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Bridging Menstrual Health and Social Progress: Overcoming Challenges for a Brighter Future
In the heart of Tigray, Ethiopia, where healthcare challenges are deeply rooted in historical conflicts and systemic barriers, the HEAL Initiative for Health (HIH)stands as a Story of resilience and transformation. Founded in response to the war-induced healthcare crisis, HEAL Initiative emerged as a structured organization in 2023 with admission to bridge healthcare gaps for the vulnerable and underserved. Through a multi-faceted approach, HEAL initiative integrates public health advocacy initiative to create sustainable and equitable healthcare solutions. Public health advocacy initiative is the designed to engage stakeholders and policymakers through evidence-based insights. This program doesn’t just amplify healthcare concerns; it mobilizes resources, fosters collaboration, and translates complex data into actionable change. Among the initiatives born out of this advocacy is the MY REACH initiative, which prioritizes maternal, youth, reproductive, and child health. By focusing on equitable healthcare access, MY REACH integrates preventive, curative, and educational interventions to reduce preventable mortality and empower communities with sustainable health solutions. As part of its ongoing commitment to public health, HEAL Initiative hosted a groundbreaking webinar titled “Period: To Pride or to Hide? Advancing Gender-Inclusive Solutions in Health and Society” on February 25, 2025. This discussion brought together experts and advocates to explore the multidimensional challenges of menstrual hygiene management (MHM) and gender-inclusive healthcare solutions.
Moderated by Selamawit Gidey, a researcher and women’s rights advocate, the webinar featured two distinguished panelists who brought invaluable insights to the conversation:
Balem Demtsu – An assistant professor and expert in Mental Health and Psychosocial Support (MHPSS), Gender-Based Violence (GBV), and Protection from Sexual Exploitation and Abuse (PSEA). With extensive research and academic contributions, Balem has trained numerous students and published over 20 research articles focused on reproductive health and gender issues. Her presentation centered on First Menstrual Experience and the Multidimensional Challenges that girls face globally.
Fayza Shemsu Kedir – A material engineer, researcher, and entrepreneur dedicated to gender-inclusive innovations in health and sustainability. With a background in materials science and over seven years of experience at Jimma University, Fayza has pioneered research on self-healing construction materials and sustainable menstrual hygiene products. As the founder of Bina Products, she developed eco-friendly sanitary pads using agro-waste from the Enset plant. Her presentation focused on Advancing Gender-Inclusive Solutions in Health and Society by exploring sustainable menstrual product innovations.
The discussions delved into the hidden struggles of menstruating individuals, the policy gaps in menstrual hygiene management, and the potential for sustainable, locally-produced sanitary solutions. The webinar served as a platform to challenge taboos, foster inclusive conversations, and advocate for gender-sensitive policies in health and society.
First Menstrual Experience and the Multidimensional Challenges – Insights from Balem Demtsu
Balem Demtsu’s presentation provided an in-depth exploration of the psychological, social, and infrastructural challenges faced by menstruating individuals, particularly adolescent girls. She began by contextualizing menstruation as a biological process that remains shrouded in stigma and misinformation, especially in many developing communities. She highlighted that while menstruation is a natural part of life for nearly half the global population, it continues to be met with silence, embarrassment, and systemic neglect.
A significant portion of her presentation focused on the psychosocial impact of menstruation on young girls, particularly their first menstrual experience. Many girls encounter their first period without prior knowledge or preparedness, leading to confusion and fear. In some cultures, menstruation is wrongly associated with impurity, maturity, or readiness for marriage, exposing young girls to harmful societal pressures, including child marriage and gender-based discrimination.
Balem also shed light on access to menstrual hygiene products and facilities as a major barrier. She presented data showing that many girls in Ethiopia and other low-resource settings lack adequate sanitary products and private, safe facilities to manage menstruation in schools. This contributes to absenteeism, with many girls missing school due to fear of leaks, lack of sanitary materials, or inadequate toilets with no privacy.
Another key challenge addressed was the negative cultural perceptions and myths surrounding menstruation. She explained how societal taboos prevent open discussions, leading to misinformation that exacerbates stigma and discrimination. In some communities, menstruating girls are forbidden from engaging in daily activities, attending religious ceremonies, or preparing food, reinforcing the notion that menstruation is something shameful.
From a policy perspective, Balem emphasized that while menstrual hygiene management (MHM) policies exist in some regions, implementation remains weak. There is a lack of accountability, inadequate budget allocations, and minimal integration of menstrual health into broader public health and education frameworks. She called for a multi-sectoral approach that includes government agencies, schools, healthcare providers, and community leaders to ensure menstrual equity.
To conclude her presentation, Balem urged for comprehensive menstrual health education that involves not only girls but also boys, teachers, and parents. Breaking the silence on menstruation through public awareness campaigns and school-based initiatives, she argued, is crucial to fostering a supportive and informed society where menstruation is no longer a source of shame but a natural and respected aspect of health.
Advancing Gender-Inclusive Solutions in Health and Society – Insights from Fayza Shemsu Kediru
Fayza Shemsu Kedir’s presentation shifted the discussion toward practical, gender-inclusive innovations in menstrual hygiene management. She introduced her pioneering work in developing sustainable menstrual hygiene products, particularly through the use of Enset plant fibers. She explained how her background in material science and engineering led her to explore biodegradable, affordable alternatives to traditional sanitary products, addressing both economic and environmental challenges.
Fayza emphasized that commercially available sanitary pads are predominantly made of synthetic, non-biodegradable materials, contributing to pollution and creating financial burdens for low-income menstruators. In contrast, her eco-friendly pads are designed to be both sustainable and accessible, using locally sourced, renewable materials. She highlighted the antibacterial and odor-absorbing properties of Enset fiber, which make it an effective alternative to conventional pads.
One of the key challenges she discussed was the cultural resistance to reusable menstrual products. Despite their affordability and sustainability, many women and girls are hesitant to use reusable pads due to misinformation and societal norms. She stressed the need for community education and advocacy to normalize sustainable menstrual products and break the stigma around menstruation.
Fayza also outlined the economic potential of local menstrual product manufacturing. By supporting women-led enterprises and small-scale production facilities, communities can create employment opportunities while ensuring the availability of affordable, high-quality menstrual hygiene products.
To conclude, she called for policy reforms and tax exemptions on menstrual products to make them more accessible. She also encouraged collaborations between researchers, policymakers, and social enterprises to drive innovation and scale up sustainable menstrual solutions across Ethiopia and beyond.
Key Takeaways from the Discussion and Audience Engagement
During the Q&A session, participants raised several critical points and inquiries about menstrual health Dr,Mussie Alemayehu(PhD)researcher and academician at Mekelle university highlighted the challenge of purchasing power in post-conflict areas, asking how women in these situations can safely manage their periods without financial strain .challenges and solutions.
Balem acknowledged the severity of the issue, particularly in displacement settings where menstrual hygiene is often deprioritized. She explained, “In post-conflict settings, menstrual hygiene products become secondary to food and shelter, making access even more difficult.” She suggested that dignity kits—which include reusable pads and essential hygiene items—should be a standard relief item in humanitarian aid efforts. Additionally, encouraging local entrepreneurs to manufacture and distribute low-cost menstrual products would improve affordability and accessibility
Menstrual Health as a Human Rights Issue
One participant, Kidisan, applauded the WHO’s recognition of menstrual health as a human rights issue and asked if there had been follow-up actions by international organizations to enforce this recognition. Balem responded, “While organizations like UN Women and the WHO have made progress in advocacy, there is still a long way to go in ensuring menstrual health policies are implemented effectively.” She called for greater accountability and monitoring mechanisms to track progress on menstrual equity policies globally.
The Role of Men in Addressing Menstrual Stigma
another participant ,Mebrahtu Kalayu pointed out that menstrual stigma is often reinforced by men, particularly in school environments. He stated, “Many boys do not understand menstruation, leading to teasing and discrimination that causes female students to miss school.” Balem agreed, stressing the importance of male involvement in menstrual education. “We must normalize conversations about menstruation in schools, workplaces, and households so that boys grow up understanding and respecting this natural process,” she said.
Expanding Menstrual Awareness to Mothers and the Wider Community a participant shared her personal experience, emphasizing the lack of menstrual management knowledge among mothers. She explained, “My mother was supportive when I got my first period, but she had no idea how to manage it properly or which products were best.” She suggested expanding menstrual education beyond schools to include community-wide awareness programs targeting parents, particularly mothers and fathers.
Policy Recommendations and Taxation
a Menstrual health advocate ,entrepreneur and CNN hero award winner ,Freweini Mebrahtu,drawing from her 15-year experience in menstrual hygiene advocacy, urged policymakers to focus on infrastructure development in schools, including access to clean water, private toilets, and disposal facilities. and Dr.tsega a public health advocate, emphasized the urgent need for tax exemptions on menstrual products. She stated, “Menstrual pads are a basic necessity, just like food and water. Taxing them places an unnecessary burden on women.” She called for policy changes that eliminate VAT and import taxes on menstrual hygiene products to improve affordability.
As the discussion concluded, the moderator, Selamawit Gidey, highlighted the key takeaways like need for policy reforms, including tax reductions and budget allocations for menstrual products, the importance of community education that involves parents, teachers, and male counter parts. Encouraging local entrepreneurs to produce sustainable menstrual products was identified as a key strategy to improve affordability and accessibility. She closed the session by stating, “This discussion has shown us that menstrual hygiene is not just a women’s issue—it is a societal issue that requires collective action.”
Rebuilding Health Systems in Tigray: Resilience, Trust, and Community Ownership in Post-Conflict Recovery
In the wake of devastating conflict, rebuilding a region’s health system requires more than just reconstructing hospitals and clinics—it demands a strategic, evidence-based approach that ensures long-term resilience. This was the focus of the Feb2,2025 webinar, “Strengthening Health Systems in Fragile Contexts: Insights and Strategies for Post-Conflict Recovery and Resilience in Tigray, Ethiopia,” hosted by the HEAL Initiative for Health.
Moderated by Dr. Tsega Tewele, a primary care physician and public health advocate, the discussion brought together experts to explore strategies for restoring healthcare in Tigray. Dr.Azeb Gebresilassie Tesema, a global health lecturer at the University of New South Wales and an award-winning researcher, presented “Rebuilding Health Systems in Fragile and Conflict-Affected Settings: Lessons for Tigray’s Post-War Recovery.” Drawing on global evidence, she highlighted key challenges and opportunities for reconstructing healthcare in conflict-affected regions.
Mr. Mengistu Hagazi Tequare, a health systems expert with extensive experience in healthcare quality management and resilience planning, followed with his presentation, “Understanding Health System Resilience to Inform Recovery Planning in Ethiopia’s Tigray Region.” Sharing preliminary findings from his research, he examined how resilience capacities have shaped the region’s ability to absorb, adapt, and transform in the aftermath of war.
At the heart of this discussion was the HEAL Initiative for Health, an organization born out of
the urgent need for healthcare access during the crisis in Tigray. As Dr. Tsega introduced, HEAL has since evolved into a public health advocacy program dedicated to rebuilding and strengthening health systems through evidence-based interventions, policy engagement, and capacity building. This webinar marked yet another step in HEAL’s ongoing commitment to ensuring equitable, sustainable healthcare solutions for conflict-affected communities.
Through the perspectives of these experts, this blog will delve into the key insights from the webinar, examining the challenges, strategies, and lessons that can guide the reconstruction of Tigray’s health system in the years ahead.
Rebuilding Health Systems in Fragile Contexts: Insights from Dr. Azeb Gebresilassie Tesema
As the discussion commenced, Dr. Azeb Gebresilassie Tesema took the virtual stage, expressing her gratitude for the opportunity to share insights on rebuilding health systems in fragile and conflict-affected settings. She acknowledged the firsthand experiences of many participants in witnessing the devastation of war on healthcare, emphasizing the need for an evidence-based dialogue centered on lessons learned from global recovery efforts and their application to Tigray.
