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Global Health Now discusses the sexual assaults taking place in Ethiopia

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Global Health Now discusses the sexual assaults taking place in Ethiopia

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https://globalhealthnow.org/2022-01/ethiopian-feminists-mission-help-sexual-assault-survivors

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Ethiopian Feminists on a Mission to Help Sexual Assault Survivors

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After conflict flared across Ethiopia’s Tigray region in November 2020, hundreds of women reported they’d been raped and sought care at a clinic in Mekele, the region’s capital city—leading to a surge in international media coverage of sexual violence in Tigray.

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"Human Rights Watch," an international non-governmental organization writes about government’s blocking of aid and essential services

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"Human Rights Watch," an international non-governmental organization writes about government’s blocking of aid and essential services

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https://www.hrw.org/news/2021/11/09/ethiopia-blocking-tigray-aid-harms-rape-survivors

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The Ethiopian government's blocking of aid with health facilities in Ethiopia's northern Tigray region destroyed is preventing sexual violence survivors from getting post-rape care.

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 UN, and international donors should support an international inquiry and press all parties to the Tigray conflict to halt abuses and allow rapid and unimpeded aid access.

(New York) - 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."

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Ethiopia: Blocking Tigray Aid Harms Rape Survivors

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The Ethiopian government's blocking of aid with health facilities in Ethiopia's northern Tigray region destroyed is preventing sexual violence survivors from getting post-rape care. The government's effective siege of Tigray since June is doubly victimizing survivors by denying them critical medical and psychosocial - mental health - support.

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NYT tells the story of Mona Lisa, an Ethiopian woman who survived her sexual assault

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NYT tells the story of Mona Lisa, an Ethiopian woman who survived her sexual assault

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https://www.nytimes.com/2021/04/01/world/africa/ethiopia-tigray-sexual-assault.html

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Rape is being used as a weapon as fighting rages in remote parts of Tigray region. "Even if we had shouted," one woman said, "there was no one to listen."

Wukro General Hospital, north of Mekelle, Ethiopia, in February. Over 500 sexual assaults have been reported at five health centers in Tigray, a senior United Nations official said last week, and the actual figure is likely much higher. Credit... Eduardo Soteras/Agence France-Presse - Getty Images

Mona Lisa lay on a hospital bed in Mekelle, the main city in war-torn northern Ethiopia, her body devastated but her defiance on display.

Named for the iconic painting, the 18-year-old Ethiopian high school graduate had survived an attempted rape that left her with seven gunshot wounds and an amputated arm. She wanted it to be known that she had resisted.

"This is ethnic cleansing," she said. "Soldiers are targeting Tigrayan women to stop them giving birth to more Tigrayans."

Her account is one of hundreds detailing abuses in Tigray, the mountainous region in northern Ethiopia where a grinding civil war has been accompanied by a parallel wave of atrocities including widespread sexual assault targeting women.

A senior United Nations official told the Security Council last week that more than 500 Ethiopian women had formally reported sexual violence in Tigray, although the actual toll is likely far higher, she added. In the city of Mekelle, health workers say new cases emerge every day.

The assaults have become a focus of growing international outrage about a conflict where the fighting is largely happening out of sight, in the mountains and the countryside. But evidence of atrocities against civilians - mass shootings, looting, sexual assault - is everywhere.

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"My case is not unique," said Mona Lisa. "I fought the soldier off. But there are so many women all over this region who were actually raped." Credit... The New York Times

In early December, Ms. Mona said, an Ethiopian soldier burst into the house she shares with her grandfather in Abiy Addi, a town in central Tigray, and ordered them to have sex.

"Please," she recalled her grandfather, an Orthodox Christian, telling the soldier. "This is abnormal and against our religious beliefs."

When her grandfather refused, the soldier shot him in the leg and locked him into the kitchen. Then he pinned Ms. Mona to a sofa and tried to rape her. She fought back, kicking the man in the crotch and briefly grabbing his gun, she said.

But he quickly overpowered her and, after shooting her in the hand and firing warning shots into the floor, issued another ultimatum. "He said he would count to three and if I did not take off my clothes he would kill me," she said.

The soldier fired a volley of bullets that cut through Ms. Mona's right arm and right leg. By the time she got transportation to the Mekelle General Hospital a day later, doctors were forced to amputate the arm.

She is still in the hospital, the bones in one leg still shattered. An uncle at her bedside corroborated her account of the assault on Dec. 4. Ms. Mona, who consented to be identified, called it a calculated act of war.

"My case is not unique," she said. "I fought the soldier off. But there are so many women all over this region who were actually raped."

After months of increasingly desperate pleas for international action on Ethiopia, led by senior United Nations and European Union officials, the pressure appears to be producing results. President Biden recently sent an envoy, Senator Chris Coons, Democrat of Delaware, to Ethiopia for talks with Ethiopia's prime minister, Abiy Ahmed, that lasted five hours.

On Tuesday, addressing Ethiopia's Parliament, Mr. Abiy publicly acknowledged that sexual assault had become an integral part of a war that he once promised would be swift and bloodless.

"Anyone who raped our Tigrayan sisters, anybody who is involved in looting, will be held accountable in a court of law," Mr. Abiy told lawmakers, appearing to implicate his own soldiers. "We sent them to destroy the junta, not our people."

A damaged tank on the outskirts of Mekelle, Tigray's capital city. Months into the war, stories of rape and sexual assault have become a central element in the conflict. Credit... Eduardo Soteras/Agence France-Presse - Getty Images

The "junta" is a reference to the Tigray People's Liberation Front, known as the T.P.L.F., which governed Tigray and now fights under the banner of a new group, the Tigray Defense Forces. The majority of sexual violence accusations in Tigray have been leveled against Ethiopian and allied Eritrean soldiers. But Tigrayan forces may also be guilty of war crimes, the top U.N. human rights official, Michelle Bachelet, said this month.

