The Ethiopian government’s blocking of aid and essential services, with health facilities in Ethiopia’s northern Tigray region destroyed, is preventing survivors of sexual violence from obtaining essential post-rape care, Human Rights Watch said in a report released today.
The 89-page report, “‘I Always Remember That Day’: Access to Services for Gender-Based Violence Survivors in Ethiopia’s Tigray Region,” documents the serious health impact, trauma, and stigma experienced by rape survivors ages 6 to 80 since the beginning of the armed conflict in Tigray in November 2020. Human Rights Watch highlighted the human cost of the Ethiopian government’s effective siege of the region, which has prevented an adequate and sustained response to survivors’ needs and the rehabilitation of the region’s shattered healthcare system.
“Warring parties in the first nine months of Tigray’s conflict committed widespread sexual violence while deliberately targeting healthcare facilities, leaving survivors and their communities reeling,” said Nisha Varia, women’s rights advocacy director at Human Rights Watch. “The government’s effective siege of Tigray since June is doubly victimizing survivors by denying them critical medical and psychosocial – mental health – support.”
The African Union, the United Nations, and international donors should press the Ethiopian government and all parties to the Tigray conflict, including the Tigray People’s Liberation Front (TPLF), to halt abuses, allow rapid and unimpeded access to aid throughout northern Ethiopia, and support international investigations into alleged abuses.
Human Rights Watch interviewed 28 health and aid workers, donors, and sexual violence survivors and witnesses. Human Rights Watch also reviewed 43 additional individual cases of sexual violence in Tigray, documented through anonymized medical and intake notes from service providers, and conducted telephone and written interviews with Tigray regional authorities. Human Rights Watch sent a summary of findings and requests for information to Ethiopian federal authorities, but did not receive replies.
The Tigray conflict has resulted in widespread reports of sexual violence in areas controlled by Ethiopian and Eritrean federal forces, and regional Amhara militias, including rape, gang rape, sexual slavery, and torture, often accompanied by killings of family members, beatings, and degrading, ethnic-based slurs. Tigrayan fighters have been implicated in rape, killings, and other abuses against Eritrean refugees in the region, and against Amhara civilians in the Amhara region.
Human Rights Watch found that the healthcare needs of sexual violence survivors have included termination of pregnancy, treatment for HIV and Hepatitis B, and care for broken bones, stab wounds, and traumatic fistula. Survivors also sought support for depression, anxiety, and post-traumatic stress.
“One day Ethiopian military men came to the hospital with a [teenage] girl,” said a doctor working in a hospital in an urban center. “We checked her and found that she was pregnant. She was one of the sex slaves in the Gereb Giba military camp [near Mekelle, the regional capital].”
The doctor said that she had hepatitis: “With her consent we terminated her pregnancy. Gave her anti-hepatitis drugs. After that quite a lot of women and girls were coming in, seeking medication, and to terminate their pregnancies, raped by conflict actors, mainly by Eritrean troops and Ethiopian forces.”
During the first nine months of the conflict, Ethiopian, Eritrean, and Amhara forces pillaged and destroyed health facilities in Tigray. This, along with the presence of soldiers at checkpoints on the roads and near or inside health facilities, prevented survivors, especially from outside urban areas, from getting treatment within the critical 72-hour window to prevent pregnancy and HIV. A humanitarian aid provider said that of the sexual violence cases handled by their agency, “more than 80 percent of victims and survivors didn’t present [themselves] within the 72-hour window.”
After Ethiopian authorities declared a unilateral ceasefire in late June, the government besieged the region, including blocking food, medicines, cash, and fuel, in violation of international humanitarian law, which has stymied the recovery of health services.
Aid agencies have been unable to establish and scale-up a response that meets international standards, Human Rights Watch said. Any expanded response will need to fill the massive gaps including the need for community-level outreach and support, creation of “safe spaces” for women and girls, availability of clinical management of rape, mental health, and psychosocial support services, and access to specialized care. All services should be accessible and take into account the particular requirements and circumstances of people with disabilities, men, older people, and children. Healthcare providers, who have treated and worked with distressing cases with little support amid enormous challenges, should also receive mental health support.
The scale of sexual violence against women and girls in Tigray, ongoing abuses, and harm against survivors by federal government actions, as well as sexual violence by Tigrayan forces against Amhara civilians in the Amhara region, point to the need for the UN Human Rights Council to establish an independent investigation into conflict-related abuses, including the obstruction of aid, Human Rights Watch said.
“One year since Tigray’s devastating conflict began, survivors of sexual violence – from gang rape to sexual slavery – remain in desperate need of health care and support services,” Varia said. “Not only have Tigrayan women and girls experienced horrific abuses, they are confronting shortages of food, medicine, and other desperately needed support to rebuild their lives.”