Tigray dialysis service cut due to dwindling supplies amid war
March 07, 2022
Ethiopia’s civil war erupted in November 2020, rendering 70% of healthcare facilities in the Tigray region dysfunctional(1). At Ayder, Tigray’s flagship tertiary centre, even basic care has become a luxury.
Ayder offers the region’s only haemodialysis facility(2)serving 9,000,000 people. War and blockade have caused reduced access, funding and severe supply shortages (3). Dialysis utilization has been drastically curtailed (Figure).
Patients with treatable illnesses are dying. Overall, mortality increased from 25.5% (28/110 patients) in 2020 to 53.1% (43/81 patients) in 2021. Among the dying are chronic hemodialysis patients on maintenance and children with acute reversible conditions. Between 01/07/2021 and 15/01/2022, 61new patients requiring emergency dialysis succumbed (including 36 with acute kidney injury).
Consumables were prevented from reaching Tigray from the capital, Addis Ababa from July 2021.Consequently; difficult decisions had to be made, including employing suboptimal protocols. For example, 300(12.5%) dialysis sessions entailed; using single-use dialyzers, 6-8 times. Dialysis frequency was reduced from twice to once-weekly or even fortnightly, impairing both quality of treatment and life. Using expired central venous catheters or exchanging dialyzers after patient deaths were among the desperate measures adopted. Now, even these staggering compromises are unsustainable; new patients are simply turned away.
Peritoneal dialysis was improvised using locally-prepared fluids, saving a few lives. Currently, even intravenous fluid supplies have run out. Advising patients to stop dialysis, and live out their remaining days untreated in hospital or at home is the tragic daily predicament of the trained dialysis team. Witnessing the painful deaths of veteran and new patients has imposed huge psychological burdens on the staff.
Ayder’s hemodialysis service was an outstanding example of sophisticated care in a low-resource environment enabled by private-public partnerships, community engagement and an ethical commitment to care(2).Service provisions now acutely jeopardized by conflict (3,4). Ayder is counting down the clock, knowing patients with kidney failure will succumb to slow, bitter and painful death.
We call upon nephrologists worldwide and relevant international bodies, including the International Society of Nephrology, to appeal to the Ethiopian Government to lift the blockade, re-establish supply chains and restore healthcare, including the right to dialysis for the people of Tigray.