Dr. Azeb began her presentation by providing a broad overview of the impact of conflicts on health systems worldwide. She cited alarming statistics, highlighting that 25% of the global population currently lives in conflict, displacement, or violence-affected settings. According to the Global Peace Index, 97 countries have experienced a decline in peacefulness, while the Conflict Index estimates that one in eight people worldwide has been exposed to war or armed conflict. Ethiopia, and specifically Tigray, ranks among the most severely affected regions. The consequences of war on health systems are profound and multifaceted. Beyond the immediate destruction of infrastructure, conflicts disrupt governance and coordination mechanisms, weaken health services, and displace healthcare workers. These disruptions translate into severe declines in healthcare delivery, increased disease burdens, and a critical shortage of medical supplies and personnel. The war in Tigray, in particular, has led to an unprecedented collapse of health services, exacerbating existing vulnerabilities and making health system recovery an urgent priority.
Drawing from global recovery models, Dr. Azeb outlined key priorities for rebuilding Tigray’s health system, emphasizing that rebuilding is not merely about restoring services but about creating a more resilient, sustainable, and community-driven system. She highlighted theimportance of coordinating actors and resources, aligning efforts among national authorities, international donors, and local health institutions to prevent fragmentation and duplication of efforts. Establishing strong governance mechanisms ensures the efficient allocation of resources and coordinated service delivery while strengthening partnerships between
government, NGOs, and private health actors fosters long-term integration and effectiveness.
Balancing external influence and local ownership emerged as another critical theme. While international aid is crucial, dependency on external actors can create power imbalances and weaken local decision-making. Sustainable rebuilding requires that donors strengthen and work through local health institutions, rather than operating in silos. Community engagement plays vital role in ensuring that rebuilding efforts reflect local health needs and cultural contexts. Transparent and accountable governance is also paramount. Ensuring that health system governance is transparent and responsive to community needs is essential, as is advocating for policies that integrate local networks and power structures in rebuilding efforts. Establishing mechanisms for accountability and oversight ensures that resources are used efficiently and equitably.
One of the most pressing challenges, Dr. Azeb noted, is healthcare financing. Financial dependency on international donors can create vulnerabilities, especially in times of global
economic shifts. She stressed the need for innovative resource mobilization strategies, including diversifying funding sources by combining government allocations, donor funding, and community-based financing mechanisms. Research-driven investment strategies are crucial for securing long-term, sustainable funding, while reducing out-of-pocket healthcare expenses enhances accessibility and equity. Designing health financing policies that prioritize essential health services and reduce financial barriers to care is imperative. Dr. Azeb emphasized that funding mechanisms should not only be sustainable but should also ensure financial autonomy for local health systems, reducing reliance on unpredictable external aid.
In post-conflict settings, rebuilding essential health services requires a shift in care models. Dr. Azeb highlighted the urgent need for trauma care and disease burden management in Tigray, given the high incidence of war-related injuries, mental health disorders, and infectious diseases. Redesigning primary healthcare services with a focus on community-based
interventions and health extension programs is crucial. Strengthening maternal and child health services, which have been particularly impacted by the crisis, ensures continuity of care for vulnerable populations. Expanding mental health and psychosocial support services is essential to address the trauma experienced by both healthcare workers and the general population.
A health system cannot function without its workforce. Dr. Azeb underscored the critical need to retain and support healthcare workers, who have faced immense challenges throughout the conflict. Providing financial and non-financial incentives for healthcare workers, particularly in remote or underserved areas, is necessary to prevent mass attrition. Ensuring psychosocial support for frontline workers is also vital, as many have endured war-related trauma and burnout. Developing a harmonized incentive structure helps prevent disparities and workforce demotivation. Investing in training and re-skilling programs ensures that healthcare workers are
equipped to meet the evolving healthcare needs of post-war Tigray.
