In our continent, internet shutdowns are not uncommon. We have unfortunately come to expect and tolerate them. They can occur following election announcements or following small bouts of conflict in certain areas. We obstinately accept them. We groan and wait for the few days or weeks to pass while longing for the return of that global connection to which we have grown so accustomed. Yet, imagine a place where not only the internet, but the complete telecommunications grid was willfully cut, impeding citizens from accessing direct phone lines, SMS, and banking services. A place where access to the internet was an added privilege. Imagine this shut-down continued for two whole years hindering even those in close proximity from connecting. Imagine then that the victims of this complete outage were besieged communities suffering multiple complexities including ethnic cleansing, man-made famine, a humanitarian siege, and weaponized rape. Imagine a community purposely frozen in an imposed state of persecution while simultaneously and deliberately disallowed from sharing its afflictions with the rest of humanity. Worse yet, imagine that this place is not at all imaginary. In fact, this is the current reality in Tigray - Ethiopia’s northern region - deemed the world’s worst humanitarian catastrophe by the World Health Organization. Tigray’s population is estimated at seven million - and all seven million remain sealed off from the world. The only access remains within a limited number of UN Offices. There are some countries that have sought and still seek to silence the voices of their constituents for limited periods to which we rightfully disagree. Then what are we to say to Africa’s worst and longest blackout in current history? And what are we to say when those who bear the brunt of this muzzlement are women and children?
On 4 November 2020, the Ethiopian government and its Eritrean allies launched a full-blown offensive on Tigray. From the onset, indiscriminate and wholesale attacks against the civilian population characterized the war. Despite the blackout, various human rights and humanitarian reports confirm that atrocities committed by the Ethiopian and allied forces amount to war crimes, crimes against humanity, and acts of genocide. The roster of brutalities is lengthy: hundreds of thousands are dead, millions displaced, and essential civilian infrastructure and services completely annihilated. As women, perhaps the most gruesome and defining feature of the war has been the extensive weaponization of rape and the widespread prevalence of Conflict-Related Sexual Violence (CRSV) - consistent with the well-established definitions of genocidal rape. Most alarming of all is that these reports have come out, through the concerted efforts of humanitarian organizations and infiltrating journalists, who have risked much to disclose these stories. Until the communications black-out is lifted, a true understanding of the scale of atrocities that lie buried beneath the shutdown remains beyond reach.
Tigrayan Women: Shutdown and Health Services
Tigray is known as a nation of resilience and owes much of this character to its women. Tigrayan women are the backbone of their communities, both in peacetimes and during wars. They have led movements, innovative breakthroughs, turned stones into fruits and built communities from the ground up. Their exemplary leadership has not only benefited their local communities but impacted people across the world, transcending borders and racial divides. Although history and current events are replete with the courage, resilience, and indomitability of Tigrayan women, here we highlight the women health professionals in Tigray amidst a sealed-off grid.
Tigrayan women are the backbone of their communities, both in peacetimes and during wars.
In March 2021, more than a year ago, Medicins Sans Frontiers (MSF) reported that 70% of Tigray’s health facilities had been “looted, vandalized, and destroyed in a deliberate and widespread attack on health care.” Where aid organizations restocked health facilities, Ethiopian and Eritrean soldiers continued to loot them, depriving the civilian population of access to life-saving healthcare. Tigray’s health infrastructure is further crippled due to a de-facto humanitarian blockade whereby humanitarian access to transport life-saving items into Tigray has been severely impeded by the government. The blockade on communication lines is critically impacting Tigray’s health infrastructure and has resulted in the suspension of essential health services, particularly those affecting women’s health and reproductive health, including victims of weaponized rape and CRSV. The blackout has also meant that public servants are not paid due to an imposed discontinuation of banking services by the Ethiopian government. Despite these challenges, health professionals in Tigray continue to serve their population with utmost selflessness and care. Ayder Hospital, located in Tigray’s capital, Mekelle, was one of the “crown jewels” of the Ethiopian health care system and the second largest in the country. Below, Dr. Bisrat shares how the communication blackout has affected medical service delivery at Ayder, now basically defunct:
“The inability to call ambulances is costing the lives of many pregnant and laboring mothers. Patients with acute illnesses, including COVID-19, are also impacted. We had a patient who came to Ayder hospital carried by family members. The journey took about three weeks. As expected, she died on arrival at the emergency Out-Patient Department/OPD.” Dr. Bisrat continues: “[The blackout] has also negatively impacted the intra-hospital service. Staff must go many blocks to convey information, leaving patients unattended. Work during night shifts is among the most compromised. There is no way you can undergo on-call consultations both intra and inter-departments. You feel stranded. Everything which seemed easily accessible before is no more so. Not being able to do anything about it is so painful. You feel suffocated.”
