Whenever you need to upgrade database schemas in more than one installation and your application supports more than one database (even MySQL and MariaDB differ in some details), you need a tool for schema management. And even if you only support one database vendor, it simplifies live because you don't have to create messy custom scripts with raw SQL statements.
Aimeos used the Doctrine DBAL API directly up to 2021.10 LTS but DBAL has a very verbose API and requires a lot of code to do simple things. For example, creating/updating a table usually looks similar to these lines: