By Fenta Takele
Caught in the crossfire of ongoing armed conflicts, the Amhara people in Ethiopia today face an escalating public health crisis that demands immediate global attention. Over the past three years, Ethiopia has become a battleground, with the conflicts leading to significant humanitarian and health challenges. As recent as April 2023, a new conflict erupted in the Amhara region, displacing millions and pushing the region into a vortex of malnutrition, food insecurity, and a surge in communicable diseases like cholera, malaria, and measles. This rapidly devolving situation has received insufficient attention and support from both the Ethiopian government and the international community, leaving Amhara people’s lives hanging precariously. The aim of this commentary is to shed light on the direct and indirect public health consequences of the conflict in the Amhara region, urging immediate action to prevent further degradation of life and living conditions in the region.
Overview of the Conflict in the Amhara Region
In order to get to the core of the public health crisis in the Amhara region, one must dig deep into the root causes—armed conflicts that have caused irreparable losses and subsequent health deterioration.
Historical Context of Armed Conflicts in Ethiopia
The Northern Ethiopia War
Emerging in 2020, the Northern Ethiopia War involved a violent conflict between the Federal government of Ethiopia and the Tigray People’s Liberation Front (TPLF). Throughout the war, clashes and airstrikes created an alarming humanitarian disaster, leading to hundreds of thousands of fatalities and a large-scale population displacement. These disruptions made it exceedingly difficult for health workers to reach the affected populations and, even if they succeeded, the lack of resources and facilities imposed substantial barriers [1].
Recent Conflict Dynamics
Just a few months after the conclusion of the Northern Ethiopia war, conflict emerged anew–this time in the Amhara region in April 2023. Marked by civilian attacks and extrajudicial killings, the clash spread rapidly throughout the region. The displacement of millions of people due to this armed strife has resulted in limited access to basic life-saving support, contributing to both direct and indirect public health challenges. The onset of violence and insecurity has left the region’s health system unable to cope with the escalating crisis.
Impact on the Amhara Population
The effects of these conflicts on the Amhara population have been devastating and multidimensional. With the displacement of millions of Amhara people, many residents have become trapped in conflict-affected areas and under-served in terms of humanitarian assistance. This has led to a high burden of malnutrition and food insecurity, as access to essential services like clean water, hospitals, roads, and financial institutions became compromised. Meanwhile, attacks on the region’s water, sanitation, and hygiene (WASH) facilities, coupled with hindered access to early identification and treatment, have resulted in an increased incidence of communicable diseases such as cholera, malaria, and measles. The collective impacts of these armed conflicts paint a distressing portrait of a region in crisis, beset by a public health catastrophe that demands immediate attention from the Ethiopian government and the international community.
Direct Public Health Challenges in the Amhara Region
The Amhara region experiences several direct public health challenges due to the ongoing conflict. These challenges primarily revolve around the displacement of the population and its health consequences and the increasing outbreaks of communicable diseases.
Displacement and Its Health Consequences
Communities forced to flee their homes due to conflict often face numerous health challenges in their new locations or in the process of relocation.
Access to Health Services
One of the significant consequences of displacement is the compromised access to health services. Many displaced Amhara populations find themselves in areas with severely inadequate health facilities, insufficient healthcare personnel, and poor availability of essential drugs. Visiting far-off health centers becomes a daunting task due to the unsafe environment and limited means of transportation. Consequently, their likelihood of receiving timely treatment for ailments drops, exacerbating the health risks already heightened by displacement.
Psychosocial Impacts
Displacement has profound psychosocial impacts on individuals, particularly the elder populations and children. Experiences of violent conflict and the trauma of displacement intensify feelings of grief, anxiety, and depression among those affected, leading to chronic mental health problems if left untreated.
Outbreaks of Communicable Diseases
In the midst of conflict and displacement, the Amhara region is also grappling with the increased incidence of communicable diseases, contributing significantly to the public health crisis.
Cholera
An outbreak of Cholera has been reported in several displacement camps across the Amhara region. Poor sanitation facilities coupled with unsanitary practices precipitate the spread of this waterborne disease. The limited capacity of healthcare centers in these camps prevents the immediate treatment of those affected, raising the case-fatality rate.
Malaria and Measles
Equally worrisome is the upsurge of Malaria and Measles cases in the region. The large influx of displaced Amhara populations into Malaria-endemic areas exposes them to the risk of infection. Simultaneously, the disruption of vaccination drives due to conflict has led to an increased incidence of measles among children. The combination of displacement, inadequate health facilities, and outbreaks of communicable diseases have created an acute public health crisis in the Amhara region. It requires concerted efforts from the international community to mitigate this crisis and safeguard the health of the Amhara people.
Indirect Public Health Challenges
Malnutrition and Food Insecurity
The availability and accessibility of nutritious food have become a critical issue in Amhara, following the hostilities. The region’s agricultural production, already strained prior to the conflict due to erratic weather patterns and locust invasions, has been heavily disrupted by the war. This has consequently led to a steep rise in food prices, making it even more challenging for families to meet their nutritional needs.
Access to Nutrition
Moreover, the region’s mass displacement has led to crowding in unaffected areas and exacerbating food scarcity in those regions. Children are particularly vulnerable, with thousands at risk of severe acute malnutrition—a condition that can be life-threatening if not treated. Pregnant and lactating women too, who need extra nutrients, are facing extreme difficulties in maintaining a balanced diet, further endangering their health and that of their children.
