called a concerted effort to destroy the region’s health care system. In his meeting with Mr. Abiy in March, Senator Coons said they discussed “directly and forcefully” the reports of widespread human rights violations including rape.

Whether Mr. Abiy delivers on his promise of bringing the perpetrators to justice, he added, “is going to be critical to any successful resolution of this conflict.”

marched into Mekelle on Nov. 28. Some said they had been raped by soldiers in the camps for displaced people on the edge of the city; others were abducted from their homes in rural areas and held for days as soldiers repeatedly raped them.

The doctor, who like several other medics spoke on the condition of anonymity for fear of reprisals from the authorities, produced a list of 18 registered sexual violence patients at the hospital. The youngest was 14. Most said their attackers were soldiers, he said.

In one bed, a 29-year old woman who asked to be identified only by her first name, Helen, trembled as she recounted how Eritrean and Ethiopian troops tied her to a tree near her home in Agula, 15 miles north of Mekelle, and assaulted her repeatedly over a 10-day period in late November.

“I lost count,” she said. “They took photos of me, poured alcohol on me and laughed.” Some of her assailants also shot dead her 12-year-old son, she added.

Selam Assefe, a police investigator working on rape cases at the Ayder Referral Hospital, corroborated Ms. Helen’s account.

Most sexual assault cases in Tigray, however, may not be recorded anywhere. Health workers said that officials are reluctant to register such violence, fearing the military could target them for documenting the crime. Patients often remain anonymous for the same reason.

Filsan Abdullahi Ahmed, Ethiopia’s minister of women, children and youth, insisted that the federal government was taking seriously the reports of sexual violence in Tigray, and had sent a task force including social workers, police and prosecutors to investigate.

While her own mandate was limited to providing victims with psychological support, Ms. Filsan said she had pressured Ethiopia’s attorney general to deliver justice. But it is a difficult process, she insisted.

“I cannot 100 percent confirm whom this is being committed by,” Ms. Filsan said, referring to the perpetrators.

The sexual attacks are so common that even some Ethiopian soldiers have spoken out. At a public meeting in Mekelle in January, a man in military uniform made an outburst that was broadcast on state TV.

“I was angry yesterday,” he said. “Why does a woman get raped in Mekelle city?” The soldier, who was not identified, questioned why the police weren’t stopping them. “It wouldn’t be shocking if it happened during fighting,” he said. “But women were raped yesterday and today when the local police and federal police are around.”

Haben, a waitress in Mekelle, was raped with two other women at the cafe where they work in December, she said. Her body is still covered in bruises from the assault.

“They told us not to resist,” she recalled. “‘Lie down. Don’t shout.’”

But even if they had shouted, she added, “there was nobody to listen.”

An employee of The New York Times contributed reporting from Mekelle, Ethiopia.

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A Collapse Foretold: How Brazil’s Covid-19 Outbreak Overwhelmed Hospitals

The virus has killed more than 300,000 people in Brazil, its spread aided by a highly contagious variant, political infighting and distrust of science.


PORTO ALEGRE, Brazil — The patients began arriving at hospitals in Porto Alegre far sicker and younger than before. Funeral homes were experiencing a steady uptick in business, while exhausted doctors and nurses pleaded in February for a lockdown to save lives.

But Sebastião Melo, Porto Alegre’s mayor, argued there was a greater imperative.

“Put your life on the line so that we can save the economy,” Mr. Melo appealed to his constituents in late February.

Now Porto Alegre, a prosperous city in southern Brazil, is at the heart of an stunning breakdown of the country’s health care system — a crisis foretold.

More than a year into the pandemic, deaths in Brazil are at their peak and highly contagious variants of the coronavirus are sweeping the nation, enabled by political dysfunction, widespread complacency and conspiracy theories. The country, whose leader, President Jair Bolsonaro, has played down the threat of the virus, is now reporting more new cases and deaths per day than any other country in the world.

