Seit Ende 2020 schwelt in Tigray ein militärischer Konflikt, der die nördlichste Provinz Äthiopiens durch die Blockade von Hilfsgütern in eine schwere humanitäre Krise gestürzt hat. Melanie M. Klimmer führte ein Interview mit Kibrom Gebreselassie, dem medizinischen Direktor des Ayder Hospital in Mekelle, der Provinzhauptstadt von Tigray, über die schwierige Versorgungssituation und wie er selbst den Alltag bewältigt. +++ Die deutsche Version des Interviews ist in der Tageszeitung Neues Deutschland erschienen. Hintergründe zur Situation in Tigray hat die Interviewerin Melanie Klimmer für den Freitag aufgeschrieben. +++ Prof. Dr. Gebreselassie, how many patients do you have at the moment, per day, in comparison to the situation at the beginning of the civil war? Our hospital is a 500-bed hospital. During the war we started to have so many more patients that we had to add more beds to the wards. This swelled the number of patients to more than 700, and at times we may even put patients in the corridors, accommodating more than a thousand patients at a time. Do you have enough medical staff to take care of them all? The number of physicians was dramatically reduced after July, 2021. This was because some of the doctors (residents who were in specialty training) went to other parts of the country for many reasons, such as the communications blackout, lack of access to their bank accounts, lack of salaries, the threat of starvation, and other personal reasons. We are handling the situation with whatever staff we have now. We currently have only 136 senior staff. Where do you and your staff eat and sleep at the moment? I eat and sleep in my home which is located in the hospital compound. This was provided to me by the hospital ten years ago. Are you and your staff able to eat and sleep enough to make it through your daily work? We don’t get enough food or sleep. We are overworked. We have no rest or vacation. We haven’t received our salaries in more than a year. We are living on donations from our friends and supporters. ICRC (Red Cross) donated a 12kg sack of wheat flour, one litre of vegetable oil, salt and lentils to the staff last month. It was a life-saving donation; but to see doctors (specialists and sub-specialists queuing to collect this donation was heart-breaking). What we get from Etiopia-Witten in Germany is our biggest and most reliable source of help. Our staff is in serious trouble. We have staff members whose children have been admitted to the hospital because of malnutrition. We have staff who collapse during surgical operations due to lack of nourishment. We have staff members begging in the streets with their children! These are once prosperous and well-to-do families who used to help other community members. Where do you get your medical supplies and resources at the moment? All our medical supplies are from donations. ICRC, WHO, and to a lesser degree World Vision, help us in getting medical supplies. As to the personal resources, we get occasional monetary donations from Etiopia-Witten. It is really helpful for our besieged people to get such donations, and we thank Etiopia-Witten for these efforts! How do you feed yourself, your medical staff, and your family, and relatives? Eating three times a day or getting nutritious food is a thing of the past. We are barely living. I have been supporting my relatives for a year now. For our poorest staff members, we are providing one meal a day at a feeding center (LiSa Kitchen). The kitchen is supported by Etiopia-Witten. What are your daily work routines in light of the ongoing shortages of personnel and supplies? How do you manage the needs of all these patients: those who have been injured, those with starvation, the chronically sick or those traumatized physically and mental by the war? We routinely beg for medical supplies and patient food every day. Currently we have a severe shortage of fuel. The staff have to walk on foot a very long distance to come to the hospital. This is on top of their empty stomachs, without their being paid a single penny for over a year. The war injured, raped and starving patients are even worse. They come to our hospital from far-away places, hoping to be treated and cared forbut we are not able to perform even the simplest laboratory investigations due to lack of reagents. We have no adequate radiology service (our CT scanner and MRI machine are both out of order due to lack of spare parts). Our oxygen generator no longer works due to lack of needed routine maintenance and lack of spare parts. The patients with chronic conditions such as diabetes, hypertension, or HIV are among the worst affected. We used to give them enough medications at least one month, but now we can only give them enough drugs to last for one week. What takes up the most of your time? Currently the most demanding issue in the hospital is lack of electricity and fuel. We have completely shut down all elective admissions. The hospital provides only emergency services. This is the top priority, but we can only last this way for another week. What are main complaints and diagnoses of the women who seek help at Ayder Hospital—whether they are pregnant or not? Why do women come to Ayder? Gender-based violence was the number one complaint of women during the occupation of Tigray by the invading Eritrean troops and their allies, the Ethiopian Federal Defence Force and the irregular