Analysis: Tigray's Ayder Hospital struggles to deliver essential services as budget cuts bite; staff, patients confront tough choices

By Molla Mitiku @MollaAyenew

Addis Abeba – Berhane Gebremichael, a resident of Mekelle, the capital of the Tigray region, faced a challenging situation this year when his nearly three-year-old daughter, severely injured in an accident, was in critical condition.

In ordinary circumstances, Berhane, who serves as a public relations coordinator at Ayder Referral Hospital, would have relied on the hospital’s resources to provide the necessary care.

However, due to severe shortages of medical supplies, the hospital was forced to prioritize urgent cases, leaving his daughter’s life in a precarious state.

Although she is currently receiving treatment, the hospital was unable to supply the required medication, forcing Berhane to purchase it privately.

In an interview with Addis Standard, Berhane expressed that this situation contradicts the agreement he had with the hospital upon joining.

According to him, his daughter should be eligible for free medication as part of his employee benefits package.

“I am a staff member of the hospital, and my daughter should receive medicines free of charge,” he emphasized. “But due to the severe shortages at the hospital, I spent about 3,000 birr to buy medicine from my own pocket.”

Berhane is not the only Ayder Hospital staff member facing this predicament.

Desta Gebrehiwot, another hospital employee working as a medical receptionist, is struggling to provide medical care for his wife, who works at Mekelle University.

Both Desta and his wife were previously entitled to receive free medical treatment at the hospital due to their employment status. However, the ongoing crisis has rendered this impossible.

“The hospital is currently unable to provide either food or medicine,” Desta explained. “Despite being eligible for free treatment, the financial constraints and the hospital’s inability to fulfill its obligations have forced me to spend over 30,000 birr on medication in just two weeks.”

With a monthly salary of 2,700 birr, Desta noted it is nearly impossible to afford even his family’s basic needs, let alone medical expenses.

“Thankfully, I have been able to rely on the support of relatives and neighbors to navigate this challenging period,” he stated.

Hope fades

The situation for ordinary patients admitted to the hospital is equally, if not more, dire.

Hailay Alene, a local clergyman, was once a vibrant figure in his community; now, he is but a shadow of his former self.

The hospital is currently unable to provide either medicine or food.”

Desta Gebrehiwot, a medical receptionist at Ayder

His once-strong body has weakened, and the hope in his eyes has been replaced with worry. Battling chronic cancer has drained both his health and finances, making him reliant on the healthcare system.

“Each day is a constant battle,” Hailay shared with Addis Standard. “The shortage of medications, the soaring cost of living, and the fear of not having enough to eat weigh heavily on my mind.”

Hailay, who has been struggling to access essential care, emphasized that he has no one to support him, making the challenges he faces even more unbearable.

“I receive no food and cannot afford hospital medications,” the clergy stated. “The pharmacy is always out of stock, forcing me to buy medicines in the city at much higher prices.”

The stories of Hailay, Desta, and Berhane are not isolated cases.

Countless others are facing similar hardships at the hospital, forced to make impossible choices between their health and financial stability.

Established in 2008, Ayder is one of the largest hospitals in the Tigray region. Located in Mekelle, the hospital operates under the auspices of Mekelle University as part of its health sciences and medical training initiatives.

However, Ayder is presently unable to provide essential services to patients due to a severe financial crisis exacerbated by the ongoing humanitarian challenges in the region.

The hospital, which has been providing medical care to 300,000 patients each month, now confronts a critical shortage of food, medical supplies, and operational funding.

Administrators at Ayder underscore that the healthcare crisis has cast a dark shadow over the entire community.

In an interview with Addis Standard, Dr. Haileselassie Berhe, Chief Administrative and Business Development Director at Ayder, has issued a stark warning about the facility’s deteriorating state.

“The hospital’s urgent need for assistance cannot be overstated,” the director emphasized, drawing attention to the critical situation faced by its patients. “The 600-bed facility has been unable to provide adequate care to patients, many of whom are suffering from malnutrition.”

According to Dr. Haileselassie, the hospital’s financial crisis stems directly from government budget cuts that have drastically limited its operational funds, restricting its ability to procure essential supplies and sustain basic services, thus compromising patient care.

He highlighted that patients, especially those suffering from malnutrition, are not receiving adequate care due to the severe lack of food and vital medical supplies.