125 Brazilians succumbing to the disease every hour. Health officials in public and private hospitals were scrambling to expand critical care units, stock up on dwindling supplies of oxygen and procure scarce intubation sedatives that are being sold at an exponential markup.

Intensive care units in Brasília, the capital, and 16 of Brazil’s 26 states report dire shortages of available beds, with capacity below 10 percent, and many are experiencing rising contagion (when 90 percent of such beds are full the situation is considered dire.)

a model for other developing nations, with a reputation for advancing agile and creative solutions to medical crises, including a surge in H.I.V. infections and the outbreak of Zika.

Mr. Melo, who campaigned last year on a promise to lift all pandemic restrictions in the city, said a lockdown would cause people to starve.

celebrated setbacks in clinical trials for CoronaVac, the Chinese-made vaccine that Brazil came to largely rely on, and joked that pharmaceutical companies would not be held responsible if people who got newly developed vaccines turned into alligators.

“The government initially dismissed the threat of the pandemic, then the need for preventive measures, and then goes against science by promoting miracle cures,” said Natália Pasternak, a microbiologist in São Paulo. “That confuses the population, which means people felt safe going out in the street.”

Terezinha Backes, a 63-year-old retired shoemaker living in a municipality on the outskirts of Porto Alegre, had been exceedingly careful over the past year, venturing out only when necessary, said her nephew, Henrique Machado.

But her 44-year-old son, a security guard tasked with taking the temperature of people entering a medical facility, appears to have brought the virus home early this month.

Ms. Backes, who had been in good health, was taken to a hospital on March 13 after she began having trouble breathing. With no beds to spare, she was treated with oxygen and an IV in the hallway of an overflowing wing. She died three days later.

“My aunt was not given the right to fight for her life,” said Mr. Machado, 29, a pharmacist. “She was left in a hallway.”

anti-parasite drug ivermectin as a preventive measure. The drug is part of the so-called Covid kit of drugs, which also includes the antibiotic azithromycin and the anti-malaria drug hydroxychloroquine. Mr. Bolsonaro’s health ministry has endorsed their use.

Leading medical experts in Brazil, the United States and Europe have said those drugs are not effective to treat Covid-19 and some can have serious side effects, including kidney failure.

“Lies,” Mr. Monteiro, 63, said about the scientific consensus on the Covid kit. “There are so many lies and myths.”

He said medical professionals have sabotaged Mr. Bolsonaro’s plan to rein in the pandemic by refusing to prescribe those drugs more decisively at the early stages of illness.

“There was one solution: to listen to the president,” he said. “When people elect a leader it is because they trust him.”

The mistrust and the denials — and the caravans of Bolsonaro supporters blasting their horns outside hospitals to protest pandemic restrictions — are crushing for medical professionals who have lost colleagues to the virus and to suicide in recent months, said Claudia Franco, the president of the nurses union in Rio Grande do Sul.

“People are in such denial,” said Ms. Franco, who has been taking care of Covid-19 patients. “The reality we’re in today is we don’t have enough respirators for everyone, we don’t have oxygen for everyone.”

Ernesto Londoño reported from Porto Alegre. Letícia Casado reported from Brasília.

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Eritrea Agrees to Withdraw Troops from Tigray, Ethiopia Says

NAIROBI, Kenya — After months of denial, Prime Minister Abiy Ahmed of Ethiopia admitted this week that Eritrean troops had been fighting in Tigray, the war-torn northern Ethiopian region where the brutal conflict between pro-government and local fighters has become a byword for atrocities against civilians.

On Friday, under mounting American and international pressure, Mr. Abiy went one step further and announced that the Eritrean soldiers had agreed to go home.

Mr. Abiy’s statement, issued after a meeting with President Isaias Afwerki of Eritrea, offered a faint glimmer of hope amid a stream of horrific reports about widespread looting, massacres and sexual violence in Tigray.

soldiers from Eritrea — even as Mr. Isaias, the dictatorial leader of the notoriously secretive country, denied that his troops were even present in Tigray.

