At the entrance to Ayder hospital in Makalé, the largest in Tigray, the lists hung on a cork board are not job announcements. The hospitals in this region of northern Ethiopia could, however, need reinforcement in these times of post-war reconstruction. Unfortunately, on the contrary, these are the names of the hundred doctors who resigned, abandoned the hospital and, most often, left the province.
After two years of civil war (2020-2022) marked by the blockade of the region, shortages of medicines, the occupation and destruction of all health structures, peaceful Tigray faces a new threat: the exodus of its caregivers. The Ayder Hospital Faculty of Medicine indicates that 67 of the region’s 190 specialist surgeons took advantage of the reopening of borders, after the November 2022 peace accords, to flee a Tigray in ruins. That’s more than a third. In all, 221 doctors left their posts.
“Staff at Ayder Hospital worked tirelessly for two years without pay. He has shown incredible dedication and compassion, but now he is at his wits’ end. Everyone is exhausted, demoralized and starting to leave the hospital,” notes the director of the establishment, Kibrom Gebreselassie, as a cry for help.
Observation of helplessness
After the time of devastation, Tigray is barely recovering. During the war, Ayder Hospital operated “at 15 percent capacity,” according to Kibrom Gebreselassie. More generally, 70% of health facilities have been “looted” across the region, according to Médecins Sans Frontières (MSF). Although, since the peace agreements, part of the budget, including salaries, has once again been paid by the federal government, doctors have continued to flee.
“It’s a trend that we have difficulty controlling,” recognizes Amanuel Haile, director of the regional health office, who dates the start of the exodus to January, following the resumption of air connections to Makalé, the capital of Tigray: “Some of our best specialists leave to work in private clinics in Europe and the United States or in NGOs, notably in Somaliland, Rwanda and South Sudan. »
Doctors choose exile above all for financial considerations, in order to settle their debts after eighteen months without income or compensation. Kahsay Hailu (his identity has been changed at his request) was a surgeon for more than twelve years in Ayder. Trained in Makalé, he owes everything to this hospital. However, he chose to flee to Canada in March, accompanied by his wife and three children. “I have a family to support, I can’t stay with little or no pay in an establishment that no longer works,” he explains. In Ethiopia, a public sector surgeon earns on average 230 euros per month, but up to 20 times more if they work for UN agencies or NGOs.
Certainly, there is the guilt of leaving a province on the edge of the precipice, faced with an increase in cases of sexual violence, cancer and HIV. But these deserting doctors also face a realization of helplessness. “I feel like I sacrificed two years to care for my loved ones when we had nothing, no salary, no electricity, not even plastic gloves, nor food for the patients,” says Kahsay Hailu.
“We’re underwater.”
“I absolutely do not judge them,” reassures Amanuel Haile, who claims that everything will be done to welcome back exiled doctors who wish to return to their positions. In the meantime, the quality of care suffers. The only abdominal surgery specialist having left, you have to go to Addis Ababa to receive this type of care. The same goes for vascular surgery. “We’re doing DIY,” quips surgeon Fasika Amdeselassie. We are underwater, my waiting list has tripled since my colleagues left. »
This Ayder hospital executive knows that post-traumatic stress disorder is another reason for the departure of Tigrayan doctors. To treat them, he set up a small structure, called “Haqi”, which offers psychological support for health professionals who were on the front line during the war. “The psychological damage is colossal, the pressure intense, and we have almost no one to talk about it, because Tigray only has three psychiatrists for 6 million inhabitants,” he says.
If humanitarian actors have returned to Tigray to support a faltering health system, there is little chance that the exiled doctors will return quickly. “The budget allocated by the Ministry of Health has decreased by a third compared to the pre-war level,” confides, disillusioned, a doctor who wishes to remain anonymous. In addition, the slow demobilization of the armed forces of Tigray and the state of emergency in the neighboring region of Amhara raise fears of a resurgence of clashes. “The political outlook is too gloomy to hope for the return of our colleagues,” assures Fasika Amdeselassie. If peace is not confirmed soon, we have no chance of seeing our doctors return. »