The war started in November after Mr. Abiy accused the T.P.L.F. of attacking a major military base in a bid to overthrow his government. The T.P.L.F. ruled Ethiopia for nearly three decades until Mr. Abiy came to power in 2018, then retreated to its stronghold in Tigray, where it began to openly defy the new prime minister's authority.

In some ways, the bitter fight is driven by deeply rooted forces - longstanding land disputes, opposing visions over the future shape of Ethiopia, and a rivalry with Eritrea going back decades. But civilians, and particularly women, are bearing the brunt of the most disturbing violence.

Rocks, nails and other objects have been forced inside the bodies of women - and some men - during sexual assaults, according to health workers. Men have been forced to rape their own family members under threat of violence, Pramila Patten, the top U.N. official on sexual violence in conflict, said in January.

"Rape is being used as a weapon of war," said Letay Tesfay of the Tigray Women's Association, which runs a safe house for women in Mekelle. "What's happening is unimaginable."

The epidemic of sexual assault is exacerbated by a collapsing health system. Many victims have contracted sexually transmitted diseases, including H.I.V., doctors say. Demand for abortions and emergency contraceptives has risen.

But outside the main towns of Tigray, most health clinics are shut - some destroyed in fighting, others plundered by soldiers as part of what Doctors Without Borders recently 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."

A damaged home after a confrontation with federally aligned forces in the city of Wukro, north of Mekelle. Credit... Eduardo Soteras/Agence France-Presse - Getty Images

The anguish of victims resonates quietly through the wards of the Ayder Referral Hospital in Mekelle, the region's biggest medical facility.

A doctor specialized in sexual assault said he had received at least three new patients every day since Ethiopian troops 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 had 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 that 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 officers 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 television.

"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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'They Told Us Not to Resist': Sexual Violence Pervades Ethiopia's War

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Rape is being used as a weapon as fighting rages in remote parts of Tigray region. "Even if we had shouted," one woman said, "there was no one to listen." Mona Lisa lay on a hospital bed in Mekelle, the main city in war-torn northern Ethiopia, her body devastated but her defiance on display.

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More detailed personal stories and insight into government response

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More detailed personal stories and insight into government response

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https://www.reuters.com/world/special-report-health-official-alleges-sexual-slavery-tigray-women-blame-2021-04-15/

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ADIGRAT, Ethiopia, April 15 (Reuters) - The young mother was trying to get home with food for her two children when she says soldiers pulled her off a minibus in Ethiopia's Tigray region, claiming it was overloaded.

It was the beginning of an 11-day ordeal in February, during which she says she was repeatedly raped by 23 soldiers who forced nails, a rock and other items into her vagina, and threatened her with a knife.

Doctors showed Reuters the bloodstained stone and two 3-inch nails they said they had removed from her body.

The woman, 27, is among hundreds who have reported that they were subjected to horrific sexual violence by Ethiopian and allied Eritrean soldiers after fighting broke out in November in the mountainous northern region of Ethiopia, doctors said.

Some women were held captive for extended periods, days or weeks at a time, said Dr Fasika Amdeselassie, the top public health official for the government-appointed interim administration in Tigray.

"Women are being kept in sexual slavery," Fasika told Reuters. "The perpetrators have to be investigated."

Reports of rape have been circulating for months. But Fasika's assertion, based on women's accounts, marks the first time an Ethiopian official - in this case, a top regional health officer - has made a sexual slavery accusation in connection with the conflict in Tigray.

In addition, eight other doctors at five public hospitals told Reuters that most of the rape victims described their attackers as either Ethiopian government soldiers or Eritrean troops. It was more common for women to report sexual violence by Eritrean soldiers, the doctors said.

The Eritreans have been helping Ethiopia's central government fight the region's former ruling party, the Tigray People's Liberation Front (TPLF), in the conflict plaguing the Horn of Africa nation.

Taken together, the descriptions paint the most detailed picture to date of the sexual violence against women in Tigray and the military's alleged involvement in it.

Most people interviewed for this article declined to be identified. They said they feared reprisals, including possible violence, by soldiers who guard the hospitals and towns.

Ethiopia's Prime Minister Abiy Ahmed acknowledged in a speech to parliament on March 23 that "atrocities were being committed by raping women" and promised that the perpetrators would be punished. He did not identify the alleged perpetrators.

He said then for the first time that Eritrean soldiers had entered the conflict in Tigray in support of the Ethiopian government after the TPLF attacked military bases across the region in the early hours of Nov. 4. Ethiopia's government had previously denied this, and the Eritrean government still does not acknowledge their troops' presence. The TPLF was the dominant power in the central government when Eritrea fought a bloody border war with Ethiopia a generation ago.

Neither the Ethiopian nor the Eritrean governments responded to Reuters' questions about specific cases raised by women and their doctors, or about the accusation of sexual slavery. No charges have been announced by civilian or military prosecutors against any soldiers. However, officials in both countries emphasized that their governments have zero tolerance for sexual violence - a point Abiy's spokeswoman, Billene Seyoum, said the prime minister reiterated recently in discussions with military leaders.

The alleged sexual violence has drawn international attention.

Billene said the United Nations, the African Union and Ethiopia's state-appointed human rights commission have been authorized to carry out joint investigations into alleged abuses by all sides in the conflict. That includes the "criminal clique," she said, referring to the TPLF.

An Ethiopian military spokesman and the head of a government task force on the Tigray crisis did not respond to phone calls and text messages seeking comment. Reuters could not reach military leaders in either country.

