By Kibrom Hiluf, MD, Mohammed Mustefa, MD, Isaias Irgau, MD, and Solomon Woldu, MD

On the last week of May of 2022, 37-year-old Desta (name changed for privacy) presented to a clinic in the Ethiopian capital city of Addis Ababa, after an arduous journey from the besieged northern Ethiopian region of Tigray.

Upon presentation he was profoundly emaciated and had foul-smelling drainage from obvious perirectal abscesses. Rectal examination also revealed near total obstruction by a large low-lying rectal mass. CT scan of the abdomen and pelvis revealed locally advanced rectal adenocarcinoma, confirmed eventually with biopsy.

Desta, a resident of Mekelle, the capital city of the northern Ethiopian region of Tigray, had been suffering from diarrhea and poor appetite for over 18 months. Onset of his symptoms coincided with the start of the war in Tigray, when federal forces of the Ethiopian government and their allies, including the army of the neighboring country of Eritrea and militias from various parts of Ethiopia, began a concerted military campaign to oust the regional government of Tigray on November 4, 2020. The military campaign, launched on a day when the world attention was focused on a highly contested U.S. presidential election, was undertaken after imposing a total communication blackout on the Tigray region.

Desta had been unable to access any type of medical care throughout the duration of his illness. The diagnosis of locally advanced rectal cancer resulting in perirectal abscesses was established for the first time after he escaped the besieged region of Tigray and arrived in the Ethiopian capital, Addis Ababa, following a perilous journey.

Prior to the onset of the war, the city of Mekelle prided itself as the home of one of the best health institutions in the area. Ayder Hospital, a tertiary referral hospital in Mekelle, was the only health facility in Tigray that provided treatment for patients with cancer including surgery, chemotherapy, and palliative care. Five years ago, Ayder Hospital spearheaded an initiative to expand its oncology services with the establishment of a modern comprehensive cancer care center, training specialists in pediatric and adult oncology and procuring a radiation therapy machine.¹ This development was brought to a halt by the war. In March 2021, Doctors Without Borders reported that 87% of “health facilities across Ethiopia’s Tigray region have been looted, vandalized, and destroyed in a deliberate and widespread attack on health care.”^2-4

Nearly 2 years after the onset of the war in Tigray, a medieval-type siege remains imposed on Tigray by the Ethiopian government and its allies. There is a complete communication blackout, with absence of telecommunication, internet, electricity, and other basic services such as banking and transportation. This has a major impact on the information flow and the ability to reflect the reality on the ground, particularly considering the fact that, in any war, the news doesn’t even keep up with what is happening on the ground. In addition, during a communication blackout and a de facto blockade, the source of the majority of the information is the unreliable media outlet of the perpetrators, with the intention of misleading the audience and the international community at large.

The embargo also includes restriction of food provisions and medicines. The lack of medical supply has affected patients with cancer as well. In an article aptly titled “I Saw an Oncologist Cry: Tigray Cancer Patients Sent Home to Die for Lack of Drugs,” the British daily newspaper The Guardian reported on May 25, 2022, that “doctors caring for cancer patients at the main hospital in Tigray…are treating terminally ill people with expired medication and paracetamol [acetaminophen]. Eighteen months of war have left the sickest in society suffering agonizing deaths.”⁵

The international community that has rightly jumped in to aid the people of Ukraine in their time of need from the first day of the Russian invasion has been lukewarm in its reaction to the catastrophe affecting the civilian population of Tigray, under siege for almost 2 years. Trying to get help to the people of Tigray with food and medical supplies through the central government of Ethiopia is akin to trying to get help to the Ukrainians via Moscow. Consequentially, in almost 2 years of near total blockade, the people of Tigray have seen only a fraction of the food and medical supplies that they desperately need. This includes chemotherapy medications, the distribution of which is set by default to be allocated after an initial centralization of the supplies in the Ethiopian capital Addis Ababa, the seat of the Ethiopian government which is showing no signs of easing its chokehold on the Tigray region.

In the same article published in The Guardian, oncologists at Ayder Hospital have appealed to global oncology associations to raise their voice in support of unfettered access to cancer care by the population of the Tigray region in northern Ethiopia.

We, as oncologists, as ASCO members, as Tigrayans, are grateful for this opportunity to share with our ASCO community stories like Desta’s. We urge our colleagues to help us to raise awareness of the humanitarian catastrophe in Tigray today.  No human being should be made to suffer like this.

Dr. Hiluf is a clinical adult oncologist and hematologist at Ayder Specialized Comprehensive Hospital, Mekelle University, Tigray. He is the unit head of the Adult Oncology Unit.

Dr. Mustefa is a clinical pediatric oncologist and hematologist and the head of Department of Pediatrics and Child Health at Ayder Specialized Comprehensive Hospital, Mekelle University, Tigray.

Dr. Irgau is a general surgeon with a special interest in bariatric and metabolic surgery. He is a fellow of the American College of Surgery and of the American Society of Metabolic and Bariatric Surgery. He is currently the medical director of the Bariatric Program of the American Surgery Center in Wilmington, DE.

Dr. Woldu is a urologic oncologist and assistant professor in the Department of Urology at the University of Texas Southwestern Medical Center. He is a Society of Urologic Oncology (SUO) member, regular contributor to the ASCO Genitourinary Cancers Symposium, and actively involved in clinical trials and translational research. He serves as medical director of urology at JPS Hospital in Fort Worth, TX.

References

1. Hiluf K, Mustofa M, Fekade S, et al. Tigray: a region where cancer diagnosis has become a death sentence. Cancer Care at Ayder Hospital, Statement. 
2. Doctors Without Borders. Widespread destruction of health facilities in Ethiopia’s Tigray region. Mar 15, 2021.
3. Gebregziabher M, Amdeselassie F, Esayas R, et al. Geographical distribution of the health crisis of war in the Tigray region of Ethiopia. BMJ Glob Health. 2022;7:e008475.
4. 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 Glob Health. 2021;6:e007328.
5. Davies L. ‘I saw an oncologist cry’: Tigray cancer patients sent home to die for lack of drugs. The Guardian. May 25, 2022.

ASCO Statement:

Whenever and wherever conflict or major natural disasters disrupt lifesaving medical care, ASCO calls on the global cancer community to come together in support of the patients whose lives are impacted as well as the health care professionals selflessly providing assistance, often at their own peril. We urge our members and the broader community to help us focus attention and resources on these crises. When critical health infrastructure is damaged, access to basic medical care is beyond reach, and lifesaving medicines are in short supply, the result is profound and needless pain and suffering. In such circumstances, policy can serve a critical role in enabling medical providers to respond and assist where needed. ASCO calls on relevant authorities to work expeditiously to create direct and protected passages through these devastated areas by which patients, medical personnel, hospital supplies, and medicines can safely travel in order for desperately needed care to be delivered to the most vulnerable.