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Tigray, Ethiopia: Conflict-related Sexual Violence Widespread and Systematic Even After Truce

304 medical records from Tigray show extensive conflict-related sexual violence, often by multiple perpetrators, violating Cessation of Hostilities Agreement

Eritrean and Ethiopian armed forces and associated militias appear to have perpetrated sexual violence on a widespread and systematic basis in Tigray, Ethiopia in the months following the signing of the Cessation of Hostilities Agreement (CoHA) in November 2022 by some parties to the conflict, according to a report published today by Physicians for Human Rights (PHR) and the Organization for Justice and Accountability in the Horn of Africa (OJAH).  

“The ongoing, widespread conflict-related sexual violence we’ve documented in Tigray shows the urgent need for aid, medical care, and reparations to the survivors,” said Sam Zarifi, JD, LLM, PHR’s executive director. “These brutal violations of international law also demand greater efforts at accountability from the United Nations and the African Union, despite the Ethiopian government’s efforts to block independent monitoring and justice.” 

In Broken Promises: Conflict-Related Sexual Violence Before and After the Cessation of Hostilities Agreement in Tigray, Ethiopia, PHR and OJAH reviewed 304 randomly selected medical records of conflict-related sexual violence from multiple health facilities in Tigray, Ethiopia, revealing widespread and systematic conflict-related sexual violence perpetrated against civilians from the beginning of the conflict in November 2020 through June 2023. The report is the first ever to document conflict-related sexual violence through hundreds of medical records that show severe violations continue to be perpetrated after the signing of the Cessation of Hostilities Agreement by the government of Ethiopia and the Tigray People’s Liberation Front (TPLF).  

The medical records analyzed by PHR and OJAH clinicians and researchers show: 

  • Conflict-related sexual violence is ongoing in Tigray, even following the Cessation of Hostilities Agreement in November 2022, in which both the government of Ethiopia and the TPLF agreed to halt all forms of hostilities, including sexual violence. 
    • 128 medical records show conflict-related sexual violence occurring after November 2022, when the Agreement went into effect. 
    • 95 percent of conflict-related sexual violence experienced by minors under 18-years-old occurred following the signing of the Agreement. 
  • Sexual violence was often perpetrated by groups, at times in captivity and with weapons
    • In 76 percent of the cases, sexual violence was carried out by multiple perpetrators rather than a single individual, suggesting an organized tactic. 
    • 10 medical records report captivity during rape by multiple perpetrators, consistent with enslavement and sexual slavery. 
    • Several accounts also described the murder of family members, including children, before, during, or after rape. 
  • Survivors identified perpetrators as largely belonging to Eritrean or Ethiopian armed forces. 
    • In 66 percent of the cases, survivors identified the perpetrators as speaking the Tigrigna language, which is spoken in both Eritrea and Tigray. 30 percent of the cases involved perpetrators identified as speaking Amharic. 
    • In 96 percent of the cases, perpetrators were identified as appearing to belong to military and paramilitary groups. 
    • Survivors report – in 99 percent of the cases – that perpetrators were not previously known to them before the assault. 
  • Survivors present serious health needs from conflict-related sexual violence, but face delays in reporting and seeking medical care. 
    • The medical records depict serious physical and psychological consequences of conflict-related sexual violence, both short- and long-term, such as PTSD (13%), depression (17%), and reproductive organ injuries and disorders (11%), including urinary incontinence, fecal incontinence, abnormal uterine bleeding, uterine prolapse, chronic pelvic pain, and fistulas.  
    • Records show that in multiple instances conflict-related sexual violence may have resulted in pregnancy (27 percent of patients tested for pregnancy at the time of examination were positive) or contraction of HIV (11 percent of patients tested for HIV were positive). 
    • A median period of five months transpired between the reported incident and survivors presenting at health facilities, reflecting both barriers to health care (e.g., ongoing conflict, limited access to health facilities, stigma) and a likely underreporting of conflict-related sexual violence in the region.  
  • The reports of conflict-related sexual violence in these 304 medical records overwhelmingly affect women and girls, with survivors of conflict-related sexual violence ranging in age from eight to 69. 
    • 21 cases of conflict-related sexual violence in our sample involved children ranging in age from eight to 17. 
    • The brutal patterns of conflict-related sexual violence against minors were similar to those experienced by adults, including rape by multiple perpetrators (57%), sexual slavery (5%), and beatings (5%). 