Asked about the reports that Eritrean troops have committed rapes in Tigray and are keeping women in sexual slavery, the country's information minister, Yemane Gebremeskel, accused TPLF activists of "coaching 'sympathizers' to create false testimonies."

"All the fabricated stories - which are alien to our culture and laws - are peddled to cover up the crimes of the TPLF which started the war," he told Reuters in a written response.

Reuters was unable to reach a TPLF spokesman.

RECORDS OF ABUSE

Fasika, the health official, said at least 829 cases of sexual assault have been reported at the five hospitals since the conflict in Tigray began.

Those cases were likely "the tip of the iceberg," Fasika said. Rape is underreported in Ethiopia because it carries a huge stigma. Also, most of the region's health facilities are no longer functioning, and travel between towns remains dangerous, he said.

Most of the women who have come forward are either pregnant or sustained severe physical injury from the rapes, Fasika said.

Reuters interviewed 11 women who said they had been raped by soldiers from Eritrea, Ethiopia or both. Four said they were kidnapped, taken to military camps and gang raped, in some cases alongside other women. The women did not know the camp names but said they were located near Mekelle and the towns of Idaga Hamus, Wukro and Sheraro.

Five other women said they were held in fields or deserted houses for up to six days. And two said they were raped in their own homes.

Reuters could not independently verify their accounts. However, all told similar stories of being beaten and brutalized. Healthcare providers confirmed that the 11 women's injuries were consistent with the events they described, and they showed Reuters medical records for three of the women detailing their conditions.

The healthcare providers also shared details of nine other cases of sexual assault, including the ordeals of two 14-year-old girls.

Although Ethiopia's government declared victory over the TPLF in November, fighting continues in some areas, and medical workers say new rapes are reported at the region's health facilities every day.

"This is being done to dishonour the women, to break their pride," said a doctor at Ayder Referral Hospital, in Mekelle, citing the brutality of the attacks and humiliation of victims. "This is not for sexual gratification. The rapes are to punish Tigray."

'TELL MY STORY'

The 27-year-old mother said uniformed soldiers from Eritrea pulled her off a minibus on the road from Mekelle to the city of Adigrat on Feb. 6. They tied her up and marched her through fields to a bush camp, she said. After 11 days of rapes and beatings, she said, the soldiers forced nails, cotton, plastic bags and a rock into her vagina and left her alone in the bush.

Villagers found her unconscious and brought her to a nearby hospital.

She said she was still bleeding from severe internal injuries and could not control her urine, walk without a crutch or sit up for long periods. One leg was broken, she said.

She also described a different kind of pain: While in the hospital, she has no way to speak to her 4-year-old son and 6-year-old daughter because the Eritrean soldiers took her cell phone. She had left the children with her mother to search for food and never returned. At the time, the family had less than a week's worth of bread.

"I don't know anything, if they are dead or alive," she said. "The enemy destroyed my life."

A 32-year-old mother in Mekelle told Reuters that soldiers removed her from a minibus on the same road at the end of February. They were dressed in Ethiopian uniforms, she said, but spoke with an Eritrean accent and had traditional facial scarification typical of the neighbouring country. She said they shot her 12-year-old son dead in front of her, then brought her to a camp where she was held with other female captives and repeatedly raped for 10 days.

"Tell my story," she said. "This is happening to women out there right now. I want this to end with me."

A 28-year-old house cleaner said soldiers grabbed her from a street in Mekelle on the afternoon of Feb. 10 and took her to a field outside a military base where she was raped by more than 10 men wearing Ethiopian or Eritrean uniforms.

Wiping away tears, she said that during her two-week ordeal, soldiers doused her with alcohol and mocked her as they assaulted her. She escaped when her captors were distracted by gunfire, she said.

SHOT FOR RESISTING

The government has set up a task force separate from the human rights commission to investigate the reports of sexual violence. Its head, Mebrihit Assefa, said the body includes representatives from the regional health bureau, the attorney general's office and federal police.

The task force plans to set up five centers where rape survivors can file reports with law enforcement and receive medical and psychosocial support.

"Our prosecutors (and) police officers are there to investigate all crimes committed, including sexual violence," said Awol Sultan, a spokesman for the attorney general's office.

He did not respond to questions about the women alleging they were raped during captivity, or whether prosecutors were in touch with either the Eritrean or Ethiopian militaries. The results of the criminal investigations will be released publicly at an unspecified date, he said.

Abera Nigus, the head of Tigray's justice bureau, said the legal process was likely to be complicated because most courts are not functioning in Tigray, and many rape victims cannot identify their assailants.

Knowing their rapists are still at large also has discouraged women from seeking help, doctors said.

Many of the women who sought treatment at hospitals had vaginal and anal tears, sexually transmitted diseases and injuries that rendered them incontinent, said the Ayder hospital doctor, an obstetrician gynecologist. The doctor shared notes from 11 cases the hospital had treated involving women raped by soldiers.

One woman had been gang raped on three separate occasions, according to the hospital notes.

Another was five months pregnant when she was raped, the notes indicate. Two 14-year-old girls were sexually assaulted in front of their families. One girl had a hand and foot amputated.

She had been shot for resisting her assailant.

Reporting by Katherine Houreld. Writing by Silvia Aloisi. Editing by Alexandra Zavis and Julie Marquis

Our Standards: The Thomson Reuters Trust Principles.

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Health official alleges 'sexual slavery' in Tigray

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ADIGRAT, Ethiopia, April 15 (Reuters) - The young mother was trying to get home with food for her two children when she says soldiers pulled her off a minibus in Ethiopia's Tigray region, claiming it was overloaded.

