The TPLF invasion of the Amhara region starts on July 10/2013and scaleup up to many zones and districts of the Amhara region within a short period Following this conflict different public health emergency responses at different times at different phases have been cascaded.
Regional disaster risk management situation: there is a leading sector of disaster risk management at the regional level in the form of a disaster risk management office. with a role in disaster prediction, data analysis, interpretation, and result dissemination in addition, organizing the responsible stakeholders before and after the occurrence of an emergency and emergency preparedness and readiness plan within the participation of members of the leading sectors such as health, agriculture, water and security
Early warning and preparedness: Though there were some clues about the Tigray invasion since October 24/ 2013 EFY; there is no documented and organized risk prediction, analysis, evidenced preparedness plan, or emergency preparedness plan concerning conflict and other disasters except drought and flood. Even if no risk mapping and prediction when the conflict starts; some evacuation, readiness to relief response, and collective site selection had been done some weeks before the risked area was invaded. in addition to human evacuation, there were some medical supplies, medical equipment, and other materials have been evacuated. The Ethiopian pharmaceutical supply agency (EPSA) evacuated a supply and medical equipment which cost 227million birr from eastern Amhara EPSA, and the Regional health bureau has been evacuated ambulances which cost 3 billion ETB. As evidenced by the regional health bureau report, especially from the north wall, south wollo, and North Shewa.
Emergency public health response: Even if it was weak and non-resilient there have been established technical working groups (TWG), Taskforce, and rapid response teams (RRT) as a region that can provide different relief tasks during an emergency of conflict. As a result,37 collective sites were selected and responsible TWG and task force were assigned at all levels for providing different services such as food distribution (984,000ton) shelter establishment (234,0000), finical empowerment (168,234,345ETB), and sanitary equipment such as soap, detergent, blench (2,134.654psc), modes(454,000pcks), different cooking materials which cost (1256712ETB), lancets(689,000), and maters and (534238 pcs) have been distributed. As a region, a total of 132,865,123(ETB) have been allocated for purchasing drugs, medical equipment, and other supplies. About 452 additional health professionals have been employed for the mobile clinic to do different tasks such as nutritional screening, vaccination, health education, gender-based violence (GBV)screening and linking to treatment, and follow-up for chronic follow-up (Table 1)
Table 1: clinical services delivery for different disease categories in the last six months at different internal displacement sites,2022
Types of disease
|
Number of patients
|
Diarrheal disease
|
34234
|
Upper respiratory tract infection
|
28986
|
dyspepsia
|
678
|
helminthiasis
|
27668
|
scabies
|
22,456
|
injuries
|
18845
|
pneumonia
|
14786
|
Fungal infection
|
16798
|
Mental health
|
3456
|
Diabetes mellitus
|
268
|
hypertension
|
167
|
HIV/AIDS
|
432
|
TB
|
89
|
Damage to health facilities and their infrastructure due to Tigray conflict in the Amhara region TPLF-led invasion and terrorist attacks destroyed health system infrastructures partially or completely, pillaging medical supplies and equipment, and interruptions of health services, leaving the community reliant on emergency medical assistance. Because in less than six months of the war, health facilities including 2 comprehensive specialized hospitals (Dessie and Woldia Comprehensive specialized hospitals, 11 general hospitals, 27 primary hospitals, and 453 health centers were affected during the war period (Figure 1)
List of the damaged building health centers, hospitals, and substructures of the building during the conflict period
Medical equipment damaged and lost/stolen by the TPLF conflict and the estimated cost. The table below indicates the medical equipment damaged in each health facility and the estimated cost. From the two affected comprehensive specialized hospitals, the medical equipment was damaged and its estimated cost was (41273677.12ETB), from 11 general hospitals the estimated cost was (134,190,966.69) and from27 primary hospitals medical equipment was lost and its estimated cost was (169,559,774.82) (Table 2).
Table 2: List of the damaged building of health centers, hospitals, and substructures of the building during the conflict period, Ethiopia,2022
S.no
|
Different categories of health facilities
|
Number of health facilities whose medical equipment was looted and damaged
|
Total cost (ETB)
|
1
|
CSH
|
2
|
41,273677.12
|
2
|
General hospitals
|
11
|
134,190,966.69
|
3
|
Primary hospital
|
27
|
169,559,774.82
|
4
|
Health center
|
453
|
1,167,848,396.34
|
|
Total
|
453
|
1,512,872,814.97ETB
|
The chronic disease follows up patients during the conflict period
Chronic follow-up patients whose treatment and follow up interrupted by TPLF conflict for six months in the affected zones of the Amhara region,2022. A total of 8915 patients with chronic follow-up for chronic infectious diseases such as TB, HIV, and leprosy have been interrupted their monthly treatment and clinical follow-up (Table 3).
Table 3: Showed that Chronic disease follow up patients during the conflict period
Zones
|
TB cases
|
MDR TB
|
Leprosy
|
HIV/AIDS
|
Remarks
|
North Gondar
|
163
|
11
|
25
|
112
|
|
North Wollo
|
382
|
16
|
42
|
1100
|
|
Wag Himera
|
118
|
9
|
19
|
540
|
|
Dessie city
|
86
|
26
|
11
|
1067
|
|
North Shewa
|
291
|
29
|
95
|
861
|
|
Oromo special zone
|
178
|
3
|
27
|
1311
|
|
South Gondar
|
31
|
1
|
3
|
324
|
|
South Wollo
|
542
|
8
|
190
|
1260
|
|
West Gondar
|
49
|
9
|
76
|
123
|
|
Maternal and child health services in war-affected zones of the Amhara region during the conflict period
During the time of the war in the affected Amhara region there are 74980 home delivery,91 unsafe abortions,45980 lost post-natal care,33 maternal mortality,66 neonatal death, and 137698 interrupted family planning method, and 1035 unwanted pregnancy happened during the conflict period (Table 4).
Table 4: showed that Maternal and child health services in war-affected zones of the Amhara region during the conflict period.
Zones
|
Home delivery
|
Unsafe abortion occurred
|
Post-natal care lost
|
Maternal mortality
|
Neonatal death
|
Family planning user interrupted
|
Unwanted pregnancy
|
North Gondar
|
1363
|
0
|
363
|
2
|
1
|
8112
|
38
|
North Wollo
|
28822
|
16
|
8822
|
9
|
6
|
45100
|
343
|
Wag Himera
|
2118
|
9
|
2118
|
5
|
4
|
2540
|
168
|
Dessie city
|
2986
|
12
|
2986
|
3
|
3
|
34067
|
123
|
North Shewa
|
2291
|
22
|
291
|
2
|
22
|
9861
|
0
|
Oromo special zone
|
6178
|
3
|
178
|
0
|
0
|
1311
|
87
|
South Gondar
|
5331
|
1
|
5331
|
3
|
3
|
3324
|
86
|
South Wollo
|
23542
|
29
|
23542
|
8
|
27
|
31260
|
178
|
West Gondar
|
2349
|
9
|
2349
|
1
|
0
|
2123
|
12
|
Total
|
74980
|
91
|
45980
|
33
|
66
|
137698
|
1035
|