10 Apr USAID cuts are yet another blow to wounded Tigray
“Can the flap of a butterfly’s wings in Brazil cause a tornado in Texas?” asked the mathematician Lorenz, in one of his conferences.
Surely, he would have found an answer much more quickly to the question “can the suspension of USAID funds decided in the US cause a tragedy in Ethiopia?”
The signs of the civil war are still numerous, and some of these are real open wounds for Tigray, which is still trying to slowly restart.
The health situation is one of the sore points: if Tigray was once considered a model in the fight against HIV, thanks to years of awareness-raising efforts that had brought the HIV prevalence rate in the region to 1.4% (one of the lowest in Ethiopia), now the situation is very different.
With the conflict that opened in 2020 between the Ethiopian government (supported by neighboring Eritrea) and the Tigray fighters, HIV has had the opportunity to spread again.
This is due to the widespread use of sexual violence (as reported by numerous Amnesty International reports) as a “weapon of war”. Up to 10% of women and girls aged 15 to 49 in the region of 6 million people have been victims of sexual abuse, mostly rape and gang rape, according to a study published by BMJ Global Health.
At the same time, Tigray’s health system has been systematically looted and destroyed, leaving only 17% of health centres functioning, according to another study in the same journal.
As a result, 90% of survivors of sexual violence have not received timely medical support: the window to receive prophylaxis to prevent HIV is just 72 hours.
A period of time that can only be exploited with an adequately prepared health system in terms of facilities, staff and medicines: conditions that since the start of the conflict, in Tigray are almost no longer able to occur simultaneously.
Today, the official HIV prevalence rate in Tigray is 3%, more than double the pre-war average. Among displaced people (about 1 million), the incidence is 5.5%, rising to 8.6% among survivors of sexual violence.
Unfortunately, it must be taken into account that the data collected – given the lack of services in territorial facilities – underestimates a worse real situation.
“It was a horrible conflict,” said Amanuel Haile, head of the Tigray health office and our guest on the occasion of the 25th anniversary of the association. “The war was everywhere and it was a tragedy from all points of view. Agricultural crops failed. Rape was widespread. Hospitals were vandalized. The distribution of medicines was interrupted.”
The “complete collapse” of health services in Tigray also meant that existing HIV patients were not given antiretrovirals during the war, increasing the risk of transmitting the virus through pregnancy or unprotected sex, Amanuel said.
Even condoms were not available in the region, cut off from the rest of Ethiopia. To survive, some destitute displaced people turned to prostitution, often without protection, another factor that contributed to the increase in HIV cases.
The Trump administration’s recent decision to eliminate 83 percent of US Agency for International Development programs globally is making the situation worse.
Ethiopia has already laid off 5,000 health workers who were hired with US funds to fight the spread of HIV. Meanwhile, charities that were distributing treatment to HIV patients have been issued work stoppage orders.
Among them was the Organization for Social Services, Health and Development (OSSHD), a national agency whose Tigray branch tested for HIV and provided food and financial support to HIV patients.
“Since the war, things have been slowly improving,” said Yirga Gebregziabher, head of the OSSHD in Tigray. “Now a lot of services are disrupted again.”
Like the rest of Ethiopia, Tigray is also struggling with sharp increases in other infectious diseases due to the effects of conflict, climate change and funding cuts.
Nationwide, malaria cases have risen from 900,000 in 2019 to more than 10 million last year. The war has disrupted efforts to distribute mosquito nets and spray high-risk areas with insecticides to prevent the mosquito-borne disease. Measles has increased from 1,941 cases in 2021 to 28,129 in 2024. Cholera and tuberculosis are also making a significant comeback.
Health workers say Tigray is particularly ill-prepared to deal with these outbreaks. It has few ambulances, after most of its emergency vehicles were destroyed in the war. Some doctors haven’t been paid in 17 months. And its largest health facility, Ayder Referral Hospital, has only 50 percent of the medicines it needs.
“These outbreaks are extremely damaging,” Amanuel said. “We have a lot to rebuild, and outbreaks are draining the few resources we have.”
Meanwhile, millions of people in Tigray still rely on humanitarian aid, and 18 percent of children are malnourished, making them vulnerable to disease.
“We are trying to rebuild, but we are still in a state of crisis,” said Abraha Gebreegziabher, clinical director of Ayder Referral Hospital.
The Abraha institution is struggling with severe budget cuts and debts that prevent it from affording basic medications or items such as drains and syringes. The hospital is requiring patients to pay for services that were previously free.
And Kidane Mehret Hospital in Adwa, how is it coping with all this?
Retroviral drugs for HIV-positive and AIDS patients were previously funded by the USAID program to the Ethiopian health service, which distributed them throughout the country, including our hospital.
Now that they are no longer coming through that channel, they would have to be purchased at high costs.
Add to this the severe shortage of fuel, with prohibitive prices that is blocking all transport and deliveries of drugs: even those who could aspire to have a quasi-normal life, now risk becoming seriously ill.
Unfortunately, Tigray’s political leaders have been trapped in a power struggle, which has recently intensified: a few weeks ago one of the TPLF factions took control of several government offices. yet another act that threatens the difficult balance achieved with the 2022 Pretoria agreement, which put an end to hostilities.
A peace achieved with difficulty, which the population does not want to see threatened again: on numerous occasions the people of Tigray have taken to the streets to demonstrate against a possible new conflict, which could bring Ethiopia, Eritrea and the factions of the TPLF, the party governing the region, onto the battlefield.
In this scenario, our help is even more fundamental: just like the butterfly effect, our small gesture in Italy, or anywhere in the world, can bring serenity to Ethiopia.
Source: AP news https://apnews.com/article/ethiopia-hiv-aids-tigray-war-health-usaid-8c3275003f6894aa943cd81dacdf18cd