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VICE News discusses Ethiopian civil war and the war crimes taking place

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VICE News discusses Ethiopian civil war and the war crimes taking place

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https://www.youtube.com/watch?v=oOIhNSJSE_U

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Escaping Rape and Murder in Ethiopia's Civil War

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This is a great paper from the University of Cincinnati's College of Law that provides a detailed explanation with historical context of the sexual war crimes in Ethiopia.

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This is a great paper from the University of Cincinnati's College of Law that provides a detailed explanation with historical context of the sexual war crimes in Ethiopia.

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https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3858886

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36 Pages Posted: 3 Jun 2021

Date Written: June 2, 2021

Abstract

The human rights crisis in the Tigray region of Ethiopia has grown out of a disagreement between central and regional governments. Even though the immediate causes were related to the discrepancy between Abiy Ahmed's push toward election postponement and new party aka Prosperity Party formation. The root causes go beyond that. The country has been in violent political chaos since it was formed as an imperial state. The ideological difference has got deep. The Abiy's move toward unifying the country was not appreciated by many including Tigray People's Liberation Front (TPLF). It is "the war of vision" between pan-Ethiopians and multi-nation structured Ethiopia as some say.

When Abiy established the "prosperity party", it seems he wants to bring the old Ethiopia as some call it "glorious Ethiopia" which is aimed at by unionists. The major ethnicities, their languages, cultures, identities, economic and political representations have not been reflected in such Ethiopia. Diverse ethnicities have been forcefully marginalized, subjugated, and assimilated to accept the system that does not represent them. The problem starts there. It led to non-ending violence's in the country.

The current violence and human rights crisis in Tigray and across the country are partially grown out of such problems. This paper mainly focused on violence in the Tigray region, the root causes, Abiy Ahmed's political move that causes and turned into civil war, violence, death of thousands, massacres, mass rape, IDPs, refugee crisis, and human rights violation across the country. The discussion starts with a basic historical overview of empire formation, ethnic-based struggles, challenges to federalism, and the way forward. I have forwarded the recommendations that may be considered.

Keywords: Humanitarian Access, Human Right, Law

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human rights crisis in tigray region of ethiopia: the extent of international intervention and pm abiy ahmed’s denial of humanitarian access into the region.

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Human Rights Crisis in Tigray Region of Ethiopia: The Extent of International Intervention and PM Abiy Ahmed's Denial of Humanitarian Access into the Region.

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36 Pages Posted: 3 Jun 2021 Date Written: June 2, 2021 The human rights crisis in the Tigray region of Ethiopia has grown out of a disagreement between central and regional governments. Even though the immediate causes were related to the discrepancy between Abiy Ahmed's push toward election postponement and new party aka Prosperity Party formation.

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Amnesty, another international non-governmental group focused on human rights

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Amnesty, another international non-governmental group focused on human rights

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https://www.amnesty.org/en/latest/news/2021/08/ethiopia-troops-and-militia-rape-abduct-women-and-girls-in-tigray-conflict-new-report/

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Forces aligned to the Ethiopian government subjected hundreds of women and girls to sexual violence

Rape and sexual slavery constitute war crimes, and may amount to crimes against humanity

Women and girls in Tigray were targeted for rape and other sexual violence by fighting forces aligned to the Ethiopian government, Amnesty International said today in a new report into the ongoing Tigray conflict.

The report, 'I Don't Know If They Realized I Was A Person': Rape and Other Sexual Violence in the Conflict in Tigray, Ethiopia, reveals how women and girls were subjected to sexual violence by members of the Ethiopian National Defense Force (ENDF), the Eritrean Defense Force (EDF), the Amhara Regional Police Special Force (ASF), and Fano, an Amhara militia group.

It's clear that rape and sexual violence have been used as a weapon of war to inflict lasting physical and psychological damage on women and girls in Tigray
Agnès Callamard

Soldiers and militias subjected Tigrayan women and girls to rape, gang rape, sexual slavery, sexual mutilation and other forms of torture, often using ethnic slurs and death threats.

"It's clear that rape and sexual violence have been used as a weapon of war to inflict lasting physical and psychological damage on women and girls in Tigray. Hundreds have been subjected to brutal treatment aimed at degrading and dehumanizing them," said Agnès Callamard, Amnesty International's Secretary General.

"The severity and scale of the sexual crimes committed are particularly shocking, amounting to war crimes and possible crimes against humanity. It makes a mockery of the central tenets of humanity. It must stop.

"The Ethiopian government must take immediate action to stop members of the security forces and allied militia from committing sexual violence, and the African Union should spare no effort to ensure the conflict is tabled at the AU Peace and Security Council."

The Ethiopian authorities should also grant access to the African Commission for Human and Peoples' Rights Commission of Inquiry, and the UN Secretary General should urgently send his Team of Experts on the Rule of Law and Sexual Violence in Conflict to Tigray.

Amnesty International interviewed 63 survivors of sexual violence, as well as medical professionals. Twenty-eight survivors identified Eritrean forces as the sole perpetrators of rape.

Widespread sexual violence

The pattern of acts of sexual violence, with many survivors also witnessing rape of other women, indicates that sexual violence was widespread and intended to terrorize and humiliate the victims and their ethnic group.

Twelve survivors said soldiers and militia raped them in front of family members, including children. Five were pregnant at the time.

Letay*, a 20-year-old woman from Baaker, told Amnesty International she was attacked in her home in November 2020 by armed men who spoke Amharic and wore a mixture of military uniforms and civilian clothing.

She said: "Three men came into the room where I was. It was evening and already dark... I did not scream; they gestured to me not to make any noise or they would kill me. They raped me one after the other... I was four months pregnant; I don't know if they realized I was pregnant. I don't know if they realized I was a person."