Peggy Hicks, Director of Thematic Engagement at the UN Human Rights Office (OHCHR) rightfully notes that “when you see a shutdown happen, it is time to start worrying about human rights.” Shutdowns mean that millions of people are bereaved of their only means of speaking to their loved ones, receiving medical assistance, and making informed decisions about their lives. OHCHR warns us that blackouts and shutdowns can lead to more aggravation if they are “implemented in a discriminatory way and target communities in specific geographical locations.” In this case, shutdowns serve as a tool for marginalization and oppression. In the case of Tigray, the communication siege has allowed for ethnic cleansing and mass destruction to occur uncontested in the dark, leaving people helpless, without immediate medical support, and without consolation. These are similar stories that Dr. Bisrat continues to share with us:
“As a physician, you want to share the harrowing stories of patients with the world. You wish the world knew how a mother bled to death because she could not access emergency care. You want to tell the world how patients are becoming hypoglycemic because the hospital could not offer them meals.” If it is unjust that Tigrayans cannot share their harrowing stories with the world, it is even more agonizing that they cannot even share them with their loved ones. Those of us who live abroad are yet to find out the fates of our friends, families, and neighbors. When we get bits and glimpses into the reality beneath Tigray’s sealed-off skies, such as Dr. Bisrat’s brave testimony, we wonder about the realities of our parents, partners, siblings, and children. For those who were already suffering from chronic conditions, the apprehension is even worse and a phone call down the line bears ominous news. But unless the blackout is lifted, who really is to know? Dr. Bisrat continues to share with us that the issue is not just about connecting with the bigger world outside but with those in close proximity as well. “We cannot get in contact with our loved ones nearby. They come to the hospital but the chance they will find you is rare. Colleagues tell you that someone came looking for you and that they could not locate you. It is an everyday occurrence for everyone. My family came to my office four times this week alone. None of them managed to meet me. You get worried that something has happened to them.”
The communication siege has allowed for ethnic cleansing and mass destruction to occur uncontested in the dark, leaving people helpless, without immediate medical support, and without consolation.
Dr. Bisrat also shares with us how the shutdown has impacted education and progress in Ayder Hospital and overall in Tigray. She notes, “Ayder hospital also teaches prospective students. It has undergraduate and postgraduate programs. The teaching and learning process is heavily dependent on the availability of the internet. Today, residents cannot present journals, fatal cases, and grand rounds. You cannot access new scientific discoveries either. We abide by whatever documents we had in the past. As a result, the motivation to teach has declined. Projects that are run in the university and sandwiched Ph.D. programs have stopped.” She mentions how this has affected her on a personal level and tells us that last February, she enrolled in a Ph.D. program. “However, I missed the opportunity because I lost contact,” Dr. Bisrat tells us. “The project was also terminated. I sob every time I think about it.”
Resilience and Vulnerability
Dr. Bisrat is not an isolated case. She is the face of all women health professionals across Tigray. She might perhaps even represent the mildest of stories as she is located in the capital where some UN Offices and humanitarian agencies are operational, unlike the majority of areas in the region. What stands out equally with the suffering is the resilience, grit, and drive of Tigrayan women, like Dr. Bisrat, to improve the lives of their communities. It is a feat that deserves recognition, appreciation, and more importantly, compassion. Women health professionals in Tigray have had to wash disposable gloves for re-use and cut up their most expensive traditional dresses to be used as gauzes for deliveries. They continue to mentor, lecture, and train their fellow mentees without pay and within the confines of limited, and sometimes non-existent, resources. They have been advocates and protectors. And not surprisingly, they also continue to bear the brunt of the war, besiegement, and communications blackout. When a health facility lacks essential services, medical equipment, and items to support patients, complication rates and mortality counts inevitably soar. In today’s Tigray, pregnant women are having miscarriages and delivering fetuses with missing body parts. Some delivered infants are born prematurely or with low birth weight. Due to a lack of resources, these infants cannot be put in newborn intensive care units, leading to their untimely deaths. Survivors of sexual violence do not have access to much-needed reproductive and mental health services. Although we are all bearing the psychological brunt of this avoidable misery, mental health professionals, particularly women, suffer severe mental trauma from these experiences. Dr. Bisrat is a testimony to this fact. Yet, the worst part of it all is perhaps the knowledge that all of this is happening outside the gaze of the rest of humanity: that Tigray is out of sight and therefore out of mind - no matter how immense the suffering is.
The communication blackout in Tigray has brought forth the “social death” of Tigrayans. Social death is the unfortunate reality that you no longer “exist” in the modern world even when you do.
Out of Sight; Out of Mind
Overall, the communication blackout in Tigray has brought forth the “social death” of Tigrayans. Social death is the unfortunate reality that you no longer “exist” in the modern world even when you do. Tigrayans are perishing in silence. Their death is not outrageous because they are dying beneath sealed-off skies - they are not making a nuisance. It is that old adage of a tree falling down in the forest but no one being around to hear it. Has it, then, really fallen? Tigrayans are falling but what does it matter if no one is there to witness their stories? Women bear the brunt of this social death, further suffering the deepening of gender divides and existing inequalities emboldened by a grid blackout.
While recognizing the resilience of the Tigrayan women health professionals, it is critical for the world to remember our perished and struggling loved ones amidst the sea of the seven million Tigrayans that remain sealed off since late 2020. Black lives matter - in all corners of the world. Put Tigray back in sight, and back in mind.
Disclaimer: The opinions mentioned in the article are those of the authors and not their employers.