How a doctor’s strike became a national reckoning

When Dr. Daniel Fentahun—a Bahir Dar gynecologist affectionately known as ‘Dr. Debol’ by his patients—was arrested in June for allegedly inciting healthcare strikes, his case became a flashpoint in Ethiopia’s growing standoff between medical professionals and the state. On one side are doctors raising alarm over low wages and unsafe conditions.

On the other hand is a government citing risks to public safety and loss of life. As courts continue to extend Dr. Daniel’s remand, a difficult question hangs in the air: how far can a health system stretch before those within it are treated as threats for speaking out?

Oath Reexamined

Doctors in Ethiopia begin their careers by reciting the Hippocratic Oath[i]—a promise to always put the health and well-being of patients first. In public imagination, this oath means they must always show up, no matter how dire their own circumstances. But that interpretation is only half the story.

The oath also implies a reciprocal duty: if society expects doctors to give everything, then society must ensure they’re not exploited in return. A contract can’t be moral if only one side is bound to honor it. In Ethiopia, that contract has been broken.

Critics argue that walking off the job is unethical, even dangerous. But ask the doctors enduring 30-hour shifts, working without gloves, unable to afford lunch, and many will tell you: staying silent is what really feels immoral.

Ethical Crossroads

This conflict is more than emotional—it’s philosophical. From a deontological point of view, doctors must never abandon patients, full stop. But a utilitarian perspective suggests that short-term disruption, like a strike, could ultimately save far more lives by forcing systemic reform.

Neither view is wrong—but neither is complete on its own. The Hippocratic Oath is not a suicide pact. Ethics isn’t just about avoiding immediate harm—it’s also about preventing long-term collapse. Overworked, underpaid doctors are more prone to fatal errors. And a system that continuously loses its best-trained staff is bleeding out slowly, even in the absence of a strike.

Ethiopia ranks among the top five countries in Africa for medical brain drain, despite having one of the continent’s lowest physician densities: just 0.1 doctors per 1,000 people, as of 2020. For context, the World Health Organization recommends a minimum of 4.45 physicians per 1,000 people to meet basic health needs. In other words, Ethiopia is losing doctors it can’t afford to lose—and every resignation or emigration is a symptom of a deeper disease.

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The claim that “doctors should never strike” doesn’t hold up to history. In the UK, junior doctors have staged walkouts to demand safer conditions, and while controversial, the result was often reform that improved care. South African doctors have done the same, using symbolic protests that gained public sympathy and forced government action.

The real danger is pretending that doing nothing is harmless. Every day under this current system, patients die because hospitals are understaffed, surgeries are delayed, and diagnostics are unavailable. Some deaths make headlines during a strike; others fade silently into background statistics the rest of the time.

To strike, in this case, is not a desertion. It’s a distress call.

Systemic Hypocrisy

The Ethiopian Constitution, adopted in 1995, explicitly protects the right to protest. Article 37 guarantees freedom of assembly and demonstration, while Article 29 upholds freedom of expression, and Article 30 affirms the right to access information—each reinforcing the legal foundation for peaceful civic action.  International treaties like the International Covenant on Economic, Social and Cultural Rights (ICESCR), which Ethiopia has ratified, affirm that even workers in “essential services” have a right to strike—so long as minimum services are maintained.

But Ethiopia’s labor law says otherwise. Under the Labor Proclamation No. 1156/2019, healthcare strikes are explicitly prohibited. Article 158(3) states that the right to strike does not apply to workers and employers engaged in undertakings listed under Article 137(2). That article classifies hospitals, clinics, dispensaries, and pharmacies as providers of essential services—thereby restricting their employees from exercising the right to strike. The justification? That such actions pose too great a risk to public health.