Nigist*, a 35-year-old mother-of-two from Humera said she and four other women were raped by Eritrean soldiers in Sheraro on 21 November 2020.

She said: "Three of them raped me in front of my child. There was an eight-months pregnant lady with us, they raped her too... They gathered like a hyena that saw something to eat... They raped the women and slaughtered the men."

I don't know if they realized I was pregnant. I don't know if they realized I was a person
Letay*

Health facilities in Tigray registered 1,288 cases of gender-based violence from February to April 2021. Adigrat Hospital recorded 376 cases of rape from the beginning of the conflict to 9 June 2021. However, many survivors told Amnesty International they had not visited health facilities, suggesting these figures represent only a small fraction of rapes in the context of the conflict.

Survivors still suffer significant physical and mental health complications. Many complained of physical trauma such as continued bleeding, back pain, immobility and fistula. Some tested positive for HIV after being raped. Sleep deprivation, anxiety and emotional distress are common among survivors and family members who witnessed the violence.

Sexual slavery and intention to humiliate

Twelve survivors said they were held captive for days and often weeks, and repeatedly raped, in most cases by several men. Some were held in military camps, others in houses or grounds in rural areas.

Tseday*, 17, told Amnesty International that she was abducted by eight Eritrean soldiers in Zebangedena and held captive for two weeks. She said: "They took me to a rural area, in a field. There were many soldiers; I was raped by eight of them... Usually, they went out to guard the area in two shifts. When four of them went out, the rest stayed and raped me."

Blen*, a 21-year-old from Bademe, said she was abducted by Eritrean and Ethiopian soldiers on 5 November 2020, and held for 40 days alongside an estimated 30 other women. She said: "They raped us and starved us. They were too many who raped us in rounds. We were around 30 women they took... All of us were raped."

Eight women also told how they had been raped by Ethiopian and Eritrean soldiers and associated militia near the border with Sudan, as they sought shelter.

Two survivors had large nails, gravel, and other types of metal and plastic shrapnel inserted into their vaginas, causing lasting and possibly irreparable damage.

Soldiers and militia repeatedly sought to humiliate their victims, frequently using ethnic slurs, insults, threats, and degrading comments. Several survivors interviewed by Amnesty International said that the rapists had told them, "This is what you deserve" and "You are disgusting".

Lack of support for survivors

Survivors and witnesses told Amnesty International that they received limited or no psychosocial and medical support since they arrived in the internally displaced persons camps in the town of Shire in Ethiopia, or in refugee camps in Sudan.

Survivors also suffered because medical facilities were destroyed and restrictions imposed on the movement of people and goods, which hindered access to medical care. Victims and their families said they are short of food, shelter and clothes due to the limited humanitarian aid.

On top of their suffering and trauma, survivors have been left without adequate support
Agnès Callamard

Reports of sexual violence were mostly hidden from the outside world during the first two months of the conflict that began in November 2020, largely because of access restrictions imposed by the Ethiopian government and the communications blackout.

"On top of their suffering and trauma, survivors have been left without adequate support. They must be able to access the services they need and are entitled to - including medical treatment, livelihood assistance, mental healthcare and psychosocial support - which are essential aspects of a survivor-centred response," said Agnès Callamard.

"We must see all allegations of sexual violence effectively, independently and impartially investigated to ensure survivors receive justice, and an effective reparation program must be established. All parties to the conflict should also ensure unfettered humanitarian access."

Methodology

Between March and June 2021, Amnesty International interviewed 63 survivors of rape and other sexual violence; 15 in person in Sudan, and 48 remotely on secure telephone lines. Amnesty International also interviewed medical professionals and humanitarian workers involved in treating or assisting survivors in the towns of Shire and Adigrat, and in refugee camps in Sudan, about the scale of sexual violence and for corroborating information on specific cases.

In May, the Ethiopian authorities announced that three Ethiopian soldiers had been convicted and 25 others indicted for rape and other acts of sexual violence. However, no information has been made available about these trials, or other measures to investigate and to bring those responsible to justice.

Amnesty International wrote to Ethiopia's Office of the Prime Minister, the Office of the Federal Attorney General and the Minister of Women, Children and Youth, to Eritrea's Information Minister and a senior advisor to President Isaias Afwerki on 26 July 2021 requesting a response to the organization's preliminary research findings, but had not received a reply at the time of publication.

Since fighting began in the region on 4 November 2020, thousands of civilians have been killed, hundreds of thousands of people have been internally displaced within Tigray, and tens of thousands of refugees have fled to Sudan.

Note: *Names have been changed.

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Ethiopia: Troops and militia rape, abduct women and girls in Tigray conflict - new report

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Forces aligned to the Ethiopian government subjected hundreds of women and girls to sexual violence Rape and sexual slavery constitute war crimes, and may amount to crimes against humanity Women and girls in Tigray were targeted for rape and other sexual violence by fighting forces aligned to the Ethiopian government, Amnesty International said today in [...]

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A chance for survivors to tell their stories

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A chance for survivors to tell their stories

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https://ifex.org/ethiopias-rape-survivors-tell-their-stores/

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Ethiopia’s rape survivors tell their stories - IFEX

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A Human Rights Watch report outlining the health impacts of conflict-related sexual violence in Tigray documents the harrowing experiences of rape survivors in the Tigray conflict.

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In November 2021, BMJ Global Health published this study. They review the current crisis and present data regarding the country's health care system.

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In November 2021, BMJ Global Health published this study. They review the current crisis and present data regarding the country's health care system.