Closing her presentation, Dr. Azeb introduced the WHO’s Humanitarian-Development-Peace (HDP) Nexus, a framework aimed at integrating emergency response, development strategies, and peacebuilding in fragile settings. She explained that this model offers a context-specific approach that enhances coordination, accountability, and long-term sustainability in conflict-affected regions. The HDP Nexus emphasizes strengthening institutional capacities to integrate emergency relief with long-term health system development, fostering partnerships between humanitarian organizations, government agencies, and local communities to align rebuilding efforts with national priorities, and embedding peacebuilding efforts within health system recovery to promote stability and social cohesion.With these insights laid out, the discussion transitioned to Mr. Mengistu Hagazi, who would delve into the practical realities of health system resilience in Tigray.
Understanding Health System Resilience: Insights from Mr. Mengistu Hagazi
Following Dr. Azeb’s presentation, Mr. Mengistu Hagazi took the floor, expressing his gratitude for the opportunity to present his research on health system resilience in Ethiopia’s Tigray region. He acknowledged the difficulty of speaking after such a comprehensive discussion but emphasized the importance of examining resilience from a localized, data-driven perspective. Mengistu’s study, funded by the UK government, focuses on preliminary findings that analyze how Tigray’s health system has adapted and responded to conflict-related shocks. His research, recently published in the East African Journal of Health Sciences, aims to identify resilience capacities, assess their effectiveness, and provide a roadmap for long-term recovery planning. He highlighted that resilience in health systems is not merely about surviving crises but about the ability to absorb, adapt, and transform in response to shocks.
Providing context to his study, Mr. Mengistu detailed the historical vulnerabilities of Tigray’s health system. The region, while rich in cultural and historical heritage, has long faced chronic stressors such as recurrent droughts, locust infestations, and resource scarcity. These environmental and economic challenges, coupled with the devastation of multiple conflicts— including the recent war starting in 2020—have significantly strained the health system. Prior to the conflict, life expectancy in Tigray had risen from 45 to 65 years, demonstrating significant progress in public health indicators. However, these gains were severely reversed as a result of the war.
To assess resilience, Mr. Mengistu’s research utilizes a longitudinal mixed-methods approach, analyzing key health system components across three distinct periods: before the war, during the war, and after the Pretoria peace agreement. His study maps resilience nodes and pathways, examining how structural weaknesses and strengths influenced the region’s ability to recover.
Mr. Mengistu detailed the devastation of health infrastructure, noting that before the war, Tigray had a well-connected network of two tertiary hospitals, 14 secondary hospitals, 24 primary hospitals, 224 health centers, and 741 health posts, supported by 340 ambulances. However, within just three months of the war, 80% of these facilities were either partially or fully destroyed. The war also resulted in the blockade of medical supplies, cutting off essential medicines and leading to a public health crisis. Even 11 months after the Pretoria Agreement, 86% of the region’s health facilities remained in a damaged state due to ongoing instability, lack of resources, and a slow recovery process.
Discussing the role of humanitarian actors, Mr. Mengistu highlighted their crucial role in sustaining healthcare delivery in Tigray, particularly in areas under siege where government health services were non-functional. Organizations such as WHO, UNICEF, and other NGOs played a vital role in providing emergency aid, supporting mobile health teams, and restoring some level of healthcare access to displaced populations. However, he cautioned that humanitarian aid, while critical, is not a substitute for a functioning, government-led health system, emphasizing the importance of long-term recovery strategies.
In terms of health workforce resilience, Mr. Mengistu painted a sobering picture. Before the war, Tigray had a growing healthcare workforce. However, the war resulted in mass displacement of healthcare workers, burnout, and severe mental health challenges. An estimated 78% of healthcare workers expressed a desire to leave Tigray, with 7.7% having already left by 2023. The war also exposed healthcare workers to direct violence, economic hardship, and psychological trauma, necessitating urgent interventions to restore morale and rebuild human resource capacity.
