When two police officers entered the emergency room in Addis Ababa, Ethiopia’s capital, in the middle of May, Tewodros* was treating patients there.  , Earlier that same month, the doctor had participated in a public sector health workers ‘ strike, protesting poor working conditions and low pay.
The government had immediately declared the strike unlawful, causing a contentious standoff among the nation’s health professionals. The emergency room where Tewodros was working was one of the places where that played out.
Tewodros claims that the officers had no justification for their questioning of him. They grabbed him and pulled him out of the ward. His coworkers tried to intervene, but the police ignored them and took him to a nearby station, where he spent more than three weeks detained.
“That was the moment I felt helpless. When I first described the incident, Tewodros told Al Jazeera, “I was ashamed of my country.”
His detention was only the beginning of his ordeal. He claims that 15 other people crammed into him. They weren’t permitted to wash, and he never got to see or speak with his family. Ethiopia’s police contacted them for a response to the accusations, but they did not respond.
The strike was led by the Ethiopian Health Professionals Movement (EHPM), a loose collective of doctors that had formed in 2019. A 12-point list of demands to the government was released on May 19 that included requests for better working conditions, fair pay, health insurance, and transportation. When the deadline passed with no meaningful engagement from authorities, hundreds of doctors began walking out of hospitals across the country.
Rights groups claim that the Ethiopian government used “repressive tactics” against the injured doctors, arresting 47 people nationwide in a few days and dozens more in the coming weeks.
Tewodros was one of more than 140 doctors arrested in a sweeping crackdown in May and June, according to the EHPM. To track their arrested colleagues, how long they were detained for, and when they were released, they created a website called Health Voice Ethiopia.
All the doctors have since been released, and the strikes have ended following a government promise to address their concerns, though no concrete commitments have been made, the doctors say.
The government should stop berating and locking up healthcare workers and their representatives, Human Rights Watch’s director of Horn of Africa, said. “The government should finally engage with them in a meaningful dialogue about their complaints.”
Ethiopia’s federal police said the detained doctors had organised an “illegal strike” and accused them of endangering patients ‘ lives.
paid $60 per month
Ethiopia’s doctors are among the lowest-paid in East Africa, according to World Bank figures, with some earning as little as $60 a month, compared with neighbouring Kenya, where doctors expect to be paid closer to $1, 800.
One Ethiopian pathologist who worked in Hargeisa, the self-declared republic of Somaliland, claimed her $2,500 monthly salary was enough to cover the expenses of 20 of her coworkers in the country. She was later arrested.
Doctors have reported having trouble paying for their own medical expenses, including food, transportation costs, and living expenses.
Al Jazeera interviewed half a dozen doctors – some of whom were arrested for participating in the strike – who cited biting inflation, stagnant wages and extremely difficult working conditions as having pushed them to take industrial action.
According to one doctor, he uses what he calls “side hustles” like content creation for local businesses, where he claims to spend far more than two-thirds of his $73 monthly salary on rent. Other doctors, he added, work at pharmacies and even as Uber drivers to make it through the month.
He claimed that, “I am not really able to take care of myself, let alone consider a family.” “I struggle to travel to work, it is hard to eat, and being a doctor isn’t a job that leaves much time. Simply put, we must work incredibly hard to survive. We had higher expectations”.
In recognition of their difficulties, Prime Minister Abiy Ahmed claimed in June that his government was aware that doctors are “being crushed by life.” But he accused those striking of being “political opportunists” and “politicians in white coats”.
Since last year, Ethiopia’s currency was floated, sharply lowering the value of wages as a result of rising consumer prices in the capital. Ethiopia’s currency, the birr, hit an all-time low of 174 to the US dollar in black markets in July, a sign that despite reassurance from the central bank that inflation would subside, the economy remains fragile.
The country is also recovering from COVID-19’s combined effects, which, according to one report, are expected to cause economic damage of nearly $ 125 billion by 2027 as a result of a devastating two-year conflict in the northern Tigray region.
These overlapping crises have placed immense strain on Ethiopia’s already fragile public services, and the health sector is among the hardest hit.
30-hour shifts, fixed salaries
The effects of inflation and currency depreciation have been particularly severe for the country’s doctors, who are paid fixed and paid in birr, and many of them find themselves unable to even meet their most basic needs.
When they arrive at work, they often face long, gruelling shifts as long as 30 hours in some cases, are understaffed, and lack the equipment needed to carry out their duties.
The Ethiopian healthcare system attempted to address a previous shortage of qualified doctors, but its roots date back to that time. In 2003, Ethiopia had 0.26 physicians per 10, 000 people, lower than Kenya, which had 1.38 doctors per 10, 000 and Eritrea which had 0.42.
Meles Zenawi, a former medical student himself, then took over the presidency, promising to push for the expansion of health insurance and access to doctors as well.
The government adopted a “flooding policy” to address the shortage, rapidly increasing enrolment in medical courses and expanding the number of medical schools in the country.
The policy was successful, according to World Health Organization (WHO) figures, increasing the country’s doctors’ total from an estimated 1, 936 to 18, 413 in a decade.