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https://gh.bmj.com/content/6/11/e007328

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Abstract

The war in Tigray region of Ethiopia that started in November 2020 and is still ongoing has brought enormous damage to the health system. This analysis provides an assessment of the health system before and during the war. Evidence of damage was compiled from November 2020 to June 2021 from various reports by the interim government of Tigray, and also by international non-governmental organisations. Comparison was made with data from the prewar calendar year. Six months into the war, only 27.5% of hospitals, 17.5% of health centres, 11% of ambulances and none of the 712 health posts were functional. As of June 2021, the population in need of emergency food assistance in Tigray increased from less than one million to over 5.2 million. While the prewar performance of antenatal care, supervised delivery, postnatal care and children vaccination was 94%, 73%, 63% and 73%, respectively, but none of the services were likely to be delivered in the first 90 days of the war. These data indicate a widespread destruction of livelihoods and a collapse of the healthcare system. The widespread use of hunger and rape during the brutal war and the targeting of healthcare facilities seem to be key components of the war. To avert worsening conditions, an immediate intervention is needed to deliver food and supplies and rehabilitate the healthcare delivery system and infrastructure.

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Summary box

Large-scale full-fledged civil wars, such as the one in Tigray where foreign forces from Eritrea were involved, cause significant infrastructural damage, and enormous consequences on the physical, mental and psychosocial health of millions of people.

This is the first analysis to report the damage comprehensively and systematically to the health system in Tigray because of the ongoing war in Tigray.

The war has led to unprecedented and significant attrition of health workers, reduction in maternal and child health services and increase in rates of malnutrition, burden of infectious and non-infectious illness and gender-based violence.

The proper quantification of infrastructural damage and, measurement of key indicators in comparison to the prestate situation is critical to the short, medium and long-term postwar recovery and reconstruction plans.

Introduction

Tigray is one of the ten regional states of Ethiopia, with a population of 7.3 million in 2021 based on the 2007 Ethiopian housing and population census. 1 Since 4 November 2020, the Tigray regional state in Northern Ethiopia has faced a devastating armed conflict. 2 The occupying forces that entered and ravaged Tigray via military campaign (hereafter referred to as Ethiopian government allied invading forces unless mentioned individually) are the Ethiopian National Defence Forces ENDF (from east, southeast and south), Amhara special forces and Amhara militia (south and southeast), and Foreign Eritrean army (across the northern border). The forces fighting on behalf of the Tigray Regional government and people are called Tigray Defence Forces (TDF). 3 As a result of the war, it is estimated that more than 52 000 civilians have been killed, 2.3 million people displaced, while 70 000 people have crossed to the neighbouring Sudan in the first 3 months of the war. 3 In addition, 7 months in to the war, the World Food Programme reported that 91% of the region's population required emergency humanitarian assistance. 4 Many have reported that the deliberate destruction, vandalisation and looting of the entire health system have been the hallmarks of the ongoing conflict. 2 5 6

In this analysis, we examined the extent of the health system collapse between November 2020 and June 2021 (the war is still ongoing) and made comparisons with the previous year (prewar state). The Global Society of Tigray Scholars and Professionals 7 brought together the members of this team and helped to coordinate the activities to compile evidence on the extent of the health crisis due to the war. Accordingly, we: (1) reviewed reports from the Tigray Regional Health Bureau (the then Tigray interim administration) and (2) mapped opinion pieces, press releases and humanitarian situation updates from major multilateral organisations such as from the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), UNICEF, WHO, USAID, from November 2020 to June 2021. We then compared the current status (during-war) with the 2019 health performance of the region (prewar). The prewar data we used for comparison were obtained from: (1) unpublished 2019 report of the Tigray regional Health Bureau 8 and (2) latest Ethiopian Demographic and Health Survey report. 9

From the above data sources, we compiled: (1) functional status of health facilities, (2) functional status of ambulances, (3) number and employment status of health workers, (4) antenatal care (ANC), (5) delivery care, (6) postnatal care, (7) immunisation, (8) malnutrition, (9) food insecurity, (10) rape and gender based sexual violence, (11) non-communicable diseases (NCDs), (12) chronic infectious illnesses and (13) outbreak status of selected ailments. We then categorised the status of healthcare performance into four main themes: attacks on healthcare facilities and the attrition of health workers; the maternal and child health services and malnutrition; chronic non-infectious and infectious diseases and outbreaks; and gender based sexual violence and rape.

Attacks on healthcare facilities and attrition of health workers

Before the war, Tigray had three tiers of health system: primary healthcare unit which includes health posts, health centres and primary hospitals; secondary care provided by general hospitals; and tertiary care served by specialised referral hospitals. There were two specialised hospitals, 16 general hospitals, 29 primary hospitals, 233 health centres and 712 health posts in the region. A health post, staffed by two community health extension workers (HEWs) implementing the health extension programme (HEP), is the lowest health institution structure in the rural areas and is designed to serve one kebele (the smallest administrative unit in Ethiopia). Five Kebeles (five health posts) form a catchment area for a health centre catering to 15 000-25 000 rural or 40 000 urban population.

Prior to the war, there was also a functional healthcare financing system in the region, a system which implemented revenue retention used at health facility level, systematised fee-waiver system for the poor, standardised exemption services, set and revised user fees, introduced a private wing in public hospitals, outsourced nonclinical services and promoted health facility autonomy through the introduction of a governance system. Health information systems, electronic records of patient data, were also functional at each health centre and hospital. There were 280 functional ambulances facilitating the referral system in 2019/2020 of which 59% were serving mothers going into labour. These were fully functional before the breakout of the war.