Mr. Mengistu also discussed the role of the private sector, which saw an unexpected expansion during the crisis. The number of private health facilities increased by 37%, with pharmacies, clinics, and specialty centers filling gaps left by the decimated public health system. However, he cautioned that accessibility and affordability remain major challenges, as many in Tigray cannot afford private healthcare, raising concerns about equity in healthcare access. Closing his presentation, Mr. Mengistu stressed the need for a structured, evidence-based approach to health system resilience. He outlined key strategies for moving forward, including strengthening governance structures, ensuring sustainable health financing, expanding primary healthcare, and rebuilding human resource capacity. He emphasized that resilience should not be seen as merely surviving a crisis but as an opportunity to rebuild stronger, more adaptive health systems that can withstand future shocks.
With these insights, Mr. Mengistu concluded his discussion, opening the floor for further dialogue on how best to implement recovery strategies that ensure sustainable and equitable healthcare in Tigray.
As the discussion drew to a close, the engagement of the participants grew more profound, reflecting the urgency and significance of the issues raised. Dr. Tsega, moderating the session, encouraged further contributions from the audience, inviting experts like Dr. Tesfay, Dr. Mussie, and Professor Afework to share their insights. Their input emphasized the challenges and potential solutions in establishing a resilient health system in a conflict-affected region like Tigray.
Questions, Insights, and Expert Responses on Rebuilding Tigray’s Health System
A public health researcher & academician participant from Mekelle university from opened the floor with a critical question: “How do we create a resilient health system when we continue to face cycles of drought, famine, and war?” He further questioned the feasibility of implementing the six WHO building blocks without sufficient political commitment. This led to a compelling response from Mr. Mengistu, who stressed that resilience is a necessity, not a luxury, particularly for resource-limited settings. “Being poor itself demands daily resilience,” he remarked, emphasizing that health systems in such contexts must be creative in providing essential services despite resource constraints.
Dr. Azeb expanded on this notion, highlighting that grassroots-level interventions are vital. She advocated for strengthening primary healthcare, investing in community-based services, and providing capacity-building programs. “A resilient health system does not only require infrastructure but also a strong and well-supported health workforce,” she noted, reinforcing the importance of psychosocial support and incentives for healthcare workers who have endured trauma and displacement. Additionally, Dr. Azeb emphasized that trust is the foundation of effective community ownership. “The community must trust the system and be willing to work with us. Without trust, engagement remains superficial, and resilience remains elusive,” she asserted.
The conversation took a deeper turn when a Professor from Mekelle university challenged the very use of the term ‘resilience.’ He questioned whether resilience accurately described a system that required complete rebuilding. “When a health post is entirely destroyed, does it need resilience or reconstruction?” he asked. Mr. Mengistu responded by clarifying that resilience involves not just rebuilding but also learning from past shocks and preparing for future ones. “It is not just about restoring what was lost but about building a stronger, more adaptive system,” he explained. Other researcher & academician participant from Addis Ababa university, contributing from the message box, argued that true resilience is rooted in community ownership rather than mere engagement. He stressed that shifting ownership from the government to the community is the most sustainable approach to ensuring resilience. “If the community is the true owner of the health system, it can withstand political fluctuations and crises,” he asserted. This sentiment was echoed
by other participants, reinforcing Dr. Azeb’s earlier point on trust.
One of the final questions posed in the chat box challenged the focus on resilience, suggesting that a more comprehensive transformation of the health system was needed. Mr. Mengistu acknowledged that resilience includes three key strategies: adaptation, adoption, and transformation. He agreed that transformation is the ultimate goal, where a new, robust system emerges from past challenges.
As the session concluded, Dr. Tsega summarized the key takeaways, reaffirming the significance of resilience, trust, and community ownership. “Rebuilding the health system in Tigray is not just about infrastructure but about fostering trust and ensuring that the community takes an active role in its own healthcare,” Dr. Azeb emphasized.
The webinar closed with expressions of gratitude to the panelists and participants. Dr. Azeb and Mr. Mengistu were acknowledged for their valuable insights, and the attendees were encouraged to continue advocating for a stronger, community-owned health system. “This discussion is only the beginning,” Dr. Tsega concluded, “and together, we must ensure a resilient, transformed healthcare system that truly serves the people of Tigray.”
