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Gesesew H, Berhane K, Siraj ES, et al. The impact of war on the health system of the Tigray region in Ethiopia: an assessment. BMJ Global Health 2021;6: e007328. doi:10.1136/bmjgh-2021-007328
This article has been corrected since it was published online to reflect corrections in the main text.
The corrections reflect the authors’ decision to rethink statements that could be interpreted wrongly. We have modified expressions such as ‘invade’ or ‘ethnic cleansing’ in the document recognising their controvertial nature. We corrected inadvertent numerical and citation errors throughout the paper.
In the ABSTRACT, we removed the sentence ‘A conservative estimate places the number of girls and women raped in the first 5 months of the war to be 10 000.’ It was moved to the body of the paper where it is better placed and was better contextualised. In addition, the statement ‘The use of hunger and rape as a weapon of war and the targeting of healthcare facilities are key components of the war’ in the abstract was replaced with ‘The widespread use of hunger and rape during the brutal war and the targeting of healthcare facilities seem to be key components of the war.’
In paragraph 1 of the section titled INTRODUCTION, we revised the first sentence from ‘Tigray is one of the nine regional states of Ethiopia, with a population of six million’ to ‘Tigray is one of the ten regional states of Ethiopia, with a projected population of 7.3 million in 2022 based on the 2007 Ethiopian housing and population census.1’ This was done for the purpose of accuracy.
In paragraph 4 of the section titled ATTACKS ON HEALTHCARE FACILITIES AND ATTRITION OF HEALTH WORKERS, the sentence ‘Out of the assessed 40 hospitals, 21 were non-functional, 12 were partially functional although with severe limitations and the status of the remaining seven was unknown as they were still under the occupation of the Amhara forces and militia.’ was replaced with: ‘Out of the 40 hospitals in Tigray, 14 were non- functional, nine were partially functional although with severe limitations, and 11 were fully functional but the status of the remaining six was unknown11 as they were under the occupation of the Amhara forces and the Eritrean forces10.’ In the same paragraph, the sentence ‘A total of 238 (90%) of the 269 ambulances which have been serving before the onset of the war were either destroyed or looted.’ was also replaced with: ‘The whereabout of 90% of the 280 ambulances which have been serving before the onset of the war was unknown11.’ Figure 1, which depicts some of the numbers that were changed in this paragraph was revised accordingly.
In paragraph 5 of the section titled ATTACKS ON HEALTHCARE FACILITIES AND ATTRITION OF HEALTH WORKERS, the phrase ‘excluding the two referral hospitals in Ayder (Mekelle) and Axum which are administered by the federal government’ was missed from the first sentence of the paragraph in the published version of the paper. The sentence now reads: ‘Before the war, excluding the two referral hospitals in Ayder (Mekelle) and Axum which are administered by the federal government, there were a total of 19 324 health workers including specialist physicians (69), general practitioner physicians (411), nurses (4,402), midwives (1,394), pharmacists (296), laboratory specialists (494), health officers (935), public health specialists (43), HEWs (1,918), supportive staffs (5,344), and others (4,018)8.’
In paragraph one under the section titled GENDER-BASED SEXUAL VIOLENCE AND RAPE, we added the following statement: ‘A political figure in United Kingdom, during a debate in the United Kingdom Parliament on Tigray war on 25 March 2021 stated that an estimated 10 000 girls and women were raped in the first 5 months of the war.20’ A version of this sentence was originally included in the abstract, but missed out in the body of the paper where it is better placed and contextualised.
1. World Population Review. Ethiopia Population 2021: World Population Review; 2021 [cited 2022 1 Feb]. Available from: https://worldpopulationreview.com/countries/ethiopia-population accessed 1 Feb 2022. 8. TRHB. Tigray Regional Health Bureau II Ten Years Health Bulletin (EFY 1998-2007 or 2006/7-2014/5). Mekele, Tigray, Ethiopia: Tigray Regional Health Bureau (TRHB), 2016. 10. TRHB. Tigray Reginonal Health Buruea (interim government): Health care crisis in a war ravaged Tigray Unpublished, 2021. 11. Reuters. UPDATE 2-'People die at home': Tigray medical services struggle after turmoil of war 2021 [Available from: https://www.reuters.com/article/ethiopia-conflict-health-idUSL1N2KE11S 20. Helen H. 2021 Speech on the Tigray Region of Ethiopia London, United Kingdom2021 [cited 2021 4 April]. Available from: https://www.ukpol.co.uk/helen-hayes-2021-speech-on-the-tigray-region-of-ethiopia/ accessed 4 April 2021.
a The order of the reference is presented as it appears in the revised main document
Given the contentious nature of war and conflict, this paper received much attention, including some concerns related to its appropriateness, accuracy, and ethics. We wish to state that the paper went through the editorial and peer review processes of BMJ Global Health as would any submission of this nature to the journal. It was assessed to be worthy of publication, based on its scientific merits and for humanitarian reasons. BMJ Global Health welcomes post-publication peer review. This paper has benefited from such review with the attention it has received, including in the form of further scrutiny of its numbers, citations, arguments, and presentation. The authors have welcomed this review, responded accordingly and made changes where necessary. It is however important to note that the changes made post-publication did not alter the core analysis or the core message of the paper.