Conflict and fistula: a heart-breaking reality

The long read: 3 minutes. Please note this story contains distressing information.

As many of our supporters will be aware Ethiopia has been in a period of civil unrest since November 2020, centred in the country’s far northern region of Tigray. More recently, this spread to neighbouring Amhara and Afar regions.

Although our dedicated teams of health professionals at five of Hamlin’s six Fistula Hospitals across the country have been able to continue to deliver services normally, the conflict has had a devastating impact on the lives of thousands of women in the North of the country.

A sad outcome of the conflict in Tigray is likely to be an increase in obstetric fistulas, as women in affected areas will have been unable to access the quality maternal healthcare services they need.

Sadly, this threat became a devastating reality for Tigit*.

Tigit, 25, is from a remote, rural village in Northern Ethiopia, in a conflict affected region. Since marrying her husband eight years ago, Tigit has had a happy life, farming with her wider family. Across the years Tigit and her husband longed for a child – having children was the only thing they dreamed of to make their life full.

Last summer they were both overjoyed when it finally happened and Tigit became pregnant. This was exciting news for her entire family and she was fortunate to have a newly constructed government health clinic very close to her home where she attended regular ante-natal appointments. She told us,

“As this pregnancy happened after years of trial and prayers, I didn’t want anything to happen that could impact the delivery. Sometimes I even visited the nurses at the clinic earlier than my appointed date. A few months into my pregnancy the nurse who was following my case told me that I had two babies in my womb and should come to the clinic for delivery as soon as I see the signs he taught me.”

Tigit and her husband followed the nurse’s advice diligently, and waited for the signs of labour to go to the clinic for her delivery. However, in the final months of her pregnancy, the area fell under control of rebel fighters. The clinic’s equipment and drugs were looted and the nurses at the clinic fled, leaving the local community with no health services.

Suddenly Tigit, and other pregnant women in the area were left with no professional support for their deliveries.

“When this unexpected scenario happened I was deeply shocked” Tigit told us. “My case was critical because I had twins and the nurses repeatedly warned me to deliver only at the clinic. There was no transportation even if we want to travel to nearby towns, no one was moving around and we were living like we were under home arrest. I was praying for a miracle to happen and to deliver my babies safely. But that didn’t happen.”

Conflict affects innocent people

As a result of the fighting, Tigit had her right for a safe childbirth taken away from her.

When the time came to deliver, Tigit was at home surrounded by only her family members. Tragically her labour became obstructed and after four painful days her mother helped her deliver stillborn twin babies, ultimately saving Tigit’s life.  

“Two days after the labour started I became completely unconscious and unable to push anymore. It was only hours after the stillborn twins were delivered that I became conscious. When I woke up the first thing I asked for was my babies. It is too hard to accept the loss of the babies that I waited eight years for. I wished for my death with them and felt under deep sorrow sadness.”

Compounding her loss, Tigit had suffered a fistula from the long labour and became incontinent.

For Tigit obstetric fistula was a condition she had never heard of before:

“At first, I thought it was the aftermath of the long labour I had experienced and expected it to stop eventually. My mom kept cleaning the bed sheets as well as my clothing, but it remained same, day in, day out. I spent six months in this way feeling ashamed of myself. My symptoms were considered strange by everyone around me, including myself. And all the time, the area we live in was still under siege with no lights, no telephone, no transportation, nothing. Those months were the worst time of my life”.

A chance for a future

After six months, the fighting ended in Tigit’s community. Once it was safe, she immediately travelled to her nearest government hospital, who explained to her that she had a fistula and referred her to Hamlin’s Bahir Dar Regional Fistula Hospital in the northwest Amhara region.

In February 2022 Tigit arrived at Bahir Dar accompanied by her brother and she was warmly welcomed by the Hamlin team. Just one week after her arrival she had successful fistula surgery from experienced lead surgeon and Urogynecologist Dr Bitew.

Dr Bitew explained the stark reality of the situation for women like Tigit:

“Tigit is one of the possibly many pregnant women living inside the conflict zone who has been forced into having a home delivery that could end up in maternal death or birth complications like fistula. Had there been professional assistance during her delivery she could have delivered the twins safely and fulfilled her dream.”

He also highlighted the hospital is working hard to identify and treat more women affected by the conflict.

As she got ready to be discharged to return home Tigit told us

“Here at the hospital I have been treated like princess. I have been receiving the best and quality services such as tasty food, clean clothing, neat bedding and all these services are free. For me this is the best hospital in my life by far. I can’t thank you enough for bringing my life back. Much respect for those who started it and all of you working on its continuation”.

*The patient’s name has been changed.