Starvation: The Leading Cause of Death in Tigray After the Peace Agreement
In a groundbreaking study conducted by Mekonnen Haileselassie and his team from the Tigray Health Research Institute, Tigray Regional Health Bureau, and Mekelle University, the dire reality of hunger and starvation in post-conflict Tigray, Ethiopia, has come to light. The research, recently published in BMC Public Health, reveals an alarming death toll linked to starvation, despite the Pretoria peace agreement of November 2022, which was expected to herald stability and recovery.
The study, carried out from November 2022 to August 2023, investigated hunger-related deaths in nine districts and 53 internally displaced persons (IDP) sites across Tigray. Using WHO-adapted verbal autopsy tools, the researchers verified that starvation was the leading cause of death, accounting for 49.3% of fatalities. Vulnerable groups, including children under five and women, were disproportionately affected, with children facing a 1.7 times higher risk of death due to starvation. Disturbingly, over 60% of households in the region were found to suffer from moderate to severe hunger, a situation that forced many to rely on “famine foods” such as roots and leaves or to sell their essential belongings to survive.
This stark reality underscores the devastating interplay between conflict and hunger. The war in Tigray destroyed agricultural livelihoods, displaced millions, and disrupted food supplies, creating conditions that made hunger inescapable for many. While the Pretoria peace agreement marked an official end to hostilities, the study revealed that aid delivery has been sporadic and insufficient, with reports of aid suspension worsening the crisis. Between March and July 2023, the death rate doubled, with more than 90% of deaths occurring at home, highlighting the lack of access to healthcare and support systems.
The findings call for an urgent humanitarian response. The researchers stress the need for international aid agencies to expedite food assistance and restore essential services to the region. Immediate interventions must include the resumption of consistent aid deliveries, while long-term strategies should focus on rebuilding agricultural systems, resettling displaced populations, and addressing the structural causes of food insecurity.
Beyond immediate relief, the study highlights a deeper moral and global imperative. The ongoing crisis in Tigray represents a violation of the fundamental human right to food and underscores the failure to meet the United Nations’ Sustainable Development Goal of eradicating hunger by 2030. The interconnectedness of conflict, hunger, and human suffering demands a unified global response, not only to alleviate the immediate crisis but also to prevent similar tragedies in other conflict-affected regions.
Mekonnen Haileselassie and his team have provided critical evidence of the crisis in Tigray, turning a global spotlight on a region in desperate need of attention. Their work is a powerful reminder that peace agreements alone cannot heal the wounds of war; they must be accompanied by robust humanitarian and developmental support
Revitalizing Tigray’s Health System: Insights from the HEAL Initiative Webinar
HEAL Initiative for Health (HiH), a non-governmental health organization based in Tigray, Ethiopia, hosted an insightful webinar that delved into the pressing issue of post-conflict health system revitalization. The event, titled “Post-Conflict Revitalization of the Health System and Implications for Partnership: The Case of the Integrated Health Research Project in Tigray,” brought together public health experts and stakeholders to explore pathways to recovery. Moderated by Dr. Haregeweyni from the Tigray Regional Health Bureau (TRHB), the session featured thought-provoking presentations by Dr. Mussie and Dr. Abenezer, who highlighted both the challenges and opportunities in rebuilding Tigray’s healthcare landscape. This bi-weekly platform underscored the dire realities faced by post-conflict health systems while offering practical frameworks for recovery and partnership.
Dr. Mussie opened the discussion by emphasizing the critical role of research in guiding post-conflict recovery efforts. His presentation provided a comprehensive overview of the Integrated Health Research Project, a cornerstone initiative conducted across 19 districts and six internally displaced persons (IDP) sites in Tigray. This study aimed to assess the impact of the conflict on key health indicators, focusing on maternal health services, immunization coverage, and public health challenges.