“Following the Pretoria peace agreement, the government significantly reduced the hospital’s budget, cutting capital expenditures by 50% and recurrent spending by 40% compared to pre-war allocations,” Dr. Haileselassie explained. “This drastic reduction in funding has severely hindered the hospital’s normal operations.”

Despite a government mandate for public hospitals in Ethiopia to provide three daily meals, the director says Ayder Hospital is currently struggling to serve even one meal per day to its patients.

He attributed this shortfall to the budget cuts, which have critically impaired the hospital’s capacity to meet even its most basic obligations to patients.

Teka Gebreegziher, a nurse at Ayder Hospital, described to Addis Standard the severe difficulties patients face due to a critical shortage of medicine and food.

Prior to the war, the hospital provided patients with meals and offered free medication to those in need, according to the nurse. “Additionally, it sold medicines at affordable prices to patients who covered their treatment costs.”

Unfortunately, these services are no longer available to patients.

“All patients, regardless of their treatment status or condition, must now purchase both medicine and food outside the hospital,” Teka explained. “As nurses, it is heartbreaking to witness patients taking medication without proper nutrition.”

Breaking point

Ayder Referral Hospital is not the only health facility in Tigray confronting shortages of medicine, food, and operational funding following the devastating two-year war in the region.

Citing a report published by the World Health Organization (WHO) in October 2023, Addis Standard reported the devastating impact of the war, which ended in November 2022, on healthcare facilities and medical resources in the Tigray region.

According to the report, a staggering 86% of the 853 health service delivery units in Tigray have suffered varying degrees of structural damage, while 71% of medical equipment remains partially nonfunctional.

Additionally, 28 health facilities in Tigray have been completely destroyed, and the equipment in another 232 facilities is entirely unusable.

Furthermore, the report indicates that 92% of the total 825 health facilities in Tigray remain partially functional, primarily due to shortages of medical supplies, equipment, and funding. In contrast, residents have full access to only three percent of the medical facilities in the region, while the majority—97%—have only partial accessibility.

It also emphasizes that the primary causes of damage to buildings and medical equipment were conflict and looting. Specialized, referral, and general hospitals were the main targets of these incidents.

Notably, Ayder Comprehensive Specialized Hospital, the only specialized hospital in the region, along with 12 other general hospitals, sustained significant damage.

Healthcare in peril

Dr. Haileselassie emphasized that the humanitarian crisis in Tigray has significantly worsened the challenges faced by Ayder Hospital as the facility struggles to manage the influx of displaced individuals requiring urgent medical assistance at no cost.

“The humanitarian crisis in Tigray has had a devastating impact on the hospital,” the director noted. “With many people displaced and in need of urgent, free medical assistance, Ayder Referral Hospital has struggled to meet the overwhelming demand.”

Teka, the nurse, added that one of the major setbacks is the shortage of fuel, which is essential for ambulances, backup generators, and employee services. “The shortage has led to disruptions in patient care, including tragic deaths during surgeries due to power outages.”

The humanitarian crisis in Tigray has had a devastating impact on the hospital.”

Dr. Haileselassie Berhe, Chief Administrative and Business Development Director at Ayder

According to Dr. Haileselassie, Ayder previously received a budget of 40 million birr to cover fuel costs before the onset of the war. “However, this has been reduced to 18.9 million birr currently.”

He elaborated on the overall impact of the fuel shortage on the hospital’s operations.

“All ambulances are currently out of service due to the lack of fuel,” he explained. “Several patients have tragically died during surgeries due to unexpected power outages and insufficient backup generators.”

According to the director, the hospital provided surgeries for 8,000 patients and maternal treatments for 6,000 mothers during the last fiscal year, necessitating intensive care and resources.

“However, the budget reduction, reportedly linked to efforts to push the university towards autonomy, is causing significant challenges for the hospital,” he noted.

Dr. Haileselassie emphasized that although the hospital is affiliated with the university, it should be treated differently from other hospitals due to its recent establishment.

“Many of our machines have been in operation for nearly three years and require maintenance, repairs, and replacements to ensure proper functioning,” he explained. “While machines like the City-Scan are operational, there are still a number of significant unrepaired machines in the hospital.”

The hospital administrator also revealed that due to financial constraints and 17 months of delayed salaries following the Pretoria Peace Agreement, Ayder has faced a substantial shortage of medical practitioners.

“Hundreds of medical specialists have departed for other regions of Ethiopia, Somalia, Sudan, and other African countries, resulting in a high turnover rate of 250 to 300 specialists,” he emphasized. AS