After the onset of the war, a report by the Health Bureau of the Interim Tigray Administration 10 revealed that the HEP has become completely non-functional. The status of the community HEWs who were in charge of the HEP became unknown, with their salaries completely cut-off, and their safety not guaranteed. This is important due to the rampant incidents of sexual violence in the region, given that almost all HEWs are women. Two-thirds of the Woreda Health Offices in the region became non-functional, while the status of the remaining one third (south Tigray, southeast, western and some part of eastern Zones) is unknown as they were under the control of the occupying Eritrean and/or Amhara forces.

Before the war excluding the two referral hospitals in Ayder (Mekelle) and Axum which are administered by the federal government, there were a total of 19 324 health workers including specialist physicians (69), general practitioner physicians (411), nurses (4402), midwives (1394), pharmacists (296), laboratory specialists (494), health officers (935), public health specialists (43), HEWs (1918), supportive staffs (5344) and others (4018). After the onset of the war, more than 50% of members of the regional health work force were unable to report to their working institutions. 10 The interim government report 10 revealed that a total of 2000 healthcare workers were reportedly registered in internally displaced people camps in the capital city, Mekelle, as of May 2021. As described by several international organizations and media outlets including the MSF 12 the intentional damage of healthcare facilities in Tigray as a potential weapon of war with deliberate destruction and looting has led to displacement of thousands of healthcare workers including death of more than ten workers.

Following the war, the healthcare financing programme (including community-based health insurance) has collapsed completely, and people cannot afford to pay for medical services even when there is access to medical care. 10 The health information system has totally collapsed across the region as majority of the tools such as computers and hard-copy medical records are looted or destroyed. 10 There is an added obstacle against a rapid flow of information as the region still remains in a total internet and other communications blackout.

Maternal and child health services, and malnutrition

Gender-based sexual violence and rape

Sexual violence and abuse, including rape cases appear to be on an alarming scale. The issue has gained international attention and has been widely reported. 20-22 A political figure in United Kingdom, during a debate in the United Kingdom Parliament on Tigray war on 25 March 2021 stated that an estimated 10 000 girls and women were raped in the first five months of the war. 20 The USAID 23 also released a detailed document on its analysis report using a sample of 36 reported incidents of sexual violence among victims including 106 women and girls by 144 different perpetrators during the period of November 2020 and March 2021. The United States Agency for International Development (USAID) report found that 39% of victims reported being raped inside their homes, and 33% of them were gang-raped. 23 Moreover, 44% and 33% of the victims were raped by Ethiopian and Eritrean soldiers respectively, 6% by Amhara Militia, 6% by combinations of Ethiopian and Eritrean soldiers, and 11% did not know who raped them. 23 The New York Times released a story of an 18 years old girl who lost her limbs while defending herself against the perpetrators, identified as Ethiopian and Eritrean solders. 21 Amnesty international 24 revealed that health facilities in Tigray recorded 1288 cases of gender-based violence between February and April 2021. Adigrat Hospital alone recorded 376 rape cases from the beginning of the conflict to the 9 June 2021.

Ongoing responses

As to the role of Tigray's government, as of June 2021, though nominally the regional and zonal governments have returned to their positions, they have to deal with a near total destruction of the health system and are not in a position to completely restore it. In addition, many of the woredas and kebeles are out of reach of the interim government due to the ongoing war. We believe the administrative structure of many health facilities has been restored, and many of the healthcare workers have returned, but the government does not have cash to pay their salaries. In addition, due to the defacto blockade and siege imposed on the region, no medications and medical equipment can enter Tigray and therefore the facilities could not be made functional.

Implications

Tigray, once touted as a region with one of the best healthcare systems in Ethiopia, 9 now has a collapsed healthcare system. The reality facing the people of Tigray is a shattered health system, unknown but scary burden of diseases, unattended trauma due to widespread use of rape as a weapon, displacement crises- all painting a very dire situation. Despite international humanitarian law which states that healthcare facilities ought to be protected during an armed conflict, reports by reputed organisations including MSF, UNOCHA and others indicate that the Ethiopian army, Eritrean army, and Amhara militia deliberately attacked the health facilities and professionals, looted equipment, and converted some of them into military camps. Thus, the complete non-functionality of the HEP and district health offices, the partial or complete non-functionality of 85% of health centres and 70% of hospitals, the limited supply to the functional hospitals and health centres, and the substantial attrition of health workers, ranging from HEWs to specialist physicians, show the total collapse of the health system in Tigray.

The complete non-functionality of HEP has several implications for Tigray, a region which was the first to launch the programme in 2003 and had been one of the best performers in Ethiopia until the outbreak of the war. 9 HEWs were the pillars of the healthcare system contributing significantly to maternal and child health programmes in the region. 26 27 For example, a study in Tigray revealed that HEWs provided family planning related information to 72% of mothers, and ANC, delivery, and PNC services to 44%, 26% and 4%, respectively. 26 The HEWs had critical role in chronic disease management including HIV, tuberculosis and education of personal hygiene. 28

In Tigray, virtually all health posts, three out of four hospitals and four out of five health centres are non-functional as result of the war. The documented widespread destruction of healthcare facilities has profound implications on the healthcare services and the health of the people of Tigray now and in the future. Internal and external displacements of millions living in besieged areas, countless attacks on various medical facilities, and brain drain of healthcare workers are increasing at an alarming rate and will have profound and long-lasting impact on the healthcare delivery system. Above all, the conflict is being increasingly characterised by violations of international humanitarian laws, and disregard for the protection of health workers against international humanitarian laws, leading to further attrition and loss of critical manpower needed for recovery.