The objectives of the integrated health survey were ambitious and multifaceted. Researchers sought to evaluate maternal health services, including family planning, antenatal care (ANC), institutional delivery, and postnatal care. Additionally, the survey aimed to assess women’s knowledge and prevalence of obstetric fistula and pelvic organ prolapse, determine routine and supplemental immunization activities, and analyze COVID-19 vaccination rates among adults and healthcare workers. By integrating data from diverse populations, including IDPs, host communities, and healthcare facilities, the study offered a holistic view of the health challenges in
post-conflict Tigray.
The methodology employed was both comprehensive and inclusive, with data collected from approximately 14,000 women, 3,000 men, and 85 healthcare facilities. Using a combination of quantitative surveys and qualitative focus group discussions, the research team ensured a robust data set that captured the complex realities on the ground. However, the findings painted a grim picture of the war’s devastating impact on Tigray’s health indicators. Family planning coverage, for instance, plummeted from 36% pre-war to 28.4%, while ANC utilization dropped from over 94% to a mere 6%. Institutional delivery rates fell from 72% to 38%, and full vaccination rates for children declined from 73% pre-war to 31.4%. The prevalence of obstetric fistula and pelvic organ prolapse surged, underscoring significant morbidity burdens.
Dr. Mussie’s recommendations highlighted the need to strengthen primary healthcare, enhance morbidity surveillance, and foster multi-disciplinary partnerships. He also emphasized the cost-effectiveness of integrated health surveys, which saved over 20 million Ethiopian Birr compared to traditional approaches. These findings and recommendations set the stage for a broader systemic analysis presented by Dr. Abenezer.
Dr. Abenezer’ s presentation provided a detailed examination of Tigray’s post-conflict health landscape through the lens of the six-health system building blocks. He began by addressing the collapse of strong governance structures, a former hallmark of Tigray’s health system. Weak governance, poor coordination, and mismanagement of resources were compounded by an erosion of public trust. These challenges underscored the need for transparent and effective leadership to guide recovery efforts.
The health workforce, another critical building block, faced significant setbacks. A large-scale brain drains and unequal distribution of healthcare professionals left many rural areas underserved, as health workers concentrated in urban centers. This disparity highlighted the urgent need for equitable workforce distribution and initiatives to attract and retain talent in underserved regions.
Health financing emerged as another pressing issue, with the war’s economic toll pushing 73% of Ethiopians below the poverty line. The collapse of community-based health insurance schemes further strained the system, necessitating urgent financial injections to revitalize health financing and achieve universal health coverage. Dr. Abenezer discussed plans to reintroduce these schemes using a sliding-scale payment system to accommodate economically disadvantaged populations.
Disrupted health information systems posed additional challenges, hindering data-driven decision-making and planning. Dr. Abenezer stressed the importance of evidence-based approaches to attract donor support and guide recovery efforts. Similarly, damage to infrastructure, service fragmentation, and outbreaks of communicable diseases like malaria and cholera underscored the fragility of Tigray’s health service delivery systems. Widespread looting and destruction of medical equipment further reduced the capacity of health facilities to provide essential services, with 98% of facilities suffering damage.
In his recommendations, Dr. Abenezer called for rebuilding trust in health systems, mobilizing funds to reintroduce community-based health insurance, and strengthening evidence generation through standardized studies. He emphasized the importance of partnerships and collaboration, noting that rebuilding Tigray’s health system would require a unified effort from all stakeholders.
The webinar’s interactive Q&A session provided an opportunity for participants to engage with the panelists on pressing concerns. Dr. Abrha ,the chief clinical director of Ayder comprehensive specialized hospital arose a concern around the terminology used to describe Tigray’s situation, with participants discussing the merits of “post-conflict” versus “post-war” framing. Dr. Abenezer explained that while “post-war” might be more accurate, “post-conflict” aligns with the preferences of national and international stakeholders.
Other questions from Professor Afework centered on disparities in health service access between host communities and IDPs, the reliability of survey data, and regional plans to eradicate obstetric fistula by 2030. Dr. Mussie and Dr. Abenezer addressed these concerns, emphasizing the importance of targeted interventions, rigorous data collection, and sustainable funding models.