Yet, despite the significant increase in the number of doctors during those years, successive governments have been unable to raise doctors ‘ salaries to competitive levels, in a country that already ranks among Africa’s lowest in gross domestic product per capita. The real value of doctors’ salaries has steadily decreased as a result of a health sector that is heavily reliant on aid and a high inflationary period.
Mulugeta Gebrehiwot, an Ethiopia researcher at the World Peace Foundation, said the government has shifted its focus to “vanity infrastructure projects”, such as reshaping the capital’s skyline, abandoning the development ethos of earlier administrations. He told Al Jazeera, “They’re more focused on the way things look.”
More money can be made for truck drivers.
“This was the only way to make our voices heard”, Tewodros said about the strikes. He stated that the country’s service sector offers better-paying positions and that he is now seriously considering leaving the medical field.
“One of my relatives is employed as a truck driver and earns about $250 per month, which is more than three times my salary as a medical doctor”.
Dagwami Mulugeta, a doctor who fled Ethiopia during the sweeping arrests in May, has since settled in the US. He left shortly after two friends of his were arrested and his Facebook profile was hacked, fearing he would be next due to his role in organising and supporting the strike.
He told Al Jazeera, “We have to make such a huge sacrifice, and we end up being unpaid fairly and having to struggle to cover basic costs,” and that he and many of his fellow workers feel unpaid for their labor.
Many doctors leave the country, and those who do not go abroad leave the job, he added.
He claimed that doctors who worked 36-hour shifts and had little to no sleep when they first started practicing medicine had to use outdated equipment. This triggered strikes back then, which helped reduce their hours to 30 per week in most government hospitals, but without significant changes to their salaries.
According to Dagwami, “there were some improvements, but overall the conditions for doctors didn’t improve enough.”
Lulit* is a doctor who left medicine for humanitarian work. She recalled the 2019 strikes she took part in saying, “There was more hope back then.” She said many doctors had expected Prime Minister Abiy – who had branded himself as a reformist at the time – to meet their demands. Doctors were disappointed and their issues were left untreated, she said, “but there was a compromise.”
The most prominent doctor arrested in the strikes was Daniel Fentaneh, a resident in gynaecology and obstetrics and a lecturer at Bahir Dar University in northwest Ethiopia, who was detained at the end of June and is regarded by some of his colleagues as a Che Guevara-like figure.
He was charged with “inciting, mobilizing, and organizing” and played a significant role in organizing his colleagues during the strikes.
Rights groups like Amnesty International called for his “unconditional release”, which followed 27 days later. However, his arrest was a “shameful betrayal of justice and conscience,” according to the EHPM, and it severely affected the morale of his fellow doctors.
We don’t want to leave our jobs, we say.
A 2020 study by a group of Ethiopian academics found that just more than half of Ethiopian doctors were satisfied with their jobs, while only 6.8 percent of those surveyed said they were satisfied with their income. According to another study conducted in 2022, roughly six out of ten doctors in the nation were considering leaving their jobs.
Ethiopia allocated 8.3 percent of its budget to healthcare in 2023 and 2024, an increase from the previous year. The real value of this allocation has decreased, according to the UN Children’s Fund, which is UNICEF. It also remains well below the 15 percent target set by the 2001 Abuja Declaration, in which African Union countries pledged to allocate that share of their national budgets to health.
This makes staff recruitment and retention issues even more difficult.
Ethiopia was lauded for the dramatic expansion of its healthcare system in the early 2000s, led by then health minister Tedros Adhanom Ghebreyesus, who later became director-general of the WHO. Between 1990 and 2013, maternal deaths per 100, 000 live births decreased from 1, 400 to 420, and the share of facility births increased from 5 percent to 48 percent between 2000 and 2019.
But for a new generation of medical professionals, the legacy of that progress sits uneasily alongside new realities. Dagwami, who just finished his training, claims to be aware of many doctors who have left their fields to work in more lucrative fields, including social media management and starting their own businesses.
“Doctors are passionate about their work”, he said, “and we don’t want to leave our jobs. However, these working conditions put our patients at risk and make life difficult for them. It isn’t good for anybody”.
In a meeting with a select group of health workers in late June, Abiy attempted to strike a delicate balance between outlining their “valid concerns” about salaries and launching verbal attacks on those who took industrial action. The prime minister said the striking doctors do not understand what it means to provide a service or how to build a nation. He claimed that “these are people who reduce everything from high schools to science museums,” referring to his contemporaries.
Dagwami said “witnessing the condescension, public belittling, and imprisonment of dedicated professionals was one of the most heartwrenching and unparalleled experiences of my life”.
Doctors made an effort to be “concouraging” and “solutions-oriented,” but he believes the government fell short.
Al Jazeera reached out to the government in Addis Ababa for a response, but received no reply.
The doctors are currently anticipating the government’s response to a pledge to address the concerns they have raised. But on the Health Voice website – that was set up to track the arrests and release of their colleagues – a clock steadily ticks down.
They have pledged to resume the strike if their concerns are not addressed before the deadline.
Source: Aljazeera
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