Perilous medicine in Tigray: a systematic review

Area of Science:

• Public Health
• Conflict Studies
• Medical Ethics

Background:

• The Tigray war, beginning November 2020, has devastated regional healthcare infrastructure.
• Existing evidence on attacks against healthcare in Tigray is emerging.
• This review synthesizes available evidence on 'perilous medicine' to identify data sources, subjects, content, and research gaps.

Purpose of the Study:

• To systematically review and synthesize evidence on the impact of the Tigray conflict on healthcare.
• To understand the scope and nature of attacks on health services and personnel.
• To identify outcomes, impacts, and responses related to healthcare during the conflict.

Main Methods:

• Systematic review of literature from MEDLINE, PubMed, CINHAL, Web of Science, and Scopus.
• Inclusion of English documents published between November 2020 and October 2022, with an update in January 2023.
• Data extraction and analysis using Joanna Briggs Institute (JBI) tools and content synthesis.

Main Results:

• Analysis of 41 documents revealed key areas: attacks on health infrastructure/personnel (29 docs), interruption of health services (31 docs), significant health outcomes and humanitarian crises (33 docs), and rebuilding strategies (21 docs).
• Documented impacts include targeted attacks, medical sieges, increased illnesses, and the use of humanitarian aid as a weapon.
• Responses included service improvisation and calls for ceasefire and accountability.

Conclusions:

• Current studies on conflict and health in Tigray show promise but lack methodological quality and diverse subject coverage.
• There is a critical need for further primary research with robust designs and data sources.
• A prioritized research agenda is essential to comprehensively address the health crisis in Tigray.