Community Resilience
Community resilience, previously bolstered by social networks and community-led coping mechanisms, has similarly been eroded due to the scale and intensity of the current conflict. Traditional reciprocal systems, such as sharing resources during times of scarcity, have become increasingly untenable as the crisis persists and resources continue to dwindle.
Water, Sanitation, and Hygiene (WASH) Problems
As the crisis rolls on, the lack of basic services, particularly in the domain of water, sanitation and hygiene, has become a pressing issue for many residents of the Amhara region.
Disruption of WASH Facilities
Many WASH facilities across the region have been damaged or outright destroyed due to the ongoing conflicts, making it difficult for many communities to access clean water. Moreover, the fear of violence often limits the mobility of communities, making it even more challenging to reach functional water sources.
Health Implications
This disruption of WASH services has had far reaching health implications. Lack of access to clean water and proper sanitation facilities often leads to poorer hygiene practices, in turn exacerbating the risk of illness and disease outbreak. Infections such as skin infections and eye infections have been reported, and there is a considerable risk of transmission of water-borne diseases such as typhoid and diarrhoea.
In light of these challenges, generating institutional and collective efforts to address these public health crises is key. The international community needs to step up its support, not just in response to the immediate crisis, but to develop long-term strategies necessary to revive the region’s essential public health services.
Impact on the Health System and Surveillance
The ongoing conflict has dealt a massive blow to the health infrastructure of the Amhara region. Eine deteriorating situation has significantly crippled essential health services, laying bare the inability of the existing health system to withstand the test of such crises.
Collapse of the Health Infrastructure
The health infrastructure in the Amhara region has been hit hard by the conflict, with severe repercussions on the region’s potential to address both direct and indirect public health challenges.
Facility Damage
The severity of the conflict has led to considerable damage and, in some cases, complete destruction of health facilities in the region. Many hospitals, clinics and health posts have either been directly targeted or indirectly affected due to the war. This has grossly reduced the capacity of the region to tackle the escalating health problems arising due to displacement, circulation of communicable diseases and food insecurity. The availability of clean water and hygiene facilities, both essential to combat preventable diseases and maintain public health, are at risk due to the damage inflicted on WASH infrastructure.
Personnel Shortages
As the armed conflict has escalated, the region has suffered a shortage of health personnel as safety concerns have prompted many healthcare providers to abandon their posts. This personnel shortage, coupled with infrastructural damage, has severely impaired the delivery of critical health services. With less availability of health workers, the region is unable to provide necessary immunizations, maternity care, communicable disease treatments and non-emergency health services to the affected population, escalating the public health crisis.
Challenges in Disease Surveillance
Disease surveillance, typically aimed at early detection and containment of disease outbreaks, has encountered significant barriers in the Amhara region due to the conflict. The lack of necessary infrastructure and technological tools has crippled the region’s disease surveillance capabilities, delaying the detection and control of outbreaks such as Cholera, Malaria and Measles. Timely reporting of health information is also being hampered due to the conflict, impairing the region’s response to the unfolding health crisis. Such failures in disease surveillance increase the risk of disease transmission and pose a direct threat to public health, foreshadowing not only an immediate but also protracted public health crisis in the region. Hence, urgent attention and measures are needed from the government and international organizations to restore the surveillance system and support the local health infrastructure to avoid the exacerbation of the health crisis.
Support and Response Efforts
In grappling with overwhelming crises, efforts to support and respond to the aftermath of the armed conflict in the Amhara region of Ethiopia have been apparent, although their effectiveness and impact remain questionable. Such initiatives are mainly divided into those taken by the Ethiopian Government and the international community.
Role of the Ethiopian Government
The Ethiopian Government’s role in response to the conflict in Amhara has been marked with criticism and controversy. On one hand, the government has attempted to address some of the immediate public health crises through relief programs and assistance to displaced populations. Yet, these efforts have been insufficient, sporadic, and fraught with logistical and administrative difficulties. Further, the government has faced significant pushback for both the perceived lack of swift action and for policies that have arguably exacerbated the situation. This includes their sluggishness in guaranteeing safe humanitarian corridors for delivering essential supplies and services.
International Community’s Involvement
The global community, represented by the United Nations (UN), non-governmental organizations (NGOs), and generous countries, has also tried to alleviate some of the challenges stemming from the Amhara conflict. Notably, NGOs have filled some gaps in providing essential healthcare, nutriment, water, and sanitation services. The UN has also escalated its diplomatic efforts, aiming to cease hostilities and enable a robust and unhampered delivery of humanitarian assistance. However, their involvement hasn’t been without hurdles, often because of access restrictions and insecurities persisting in conflict-infected areas. The international response has also been criticized as being reactive, largely focusing on emergency relief rather than addressing the root causes of the crises or preparing for long-term recovery and development.
Recommendations for Future Action
To address the ongoing public health crisis, concerted and sustainable efforts must be pursued. First, it is vital for the Ethiopian government to agree to and facilitate credible peace negotiations to end hostilities. The government should also work more transparently and cooperatively with international partners, particularly in allowing safe access for humanitarian relief.
Second, the international community needs to escalate diplomatic pressure on all warring parties to uphold international human rights and humanitarian law. Continued funding for immediate humanitarian needs is critical, but there should also be strategic investment in long-term recovery and infrastructure development.
Finally, addressing underlying issues, such as systemic inequality, marginalization, and lack of access to resources which often spark and fuel these conflicts, is crucial. Doing so calls for a multifaceted strategy that encompasses diplomatic interventions, inclusive governance, development cooperation, and peacebuilding programs. The crisis in Amhara is not only a critical public health concern; it is also a stark reminder of the interplay between political instability and public health, a lesson that merits global consciousness and action.