Yet here’s the hypocrisy: other sectors widely regarded as “essential” in both Ethiopia and elsewhere, such as public transportation, often strike with little or no legal backlash. Taxi drivers in Addis Ababa have staged repeated protests that paralyzed the city, but they were not met with the same legal backlash or moral outrage that doctors now face. Why is it only healers who are expected to suffer in silence?

Let’s talk numbers. Ethiopia spends around 1% of its GDP on healthcare. Compare that to its military spending, or the privileges extended to officials—chauffeurs, per diems, international medical care. Meanwhile, most medical practitioners earn less than the equivalent of $200 a month—less than what many government drivers make.

If a doctor is punished for striking, shouldn’t those who created the conditions that forced the strike be held accountable too?

The crisis is not just about pay—it’s about priority. And right now, the system prioritizes the powerful over the sick and the people who care for them.

Paths to Reform

So, what can actually be done? This doesn’t have to be a zero-sum standoff. Both the government and Ethiopia’s medical community have real choices—if they choose wisdom over war.

The government, for one, could start by negotiating what are known as “Minimum Service Agreements,” a model used in places like South Africa and several European countries. These agreements ensure that during strikes, critical emergency services still function—preserving life while allowing protest.

To keep talks fair and depoliticized, neutral mediators like the World Health Organization or International Labor Organization could intervene to help both sides reach a workable compromise.

Beyond the immediate crisis, deeper structural reform is urgently needed. Ethiopia committed to the Abuja Declaration, which recommends dedicating at least 15% of national budgets to healthcare. That promise remains largely unmet. Reaching that target could transform public hospitals and restore public trust.

Doctors, too, can escalate their protest without endangering lives. Across the world, physicians have turned to silent “white coat” vigils—standing in their uniforms outside hospitals to quietly demand justice. Some have launched “data strikes,” refusing to fill out non-clinical paperwork to gum up bureaucracy without touching patient care.

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Others have turned to storytelling, flooding social media and press interviews with tragic but true accounts of patients lost to a system that failed long before any strike began. These testimonies put the real blame where it belongs—not on doctors, but on decision-makers.

And then there’s the public. Civil society has a crucial role to play in shifting the narrative from blame to solidarity. When patients and families join hands with health workers—through campaigns like We Stand With Our Healers—it becomes harder for the state to paint doctors as villains. Instead, the conversation shifts toward what it should have been all along: how to fix a system that’s failing everyone, not just those in white coats.

A National Reckoning

Let’s reframe the question. This isn’t “doctors vs. patients.” It’s a failing state vs. its people.

A system that forces healers to choose between starvation and abandonment isn’t just broken—it’s morally inverted. Ethiopia’s doctors aren’t abandoning their oath; they’re sounding the alarm before the entire ship sinks.

It’s time for Ethiopia’s leaders to act—not with threats or arrests, but with urgency, reform, and respect. And it’s time for the international community to stop applauding frontline heroism while funding systems that make heroism necessary just to survive.

Faith leaders—who still carry moral weight in Ethiopia—must also speak up. Silence from the pulpit, in the face of this crisis, is complicity.

Because when doctors must protest just to survive, it’s not just their promise that’s broken. It’s the nation’s promise to its own people.

[i] Oath of Medical Doctors in Ethiopia (English Translation): Today, upon receiving my Medical Doctorate, I solemnly pledge to dedicate myself to the service of humanity, with a clear conscience and in accordance with the highest standards of medical ethics. I commit to caring for my patients to the best of my abilities, using my knowledge and skills to heal and alleviate suffering. I vow never to misuse my medical expertise to cause harm, and to uphold the sacred trust of patient confidentiality at all times. I will treat all individuals with respect, without bias or discrimination based on race, ethnicity, socioeconomic status, or any other factor. I will provide care with integrity, in good faith, and with unwavering commitment—always putting the welfare of my patients first. I make this oath in the name of God and before this esteemed council, pledging to uphold these principles throughout my medical career.

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While this commentary contains the author’s opinions, Ethiopia Insight will correct factual errors.

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