The 304 cases reported here represent only a small portion of all actual cases of conflict-related sexual violence in Tigray, and likely undercount vulnerable populations, such as men and boys, and those who died during or after the conflict-related sexual violence.  

Military forces, likely associated with the Ethiopian and Eritrean governments and armed militias – which reportedly operated in alignment with Ethiopian government forces during the 2020-2022 conflict period – appear to have perpetrated serious violations of human rights and committed atrocity crimes such as war crimes (e.g., torture and humiliating or degrading treatment; rape and sexual violence, sexual slavery) and crimes against humanity (e.g., persecution, torture, enslavement and sexual slavery, rape) as defined in the Rome Statute of the International Criminal Court.  

“Hundreds of de-identified medical records from health facilities in Tigray uncover profound human suffering and harm, corroborating other reports of rape and other forms of sexual violence, and suggesting that sexual violence is being deployed as a tactic of war,” said Ranit Mishori, MD, MHS, senior medical advisor at PHR and professor of family medicine at the Georgetown University School of Medicine. “This is scientific evidence that cannot be ignored or refuted. These violations have caused survivors significant harm, leading to an urgent need for medical and psychosocial support.” 

“We honor the strength and resilience of the survivors whose experiences are reflected in this data, and commend the bravery of the Ethiopian clinicians who provide lifesaving care and document atrocities in the face of targeted attacks,” added Dr. Mishori.   

The report is published alongside a new Comment by the report co-authors in The Lancet medical journal.  

“The pattern of incidents and perpetrator profiles indicate that the incidents of conflict-related sexual violence were widespread and systematic,” said the executive director of OJAH. “The results of this inquiry align with existing reports from international human rights organizations, underscoring the use of sexual violence as a weapon of war against civilian populations in Tigray. What is even more concerning is that these atrocities continue to be perpetrated in certain areas of the Tigray region, Ethiopia, months after the Cessation of Hostilities Agreement.” 

The United Nations, human rights organizations, academics, and journalists have documented widespread civilian suffering, displacement, famine, violence, and other human rights violations, including conflict-related sexual violence, since the conflict between the government of Ethiopia and the Tigray People’s Liberation Front began in November 2020.  An estimated 600,000 civilians have died in Tigray, either by direct violence and killings or indirect violence through starvation or lack of health care. 

“Our findings demand ongoing independent monitoring and documentation to ensure survivors can safely report the abuses they suffered and have evidence for accountability and justice gathered in a timely manner,” said Zarifi, PHR’s executive director. “However, all signs point to the main international accountability mechanism – the UN International Commission of Human Rights Experts on Ethiopia (ICHREE) – being shuttered next month in the face of pressure from the Ethiopian government and acquiescence by the U.S., E.U., and other international actors.” 

Based on the data presented in this report, PHR and OJAH make the following recommendations to international, regional, national, and local actors:   

  1. Guarantee and support impartial documentation and accountability for serious human rights violations and atrocity crimes that have occurred by extending and strengthening the mandate of the UN ICHREE;   
  1. Ensure unfettered, continued independent and impartial monitoring of and reporting on ongoing conflict-related sexual violence, including the situation of children and adolescents;   
  1. Ensure a credible and benchmarked transitional justice process that meaningfully responds to the perspectives and needs of survivors of human rights violations including conflict-related sexual violence; and   
  1. Facilitate access to physical and mental health services and other forms of rehabilitation for all survivors of conflict-related sexual violence, without discrimination. 

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.

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