Reviving hope: The impact of war and resilience in global health efforts in Ethiopia

In a world where global health efforts are often challenged by conflict and instability, the recent work of Mulugeta Gebregziabher, Ph.D., in Ethiopia offers a compelling testament to the resilience and dedication required to continue advancing health initiatives amidst adversity.

Gebregziabher, a professor and vice chair of Academic Programs in the Department of Public Health Sciences at MUSC and director of the Region IV Public Health Training Center, has been a pivotal figure in fostering global health partnerships between Ethiopia and his department at MUSC. 

On Wednesday, Sept. 25, at noon, in the Bioengineering Building Auditorium, Gebregziabher will share his personal and professional experiences related to the conflict in Ethiopia. He will also discuss how his family and local residents have continued to be affected by the catastrophes of war and what he and others are doing to make a positive difference in the Tigray region, during his presentation, titled “Conflict, Health and the Need for Immediate Global Action: The Case of Tigray, Ethiopia.”

The toll of conflict

Gebregziabher was born in Adwa, Ethiopia, a town located in Tigray, which is the northernmost region of this eastern African country. Attending school locally until the 10th grade, his education was abruptly disrupted in 1988 when a civil war commenced between Tigray rebels and the communist government of Ethiopia. 

“In the middle of fighting, around March, I believe, rebels occupied Adwa,” he said. “They came from their hideouts in mountains and villages, so schooling stopped.” 

The war forced him to leave his home, making the arduous journey by foot to Eritrea, which, though now a sovereign nation in Eastern Africa, was then a district of the country. It offered a relatively safer location away from the conflict, allowing him to re-enroll in school. It would be three years – May of 1991 – before he would be able to return home. During his freshman year at Addis Ababa University, the fighting that had previously displaced him from Adwa reached Ethiopia’s capital, leading to the ousting of the communist government and restoration of relative peace. 

Gebregziabher came to the U.S. in 2001 to seek his Ph.D., which he received in 2006 from the University of Southern California. Shortly after, he moved to Charleston to join the faculty at MUSC. 

Remaining passionate about Ethiopia 

Gebregziabher’s journey to making a positive impact on his homeland while based in the U.S. ignited in 2008, as he sought to connect his expertise in biostatistics with global health initiatives. He received seed funding from the MUSC Center for Global Health to explore global health opportunities in Ethiopia. The project initially focused on capacity development, working with local junior faculty and graduate students to provide educational materials and complete demographic health surveys with a focus on AIDS and HIV. In 2018, after receiving grant funding, the project expanded to include chronic conditions such as diabetes and cervical cancer screening.

“The founding chair of my department, Dr. John Vena, was instrumental in the establishment of formal partnerships with two universities in Tigray and another one in Addis Ababa,” he said. This effort led to a South Carolina-Ethiopia collaboration to apply for a USAID grant of more than $65 million to overhaul the health system of Ethiopia.”

Gebregziabher achieved progress, but the outbreak once again of war, as well as of the COVID-19 pandemic, halted his work in-country, but it only boosted the fire within him to make a difference for the people of Tigray, even thousands of miles away.

“My mom, my brothers, my in-laws – they were all stuck there,” he said. “Those three years were a very difficult time, but I didn’t just put my head down; I had to speak up for my family and my community.”

 

Gebregziabher focused on further expanding his professional network and became very active in writing public health messages, leveraging LinkedIn and Twitter to educate others and share his thoughts on a range of topics involving the catastrophic conflict in the Tigray region. 

“The silver lining of all these challenges were I made a lot of friends, a lot of people who share my concerns and even got involved in some humanitarian work with me because of that,” he said. “All of these people – they were doing the best helping me, whether it was through prayers, moral support, making me feel courageous for my effort.” 

The war’s impact was profound: health care facilities were destroyed, transportation and banking systems collapsed and essential resources became inaccessible. Despite a Cessation of Hostilities Agreement signed in 2022, the recovery was slow, with significant delays in reopening airports, banks and communication channels. Gebregziabher went months at a time without communicating with his mother, for instance, which was an extremely stressful and complicating factor throughout the entire experience.

Finally returning home to Tigray

Gebregziabher’s return to Ethiopia this past spring, after a five-year hiatus, was marked by a mixture of relief and trepidation. The journey, fraught with security concerns and personal risks, underscored the fragile state of the region. 

After publicly sharing his thoughts and criticisms online about the fraught state of life in his home country in recent years, Gebregziabher’s family was quite concerned for his safety while in the country.

“I flew into Addis, and I didn’t want to leave the airport and go into the capital because that is where the government is mainly,” he said. “I had a little bit of fear for the two hours I was at the airport, but I was able to make a connection flight to Mekele, the capital city of Tigray. Upon my arrival, I was able to report back to my U.S. contacts that I was safe.”

 

Upon arrival, Gebregziabher observed firsthand the devastation wrought by the conflict. Hospitals were either looted or destroyed, and many health facilities remained nonfunctional. Despite these challenges, he also witnessed glimmers of hope, such as the rebuilding of a women’s health clinic, a testament to the resilience of local and international support efforts. 

During his tour of multiple facilities, Gebregziabher met with leaders, established new agreements, conducted trainings and public seminars, all while personally witnessing the devastation caused over the previous five years. 

And then, finally, he was able to visit with his mother, Atsede Mekonnen, whom he hasn’t seen since 2019. 

“I was so concerned about her; my mom is in a very fragile health condition – partly because of age, but also because she wasn’t receiving her medication, so it was a miracle she was alive. I did not expect her to survive the war,” he said. “It was quite a moment. I think she was trying to cry tears of happiness; I broke down, too. That was an emotional moment I will cherish forever.”

Continuing the work

Gebregziabher highlighted three key initiatives from a memorandum of understanding between MUSC and partnering institutions. The partnership provides opportunities for education and research, including efforts to digitize women’s health records, introduce mobile ultrasound technology to the region where greater than 90% of women lack access to prenatal ultrasounds and provide training to develop capacity in both research and clinical care.  

One of the casualties of the war was a Center for Global Health-funded project focused on the development of an electronic health record system for HPV and cervical cancer screening using visual inspection with acetic acid. Data acquired from 300 women pre-war will be compared with that of post-war data to assess the impact of the conflict on cervical cancer diagnoses.

Beyond the research, Gebregziabher is eager to continue his important work. To learn more about Gebregziabher’s experiences and his future plans, join him for his presentation on Sept. 25.