Harrowingly, 91% of the total population in Tigray now needs emergency assistance. There have been reports by international media that Ethiopian government allied forces are burning or looting cash crops, are denying farmers the chance to farm their lands and/or collect their harvests and killing or looting their domestic animals including oxen (the backbone of livelihood traditional farming in Tigray), making the future prospects for the region alarmingly dire. Similar reports in other armed conflict areas have also shown the worsening of food insecurity during and after similar atrocities. For example, an estimated 14·4 million people were unable to secure their food needs and about 0.37 million children were suffering from severe malnutrition in Yemen. 29 While the short-term effects of malnutrition are death, failure to thrive and stunting (irreversible height loss), SAM adversely affects educational performance, cognitive development, and negative impacts on broad economic parameters. 30 In sub-Saharan Africa, poor cognitive functioning and increased healthcare costs associated with stunting costs the region about 2%-3% of economic growth. 31 Accordingly, in the long term, we may be looking at an increased financial burden on the region's healthcare system and its economy.

Evidence shows that there is a risk of exacerbation or emergence of new outbreaks during an ongoing war, and our analysis revealed the likelihood of outbreaks such as COVID-19, measles, malaria and other illnesses. Polio in Syria, 32 and cholera in Yemen and Rwanda 33 were examples of outbreaks in armed conflict areas. Our study also found that significant number of NCDs patients were interrupted from their regular follow-up. Discontinuation of regular follow-ups and interruptions in refill of drug of these patients for an extended period carries the risk of disease progression, drug resistance, and increased transmission of disease for communicable illnesses-all potentially leading to death, and therefore can be used as a surrogate for morbidity and mortality.

Finally, we would like to acknowledge that the war is still ongoing and the conflict has expanded beyond the borders of the Tigray region into Afar and Amhara regions. However, the scope of our analysis and discussions is limited to the first 8 months of the war, before June 2021-which mainly involved at that time the Tigray region. The primary and senior authors of this paper, however, have highlighted the issue in the recent piece published at The Conversation. 34

Evidence also shows that there is a lack of post-war baseline data in war torn areas. Recent responses to humanitarian emergencies in Syria, Yemen and Rohingya are some of examples of conflicts of similar nature, even though the scale and intensity of the conflicts vary greatly. 35 36 In Syria and Yemen, there were shortcomings of baseline health system data, weak public health information systems, and interrupted data collection system making the humanitarian response challenging. 35 36 Hence, this study will contribute to Tigray's future recovery plans as a baseline.

Limitations

The assessment of the impact of civil war on health, nutrition and health services are fraught with difficulties. 35 37 Without exception, data and statistics are political and humanitarian tools for all parties directly or indirectly involved in an armed conflict. Massive displacement of people and lack of access to insecure areas are just a few consequences of war that further hamper objective assessment of the situation. The assessment of the situation in Tigray suffers from similar limitations. Yet, the consistency and breadth of information summarised in our paper are an important indication of the devastating impact of the conflict on Tigray' health services and system which was functioning very well prior to the war.

Conclusions

In summary, the loss of healthcare manpower and damaged infrastructure will have a lasting consequence in rehabilitating the healthcare system of Tigray once the war is over. In addition, a complete blackout of communications, as well as complete interruption of electricity, and banking services exacerbates the problem and the ability to accurately understand it-severely limiting the capacity to provide help. Furthermore, the well documented intentional denial of access to international humanitarian aid including food, the widespread use of rape and sexual harassment, possibly as a systemic weapon of war, and the occurrence of widely reported ethnic cleansing and atrocities throughout Tigray pose additional challenges to the healthcare delivery and healthcare systems in Tigray. Co-operative international push to stop the collective punishment of Tigray should be of the highest priority in order to open up basic public services including healthcare.

The focus of WHO for the past several months has been understandably on COVID-19 prevention and control. Maybe as result of that, the health crisis emanating from the Tigray war did not get the necessary attention that it deserves. Even though it was late in happening, WHO has already declared its grave concern about the humanitarian and health crises in Tigray. 38 This implies the need for WHO to apply every effort to support the collapsed health structure in the region. The findings from the current study will strengthen local and international actors' responses to the humanitarian health emergencies amid the protracted conflict. Noting the plight of Tigrayan civilians, individual health professionals and researchers working with children, women and men, and in local, national and global professional medical/public health organisations, should use their powerful collective voices to lobby the Ethiopian and Eritrean governments for enforcement of international humanitarian laws.

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

Acknowledgments

We acknowledge GSTS for bringing together this team of experts to conduct the study and prepare this analysis paper.

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The impact of war on the health system of the Tigray region in Ethiopia: an assessment

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The war in Tigray region of Ethiopia that started in November 2020 and is still ongoing has brought enormous damage to the health system. This analysis provides an assessment of the health system before and during the war.

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Video from Sky News depicting the crisis

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Video from Sky News depicting the crisis

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https://www.youtube.com/watch?v=ECo0sByGmiQ

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Ethiopia violence: Rape as a weapon of war in Tigray conflict

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BBC reveals more brutal crimes that have taken place in Ethiopia 

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BBC reveals more brutal crimes that have taken place in Ethiopia 

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https://www.bbc.com/news/world-africa-58167818

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This article from the Pittsburgh Gazette is a little outdated (Feb 2021), but shows the public's understanding of the events only shortly after they started 

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This article from the Pittsburgh Gazette is a little outdated (Feb 2021), but shows the public's understanding of the events only shortly after they started 

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https://www.post-gazette.com/news/world/2021/02/13/Ethiopian-goverment-determines-rape-has-occurred-in-Tigray-region/stories/202102140143

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Ethiopian goverment determines rape has occurred in Tigray region

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NAIROBI, Kenya - Rape has occurred "conclusively and without a doubt" in Ethiopia's embattled Tigray region, the country's...