With vaccinations in the capital of northern Ethiopia's Tigray region having been halted since conflict there began in November, preventable diseases like measles could return, Doctors Without Borders' (MSF) told <em>The National.</em> The full extent of Covid-19 in Tigray remains unclear because of limited testing capabilities, and the suspension of Covid-19 monitoring and control activities owing to the conflict. Up to a million people are thought to be displaced in Tigray and, in some cases, as many as 25 people shelter in a single home. The secessionist region has been fighting a bitter conflict with the Ethiopian government since local forces began a war of independence. An MSF trip to some of Tigray’s hospitals, including its biggest one, Ayder, has shed light on how badly the medical infrastructure there has been hit. Most of the facilities that the MSF could gain access to were looted, inoperable or largely empty of any patients because of a lack of basic equipment. “On top of that, the referral system has collapsed. A patient who lives 14, 20 or 30 kilometres from the hospital cannot reach it, even if he or she is dying because there were, and are, no ambulances,” MSF head of emergencies Maria-Carmen Vinoles said. Ethiopia has so far reported 140,883 confirmed coronavirus cases and 2,136 overall deaths, although there were several days when no cases or deaths were recorded. It is unclear if this lack of data is because of a systemic issue in recording, tracking and reporting cases. In Tigray, supplying basic healthcare services, clean water and food are the biggest concerns, Ms Vinoles said. “Covid-19 concerns are almost a luxury problem for these people,” she said. UNHCR representative Babar Baloch said some people were resorting to eating leaves owing to the lack of food. Preventable diseases, like diarrhoea, are on the rise among children because of a lack of clean water. Despite the bleak reality of what the MSF team and other humanitarian agencies have seen in Tigray and its capital Mekele, their descriptions offer only a glimpse into the actual situation. “We have been granted access to respond to the emergency needs to some areas. However, there are still many areas in Tigray that we don’t have access to, and we know the population in those areas has not had access to health care for months,” Ms Vinoles said. There are thought to be as many as 60,000 refugees from Tigray who fled into neighbouring Sudan, not only because of the fighting but because basic health services have collapsed. A UN report in January said only five out of Tigray’s 40 hospitals were physically accessible. Three months since the war between the government and the Tigray People’s Liberation Front started, humanitarian workers have yet to gain full access to the area. In February, the UN renewed urgent calls to enter the region, which it says has been hindered by “insecurity and bureaucratic obstacles”. Two refugee camps in northern Tigray, which are thought to house about 15-20,000 people also remain inaccessible.