Mr. Abiy flew to meet Mr. Isaias on Thursday, days after an envoy sent by President Biden pressed the Ethiopian leader to halt the carnage, and to reinforce American calls for an immediate withdrawal of Eritrean troops.The United States has publicly called for Eritrean soldiers to be withdrawn from Tigray.

On Friday Eritrea’s information minister, Yemane Ghebremeskel, appeared to confirm Mr. Abiy’s declaration that an Eritrean troop withdrawal had been agreed upon. Public statements from both governments “underline full agreement and consensus on all issues discussed,” he said in a text message after Mr. Abiy had left the Eritrean capital, Asmara.

Mr. Abiy launched a military campaign in Tigray on Nov. 4, accusing rebellious Tigrayan leaders of orchestrating an attack on a major military base and trying to topple the federal government.

As the fighting gathered pace, reports of gross abuses against civilians began to emerge from Tigray. Ethiopian soldiers, allied fighters from ethnic Ahmara militias, and fighters loyal to the Tigray People’s Liberation Front all faced accusations.

But United Nations officials and human rights groups singled out Eritrean troops for many of the worst violations. Last weekend, Mr. Abiy spent five hours in talks with U.S. Senator Chris Coons, who had been sent to Ethiopia by President Biden to convey his alarm at the deteriorating situation.

In a briefing to reporters on Thursday, Mr. Coons said that the talks were “forthright” at times, and that Mr. Abiy had reiterated his promise to investigate human rights abuses in Tigray, including “credible reports of sexual violence as a tool of war.”

But Mr. Abiy has fallen short on such commitments before, Mr. Coons said, and the United States intends to keep up the pressure.

“It’s actions that are going to matter,” he said.

On Friday a State Department spokeswoman welcomed Ethiopia’s announcement, calling it “an important step” toward de-escalation.

In a mark of the impunity that has come to characterize the Tigrayan conflict, Ethiopian soldiers dragged civilians from a bus on a major road in Tigray and executed four of them in front of aid workers from Doctors Without Borders, the group said in a statement Thursday.

a landmark peace deal soon after Mr. Abiy came to power.

The pact earned Mr. Abiy the Nobel Peace Prize in 2019 and helped Mr. Isaias, one of the world’s most repressive leaders, to emerge from international isolation. After the Tigray war erupted in November, though, critics said the two leaders were mostly united by their shared hostility toward the leaders of Tigray.

It was unclear on Friday whether Mr. Abiy’s announcement signaled a potential breakthrough in ending the fighting in Tigray or another feint by two leaders under international pressure.

In his statement, Mr. Abiy said Eritrea had agreed to withdraw its forces “out of the Ethiopian border,” where, effective immediately, Ethiopian soldiers were to assume border guarding duties.

But it was unclear if that included Eritrean troops stationed deep inside Tigray, where many of the worst atrocities have occurred.

Amnesty International has blamed Eritrean forces for the massacre of hundreds of civilians in Axum, a city in northern Tigray. Sexual violence survivors from Tigray have blamed horrific assaults on Eritrean troops.

over 500 rape cases have been reported at five clinics in Tigray, although the actual number is likely far higher.

“Women say they have been raped by armed actors, they also told stories of gang rape, rape in front of family members, and men being forced to rape their own family members under the threat of violence,” the official, Wafaa Said, said.

Exactly how many Eritrean troops are stationed inside Tigray and where is unclear. Much of the region remains out of bounds for aid workers and reporters, and sporadic fighting continues in rural and mountainous areas.

Still, the departure of all Eritrean troops would likely pose a serious military challenge to Mr. Abiy.

The Ethiopian army fractured in the early days of the war, when hundreds and possibly more Ethiopian soldiers defected to the rebel side, according to Western officials. Since then, Mr. Abiy has regained control of a swath of Tigray with help from his allies — ethnic Amhara fighters and soldiers from Eritrea.

Were the Eritreans to leave en masse, some analysts say, government forces might struggle to maintain their grip on the parts of Tigray that they now control.

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