Combatants in Ethiopia have perpetrated widespread, systematic, and deliberate acts of conflict-related sexual and reproductive violence, according to a new report published today by Physicians for Human Rights (PHR) and the Organization for Justice and Accountability in the Horn of Africa (OJAH).
The new report (“You Will Never Be Able to Give Birth”: Conflict-Related Sexual and Reproductive Violence in Ethiopia) is the most comprehensive study to date utilizing medical evidence to understand the intent of perpetrators in the Tigray region – documenting how Ethiopian and Eritrean armed forces aimed to prevent future Tigrayan births and exterminate the ethnic group – and how impunity for sexual and reproductive violence is enabling further attacks in Amhara and Afar.
PHR and OJAH call on all parties to the conflict to adhere to international law and facilitate rehabilitation of survivors of conflict-related sexual and reproductive violence. The international community must ensure credible, independent documentation of crimes in Ethiopia and advance full accountability for perpetrators.
Researchers analyzed an unprecedented scale of data from across the Afar, Amhara, and Tigray regions of Ethiopia, including 515 medical records of survivors of conflict-related sexual violence; 602 survey responses from health workers who have treated survivors; and 40 in-depth interviews with health workers and four focus groups with professionals who provided care to survivors.
“After triangulating medical records with survey data and interviews of health professionals, we have documented the intent that perpetrators expressed to survivors, including the Ethiopian and Eritrean militaries, to eradicate the Tigrayan ethnic group. The ongoing impunity for years of conflict-related sexual violence in Tigray – enabled by the Ethiopian government and the inaction of United Nations member states – has contributed to conflict-related sexual violence spreading to other regions of the country, including Afar and Amhara,” said Lindsey Green, report co-author and deputy director of research at PHR. “The crimes we’ve documented are harrowing and demand accountability: Perpetrators raping women and holding them in captivity until giving birth; rape by a median of three perpetrators at a time; foreign objects – including stones, nails, hand-written letters – inserted inside of survivors’ vaginas.”
“In the absence of any meaningful forms of justice and accountability, impunity for conflict-related sexual violence is fueling a vicious cycle of lawlessness and recurring conflict in Ethiopia. When perpetrators face no consequences, violence is normalized, survivors are silenced, and peace remains fragile. With conflict currently escalating in Amhara and tensions between Ethiopia and Eritrea rising, breaking this cycle is vital not only for survivors, but for the future of Ethiopia and sustainable peace in the Horn of Africa,” said a report co-author at OJAH (identity not disclosed due to security threats).
Key findings include:
- Intent to destroy reproductive capacity: 73 percent of surveyed health care workers in Tigray treated survivors who reported that perpetrators used language expressing intent to destroy their ability to reproduce or have children.
- Multiple-perpetrator rape:
- In Tigray:91 percent of surveyed health workers reported seeing patients who had experienced multiple perpetrator rape; medical records showed a median of three perpetrators per incident.
- In Amhara: 47 percent of health care workers surveyed reported treating survivors who had experienced sexual violence committed by multiple perpetrators.
- Unwanted pregnancies from CRSV: 90 percent of surveyed health workers in Tigray saw at least a few patients with unwanted pregnancy from conflict-related sexual violence.
- One survivor had a contraceptive implant forcibly removed before sexual violence with the intent to impregnate.
- Foreign objects and CRSV: Medical records and interviews reveal that perpetrators in Tigray inserted objects – stones, nails, hand-written letters with revenge plans citing previous wars – inside of survivors’ vaginas.
- Perpetrator identification:
- In Tigray: 84 percent of health workers surveyed indicated survivors identified members of Eritrean military as perpetrators. 73 percent of health workers surveyed indicated survivors identified members of Ethiopian military as perpetrators; 51 percent indicated Amhara militias and Fano.
- In Amhara: 79 percent of health care workers who were surveyed indicated survivors identified Tigray Forces as perpetrators. 35 percent indicated Ethiopian military and 24 percent indicated Amhara Special Forces.
- In Afar: 33 percent of health care workers who were surveyed indicated survivors identified Tigray Forces as perpetrators; 9.5 percent indicated Eritrean militias.
- Transmission of sexually transmitted infections: Within the medical records reviewed in Tigray, 50 percent of patients tested were positive for STIs and 17 percent were positive for HIV, while the national HIV prevalence rate in Ethiopia is 0.09 percent.
The conflict in Tigray, Ethiopia started in November 2020 between the government of Ethiopia and the Tigray People’s Liberation Front (TPLF), with involvement from Eritrean military forces who were called in to support Ethiopian armed forces, and numerous ethno-regional militia groups notably from the Amhara and Afar regions of Ethiopia. The conflict was marked by widespread and severe forms of conflict-related sexual and reproductive violence as well as other human rights violations by all parties, some of which amount to crimes under international law. Following the signature of the Cessation of Hostilities Agreement in November 2022 by the government of Ethiopia and the TPLF, violence continued, including widespread and severe sexual and reproductive violence along ethnic-political lines across regions by military actors.
As the conflict unfolded, both the United Nations and the African Union established independent investigative mechanisms to document atrocities and preserve evidence for future justice and accountability processes. However, both mechanisms were prematurely shuttered in October 2024, without investigators even being allowed into the country, after successful lobbying by the Ethiopian government to defer to national mechanisms, including the transitional justice process outlined in the Cessation of Hostilities Agreement.
The governments of Ethiopia and Eritrea failed to respond to letters sharing the findings of the report and seeking further information about the governments’ efforts to ensure justice and accountability.
The report confirms that impunity for conflict-related sexual and reproductive violence in Tigray has contributed to further violence in Amhara and Afar, where the data shows such acts constitute war crimes, breaches of international humanitarian law, and human rights violations. Survivors identified perpetrators from military groups including the TPLF, who expressed intent when committing sexual and reproductive violence related to revenge for Amhara and Afar forces actions in the conflict in Tigray.
“Buckling to pressure from the Ethiopian government, the UN decision to prematurely shut down its justice mechanism emboldened perpetrators to act with impunity – and allowed conflict-related sexual violence to continue and spread across Ethiopia,” said Payal Shah, JD, report co-author and director of research, legal, and advocacy for PHR. “Ethiopians are facing a crisis: A health system still in tatters from war; threats of conflict between Ethiopia and Eritrea; federal government crackdowns on civil society; U.S. aid cuts exacerbating public health crises. Survivors of sexual and reproductive violence and the brave clinicians who care for them have been sidelined and neglected. All parties to the conflict and UN member states must finally prioritize healing, accountability, and justice for sexual violence and forced pregnancy before impunity turns to violence yet again.”
Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.