“We heard the launching, the heavy artillery, and it went on all morning,” remembers Sara,* former MSF laboratory technician in Midre Genet, in Ethiopia’s Amhara region, next to Tigray. “The same day, we received the first wounded. They kept arriving in waves. On the first two days, we received soldiers – all very young. Then the first civilians came in by the truckload, packed into the back of vehicles.”

At the onset of the military escalation in Tigray in early November, MSF had projects in Amhara and other parts of Ethiopia. Amhara region is not far from Humera, a strategic city in the western part of Tigray that was heavily affected by the fighting.

On 5 November, our team started supporting the Ministry of Health-run health centre in Midre Genet, a remote town that was receiving an influx of people from border areas wounded in the fighting. In just a few hours, our team had to switch from everyday medical project activities to emergency medical assistance for the wounded. In one week alone, MSF and the Ministry of Health staff treated 265 casualties, many of them with severe injuries.  

The fighting shifted to other parts of Tigray region and our team focused on supporting internally displaced people in the region. Sara left Midre Genet soon after the acute fighting, when the influx of wounded reduced.

“When I left the project, there was still a sense of sadness and despair among the MSF team,” she says.

What the team experienced during these first days of clashes had a huge psychological impact on their mental health.

“They saw soldiers and civilians coming in, wounded or dead,” says Kaz de Jong, MSF staff health coordinator. “They had to do triage and make very difficult decisions. It was also hard for the nursing staff, who had to care for the people who had the best chances of survival and leave the others. That is so counterintuitive for their profession. And the sight of blood, suffering and wounds can often leave stressful images.”

The situation is particularly difficult for our Ethiopian colleagues, who have many other concerns. The ongoing fighting make them worry about their own future and that of their country. Some have relatives and loved ones who remained in Tigray and they have had no news from them for weeks due to the complete communication blackout. Many have not heard from some of their colleagues either.

“Some of them were companions for years, and from one day to the next, they just disappeared, fled to other towns or neighbouring countries without any notice,” says Kaz.

“Every day, our Ethiopian colleagues see all these people who have been displaced because of the fighting and who are now living in small settlements around them, huddled together in very bad conditions. And, of course, before the fighting started, COVID-19 had already complicated their lives, preventing most children from going to school and increasing the number of unemployed people that they and their families have to support financially.”

“I cannot be happy, but I can be a bit happier”

MSF provides psychosocial support to all the health workers to help them cope with their traumatic situation. This support ranges from phone calls to physical and psychological activities in the field. In Ethiopia, as in any context of fighting and violence, our teams have benefited from group and individual sessions to help them to better manage their daily stress.

The group workshops on stress management usually take place in five steps.

First, participants are asked to make an inventory of all the things that give them stress. They can be small things, such as family issues, or bigger ones, like the fighting. Then the group chooses the most important stress factor they want to discuss. It can be overwhelming to think about multiple problems at the same time, so we ask them to focus on one to explore in detail so that they can have the structure needed to look into improvements. The third step is to think about what is still functioning well.

“Our intention is not to push the problems aside, but rather to tell the whole story,” says Kaz. “Of course, this does not undo all the dramatic incidents, but looking at the whole story, including all the things that are still functioning well, allows them to be more inclined to look at their problems from a solution-oriented perspective. It takes time, effort and courage but people usually manage to switch, as they do not want to be stuck in unhappiness. At the end of the day, they end up thinking ‘I cannot be happy, but I can be a bit happier’”.

The last two steps involve thinking about how to improve the situation and making an action plan for themselves.  These steps are essential to diminishing the impact of the main issue, which, in this case, is the fighting. Reaching out to friends and colleagues, not only to talk about problems but also to share very simple things in their everyday lives, greatly reduces their stress.

In Amhara region, our team is made up of Ethiopians from different backgrounds. They never mentioned this during the sessions. Instead, they focused on the fact that they had saved lives together, as a team. The guards who helped with the traffic, the physicians who treated the wounds, the nurses who provided the first aid, the lab technicians who carried out the blood tests.

“Everyone had his or her role and they worked together like a smooth machine,” says Kaz. “I must say that I have been in many situations, and the way the team rapidly switched from their previous activities – kala azar, TB treatment, snakebites and clinical trials – to go into a very efficient emergency mode was remarkable. Caring for and treating large numbers of people would not have been possible if they had not been able to do this. The staff are proud of this achievement and they have every right to be proud of it.”

*MSF staff member's name was changed as she requested to remain anonymous.