” Dr. Berhane said. 

Building back the capacity to save lives

In addition to Suhul Hospital, UNFPA is supporting 38 facilities across Tigray. Each faces serious challenges.

“We are doing the impossible everyday to ensure services are available to save lives,” said Mr. Berhe, one of 20 midwives UNFPA has deployed so far. 

UNFPA is set to deploy 60 more midwives and also plans to scale up the provision of medical supplies and equipment. Seven maternity waiting homes – which provide pregnant women room and board in close proximity to a health facility – and seven mobile health teams are also being established to meet sexual and reproductive health needs in the region. 

Health workers have not lost hope. Glancing at Ms. Merhawit, Mr. Berhe said, “Every time I can save a life or help someone like Ms. Merhawit, I feel really proud of what I do. We won’t stop until we can ensure every childbirth is safe again in Tigray.”