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The impact of war on the health system of the Tigray region in Ethiopia: an assessment
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  • Published on:
    Biased analysis, a dangerous precedent
    • Makeda Semret, MD, FRCP(C); Associate Professor of Medicine McGill University Health Centre
    • Other Contributors:
      • Yakob Seman Ahmed, MPH, IA, MBA - Public health policy fellow,
      • Ephrem Abebe, Assistant Professor, Department of Pharmacy Practice, Health Services, Outcomes, and Policy
      • Mahlet Konjit-Solomon Nigatu, Chief of APCD Public Reporting and Data Release, Maryland Health Care Commission Doctoral Student; Richard M. Fairbanks School o

    Dear Editor

    The article by Gesesew et al (1) presents a highly biased analysis of the impact of war on health systems in the Tigray region of Ethiopia. The analysis rests on a premise that the region of Tigray was “invaded” and provides selective references of “deliberate attacks by allied forces”. We respectfully point out that the characterization of an invasion is not only fundamentally inapplicable to a federal army in a region of its own country but is also wrong on the simple basis of chronology. It is crucial to acknowledge that war started because of the Tigray People’s Liberation Front (TPLF) concerted simultaneous attacks of several Ethiopian Federal Army bases stationed in Tigray on Nov 4, 2020, killing thousands of troops.

    In describing the human toll of the war, the analysis does not distinguish between civilian and military casualties, nor consider the impacts of TPLF guerilla tactics on the civilian population. Egregiously, it does not mention the well-documented massacre of hundreds of Amhara civilians in Mai- Kadra, Tigray (by forces allied with the TPLF) on Nov 9-10, 2020 (2). The analysis mentions “hunger and rape as weapons of war” and “independently confirmed ethnic cleansing” but fails to acknowledge a fundamental contradiction with the outcomes of independent investigations from the United Nation’s Office of High Commissioner for Human Rights (UN-OHCHR) and the Ethiopian Human Rights Commission (EHRC). These entities used internationa...

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    Conflict of Interest:
    Mahlet Konjit reports she is the creator of Ethiopian Health Data (, a non-profit initiative that collates data from the Ministry of Health and the Public Health Institute of Ethiopia to track health indices and policy actions to conduct informed epidemiological analysis.

    Yakob Seman Ahmed reports he is a former director general for medical services at the Ethiopian Federal Ministry of Health and was a member of the Tigray Health Service Restoration Taskforce until June 2021. No other conflicts to report.

    Ephrem Abebe reports that he previously served as a lecturer, department chair, and associate director in the College of Health Sciences, Addis Ababa University, Ethiopia. He has no affiliation to any political party or conflicts to report.

    Makeda Semret reports she is the founder and co-director of the Addis Ababa – McGill Partnership in Infectious Diseases (, an academic collaboration between Addis Ababa University and McGill University’s division of Infectious Diseases. She has received in- kind contributions from the diagnostic company Biomerieux and Ethiopian Airlines for an investigator-initiated project on containing antimicrobial resistance in Ethiopia. She has no affiliation to any political party.