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Pictures by Michele Spatari. Video by Solan Kolli

At the Maiani hospital in Tigray in the far north of Ethiopia, Kiros Girmay, a 60-year-old ex-soldier, looks despairingly at the dirty sheets on his bed.

He is suffering from shortness of breath and wonders how he can get better in such conditions.

“Because of the destruction of the war, we are not receiving good treatment,” he said.

Many hospitals and clinics were targeted during the war between Ethiopian government forces and Tigrayan rebels that raged from November 2020 to November 2022.

Nimrat Kaur, a project coordinator for Doctors Without Borders, says 89 percent of Tigray’s health facilities suffered damage and 99 percent of medical equipment was either looted or broken.

“We were targeted during the war,” said Gebrehiwot Mezgebe, director of the Maiani hospital, pointing to the sheet metal that replaced the roof after it was almost completely destroyed.

Two years after a peace deal that ended the fighting, the hospital in the northern Tigray town of Shiraro remains desperately short of resources.

“We have shortages of medicines, we don’t have enough equipment… and 11 doctors were killed during the conflict,” said Gebrehiwot.

He estimates the hospital, which caters to a population of more than one million, including tens of thousands of displaced people, needs 100 million birr ($820,000) per year.

But the federal government is currently providing just four million birr, said Gebrehiwot.

More funds are unlikely to come, given the dire state of Ethiopia’s finances and overall reconstruction costs in Tigray estimated at more than $20 billion.

In the regional capital Mekele, the Ayder Referral Hospital was one of the few to continue operating through the war, despite the bombing of the city.

On an AFP visit in October, the waiting rooms were crowded, with many patients sitting on the floor, and a long line stretched out from the pharmacy.

“During the conflict, we did not receive our salary for 17 months,” said Amanuel Asafa, who works in the oncology department.

“We had to use expired medication, I survived only because I have a brother in the United States who sent me money,” he added.

“We lost a lot of patients.”

Today, the department, which sees between 15 and 20 patients a day, operates with just two cancer specialists.

“We need at least seven specialists, and we also lack medication,” said Amanuel.

Next to him, Zemeda Teklay, 28, is being treated for bowel cancer. She confirmed there was no medication for her at the hospital and she has had to buy medication sourced from elsewhere at inflated prices.

Meanwhile, more than one million people are still displaced from their homes, according to the UN, mostly from the disputed western Tigray area that is also claimed by the neighbouring Amhara region.

Many are crowded into camps, fuelling the spread of cholera and polio.

Before the war, Tigray’s health system was “one of the strongest in the country”, said Kaur, the MSF coordinator.

With external support, the system is on the mend, but barely a third of facilities have recovered from the damage and looting, Kaur said.

“I would say it’s progressing, but it’s still very fragile.”

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