Amhara Fano bandits. We are still dealing with the aftermath of these atrocities as many victims have acquired sexually transmitted diseases, unwanted pregnancies, and PTSD as a result of their experiences. The other group of women coming to our hospital are mothers with complicated pregnancies. As most of the hospitals and health centres in Tigray were looted or destroyed by the invading allied militaries of Ethiopia and Eritrea, pregnant women do not have a safe place for either antenatal care or labour. A lot of them end up having complications of childbirth, even maternal death. The number of obstetric fistulas has risen. Maternal mortality increased. Stillbirth and early neonatal death have also increased significantly. Is there an increase of birth fistulas? We have seen a dramatic surge in the incidence of fistulas related to childbirth. Why? This is due to lack of access to health centres, which were deliberately targeted and destroyed by the invading troops. Can you help these women? We are admitting these unfortunate mothers in hopes that they can get the help they need. We are getting support from the Worldwide Fistula Fund lead by Prof. L. Lewis Wall. How do you get by, when you have to triage patients and see that you can’t help a hungry child, a pregnant woman, a man needing dialyse or surgery? Do you have a time and place to talk about such problems? This is a daily occurrence. My two decades of medical training didn’t prepare me to face such human misery on a daily basis. No doctor in this world wants to see their patients dying in front of their eyes because although they know how to treat the disease, they just don’t have the supplies to do so. It is extremely painful to send your cancer patients home to die because you don’t have the chemotherapy that they need. It is sad to see young individuals die in the Outpatient Department because there are no more reagents for the dialysis machine. It leaves you in tears when you must amputate the limb of a young girl because you don’t have the appropriate sutures to repair her damaged blood vessels. What makes the pain and misery of the staff worse is that we have the skill and knowledge to treat the illness, but we don’t have the supplies needed for the procedures. We discuss the issues with the team. We improvise things. We have started washing gloves and reusing them three times. We have used the dialysis kit up to ten times for patients, even though the company who produces it says it is for one-time use. How do you cope with these awful pictures in your heads, the starvation, the helplessness? My personal escape mechanism is ‘keeping the routines’. I know the problem is man-made. I know there are criminals who want the entire people of Tigray to perish. I know the world knows about the ongoing genocide, but it has hidden its head in the sand like an ostrich. But I believe also there are kind people out there, people who feel my pain, people who care for other people just because they are human beings (irrespective of their religion or colour of their skin). But most importantly I believe the oppressed people of Tigray will win in the end. This keeps me alive. Hope is all I have. Do you talk with your staff about the terrible things that have happened, such as the rapes committed by soldiers in the hospital? How do you help your colleagues and how do they help each other? We do talk regularly. We want everything registered, recorded, and remembered, lest we forget the atrocities of the enemy. We say that this problem is temporary, that it will pass away eventually. We encourage each other. We long to reach the light at the end of the tunnel, however far away it seems. Which moments gave you the strength and trust to persevere and survive, not to give up or flee, and to continue to fight for your patients? The collapse of the mighty-looking Federal army who were occupying Tigray last year gave me strength. The once all-strong military who shot us on sight during the curfew, who raped our sisters and mutilated them with impunity, finally became prisoners of war in our city. Patients were not able to come to our hospitals because of blocked roads. Labouring mothers were not able to make it to health care facilities at night because of all-night curfew. If that eight months reign-of-terror can evaporate suddenly, for sure this time of starvation will eventually do the same. Which moments encourage you to continue despite these awful circumstances? Despite my hunger and misery now. Despite the encircling blockade by our enemies who want to extinguish us, it gives me hope to see someone completely unrelated with us, living thousands of miles away, standing up for us, fighting for our cause, continually trying to sustain us. Humanity is ill, but not yet dead. [Das Interview entstand im Juni 2022.] Spendenhinweise: 1. Etiopia-Witten e.V. Spenden werden eingesetzt für: Lebensrettende Küchen (Live Saving Kitchen) “One Stop Centre”, Ayder-Hospital (for the raped women) Gesundheitspersonal (salary for the medical stuff) Spendenkonto: Sparkasse Witten IBAN: DE70 4525 0035 0000 9010 90 BIC: WELADED1WTN 2. World Fistula Foundation (WFF) (Spenden direkt über die Website, Stichwort: Ayder Hospital oder Tigray) Das Ayder Hospital in Mekelle bekommt von WFF Gelder für Operationen bei geburtsverletzten Frauen und Überlebenden sexualisierter Gewalt.
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