Dialysis Service in the Embattled Tigray Region of Ethiopia: A Call to Action

Abstract

Haemodialysis is extremely limited in low-income countries. Access to haemodialysis is further curtailed in areas of active conflict and political instability. Haemodialysis in the Tigray region of Ethiopia has been dramatically affected by the ongoing civil war. Rapid assessment from the data available at Ayder Hospital’s haemodialysis unit registry, 2015–2021, shows that enrollment of patients in the haemodialysis service has plummeted since the war broke out. Patient flow has decreased by 37.3% from the previous yearly average. This is in contrary to the assumption that enrollment would increase because patients could not travel to haemodialysis services in the rest of the country due to the complete blockade. Compared to the prewar period, the mortality rate has doubled in the first year after the war broke out, i.e., 28 deaths out of 110 haemodialysis recipients in 2020 vs. 43 deaths out of 81 haemodialysis recipients in the year 2021. These untoward outcomes reflect the persistent interruption of haemodialysis supplies, lack of transportation to the hospital, lack of financial resources, and the unavailability of basic medications due to the war and the ongoing economic and humanitarian blockade of Tigray in Northern Ethiopia. In the setting of this medical catastrophe, the international community should mobilize to advocate for resumption of life-saving haemodialysis treatment in Ethiopia’s Tigray region and put pressure on the Ethiopian government to allow the passage of life-saving medicines, essential medical equipment, and consumables for haemodialysis into Tigray.

Vicarious trauma on the hemodialysis healthcare workers in the besieged Ethiopia’s Tigray region: a call to action

“…The HD center which is established as a public partnership model almost a decade ago is particularly severed. Dialysis utilization has been drastically curtailed as patient enrollments in the dialysis center have decreased from 110 in 2020 (before the war) to 69 in 2021(after the war) [ 7 ]. Currently, until September 2022, there were 25 patients under suboptimal HD.…”

“…Patients with otherwise treatable kidney failure are dying. Overall, the percentage of mortality in patients receiving HD has doubled from 25.5% before the war to 53.1% after the war broke out [ 7 ]. The severe symptoms of suffering patients and the inevitable preventable death in front of the attending healthcare workers lead to vicarious trauma.…”

“…The dialysis unit represents a unique population of end-stage kidney disease (ESKD) distinguished by a significant burden of disease and high mortality rates [ 8 ]. Amid the war and siege, due to the dearth of dialysis supplies and consumables, Ayder’s HD unit cannot give appropriate care [ 7 ]. Despite heroic but dangerous improvisations, the hospital’s dialysis service has collapsed putting many lives with otherwise treatable kidney problems at stake.…”

War and Siege Halt Gynecologic Oncology Services for Women in the Tigray Region of Ethiopia

“…6 The siege brought a humanitarian aid blockade, lack of transportation fuel, power outages, communications blackouts, and banking services interruption, and it depleted all essential drugs and medical supplies. [7][8][9][10] After 20 months, displacement, death, and destruction had become the defining elements of this war, putting millions of lives at risk. An assessment by Médecins Sans Frontières (Doctors Without Borders) concluded that of the 106 health facilities, nearly 70% were looted and more than 30% were damaged from mid-December through early March 2021 in a deliberate and widespread attack on health care; just 13% were functioning normally.…”

War within a war: The challenges of providing gynecologic cancer care in the besieged Tigray region of northern Ethiopia

“…Ayder Comprehensive Specialized Hospital ( Fig. 2 ), the main hospital in the Tigray region, which was relatively spared from looting and destruction, is now unable to provide basic medical care because of lack of essential medical supplies ( Berhe et al, 2022 , Wall, 2022 ). Before the war broke out, Ayder served as a specialized referral center for a catchment area of 9 million people from Tigray, and neighboring districts of the Afar and Amhara region.…”