Ayder hospital's hemodialysis service is an outstanding example of sophisticated care in a low-resource setting was established in 2013 as a public-private partnership model and it has served more than 570 patients with both acute kidney failure and End-stage kidney disease. Ayder hospital hosts the only dialysis service in the Tigray region for more than seven million people of Tigray and was also serving for the neighboring regions of Afar and Amhara and Eritrean Refugees.

Patient enrollment at the center has been progressively curtailed since the birth of the war: 110 patients in 2020, 69 patients in 2021, and 25 patients in 2022. Mortality has also doubled from 25.5% pre-war to 53.1% post-war. Patients with otherwise treatable kidney failure are dying and the loss of follow-up to the renal unit is significant.
These untoward outcomes reflect the persistent interruption of hemodialysis supplies, lack of transportation to the hospital, lack of financial resources, and the unavailability of basic medications due to the ongoing war and economic and humanitarian blockade of Tigray.

As consumables were prevented from reaching Tigray from the capital, Addis Ababa, from July 2021, dangerous and necessary improvisations have been made by the kidney care team in the hospital where > 300 dialysis sessions entailed using single-use dialyzers 6 to 8 times.

The ICRC and WHO last deliveries of trickles of medication and supplies were before the resumption of hostilities on August 24, 2022. Currently, no single hemodialysis supplies are available in the hospital leaving the 25 veteran dialysis patients awaiting death in front of the helpless renal care team, not to mention all the patients with kidney failure who are unable to come all the way to Ayder Hospital, Mekelle for lack of transport/fuel and financial issues.

Dialysis frequency was reduced from thrice and twice to once weekly impairing the quality of life and accompanying avoidable deaths. Even these staggering compromises are impossible, and new patients with kidney failure are simply turned away for lack of dialysis service.

About 10 young patients who were once on dialysis for many years in Ayder desperately tried to escape to the capital, Addis Ababa for access to dialysis service through the dangerous route of the war zone in the Afar region were not successful as the armed forces in the border returned them back to Mekelle.
From June 2021 to October 2022: more than one hundred patients with acute renal failure (including children) and chronic kidney disease requiring dialysis have died or were sent home to just die as we can’t offer them hemodialysis service.

It has become a torment for the hemodialysis staff to witness kidney failure patients who were once clinically stable with comprehensive nephrology care and watching them suffer with disabling symptoms owing to lack of adequate dialysis and medications including erythropoietin injection, intravenous iron for the significant number of anemic patients in end-stage kidney disease.
Kidney transplant recipients also lack access to kidney transplant immunosuppressive medications, including tacrolimus, Mycophenolate mofetil, and Azathioprine and Cyclosporine preparations.

Amid the protracted war and siege, this tragedy for end-stage kidney disease and kidney transplant recipients is unprecedented in history in that they are neither able to be referred to the capital city, Addis Ababa, or abroad to access renal replacement therapy/transplant medications nor able to get the dialysis service here.

We call up the Ethiopian Ministry of Health (FMOH), ICRC, WHO, and the international community to give due attention to the horrific and dire situation on the ground and send us the necessary medications and supplies needed for patients suffering from kidney failure and kidney transplant recipients.

Reaching for such hundreds of victims with kidney failure is already late as many have perished in absence of humanitarian access, we demand an urgent response to deliver supplies and life-saving medications to the desperate survivors with the first possible humanitarian flights to Tigray.

Dr. Ephrem Berhe, Head of the Nephrology Unit
November 3, 2022

photo 2022 11 03 15 49 06

A picture of Ayder hospital, hemodialysis unit displaying an empty bed with no patients connected to the hemodialysis machine( Picture: Ephrem Berhe).

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