Sexual Violence in Ethiopia: The Health Care Providers Bringing Evidence to Light and Demanding Justice for Survivors

“Imagine providing critical care to patients with no access to medications or equipment, while your salary is withheld, your basic needs are unmet, and the very place you call home is no longer safe. Hospitals are routinely attacked by combatants. Insidious acts of sexual violence persist, and places of healing are turned into death traps. This has been the grim reality for civilians and health workers in Tigray since late 2020.”

These words, spoken by a representative of the Organization for Justice and Accountability in the Horn of Africa (OJAH) at the recent Physician for Human Rights (PHR) annual gala, provide a glimpse into the ongoing humanitarian and human rights crisis in Ethiopia, including ongoing physical and psychological harm inflicted on survivors of conflict-related sexual violence.

The Conflict in Ethiopia

The conflict between the government of Ethiopia and its allies against the Tigray People’s Liberation Front began in the northern parts of the nation in November 2020, claiming over 600,000 lives. Despite the Cessation of Hostilities Agreement in late 2022, human rights violations have continued and a humanitarian crisis has deepened. Alongside this, conflicts have reignited in the Amhara, Afar and Oromia regions. There are regular reports of armed conflict as well as increases in killings and abductions occurring in the Amhara region. There are also reports of escalating tensions on the borders between Tigray and both the Amhara and Afar regions. A prominent Oromo opposition leader was killed in April – another indication that violence in Oromia could escalate.

The ensuing violence has uprooted many from their homes, causing severe disruptions to social services and humanitarian operations and requiring an estimated US$3 billion in ongoing humanitarian supplies and aid for millions of people. While some efforts have been made, financial efforts have only covered 12 percent of what is required.

Recurring droughts and severe flooding have worsened displacement and destroyed infrastructure. Inadequate care access has led to Ethiopia’s longest cholera outbreak, with over 15,000 new cases since January 2024. The humanitarian crisis in Tigray is acute with an ongoing famine, in addition to a lack of access to medical services in the ongoing occupation of Tigray. Food insecurity and malnutrition are expected to reach 15 million people needing aid by late this summer.

Concurrent with other challenges, conflict-related sexual violence has stood out as a persistent and ongoing threat to the people of Ethiopia from the beginning of the conflict. Military actors have continued to perpetrate acts of conflict-related sexual violence in Tigray, despite the peace agreement.

The Organization for Justice and Accountability in the Horn of Africa

Amid these vicious cycles of suffering in Ethiopia, in 2020, OJAH was formed.

OJAH is a nonprofit, independent nongovernmental organization that consists of both Ethiopian citizens, and international professionals who are clinicians and human rights advocates dedicated to ensuring justice for victims of international crimes including war crimes, crimes against humanity, and genocide. It works to address grievances and facilitate justice for victims and survivors of conflict-related human rights abuses and atrocity crimes throughout the Horn of Africa.

OJAH has documented conflict-related sexual violence in Tigray and provided support to the staggering number of people impacted by this conflict.

As a representative from OJAH aptly put, “It is our collective responsibility to extend a lifeline of support, to help survivors of conflict-related sexual violence move toward a future where life is not merely about enduring, it is about thriving once again.”

Since its beginnings as a nonprofit born from grassroots concern from Ethiopian civilians as well as those in the global diaspora, the organization has grown swiftly, and now partners with several local and international entities. The OJAH team is now working on evidence collection and preservation, capacity building, and support for domestic and international justice and accountability efforts.

A Partnership for Justice

While several organizations reported on the large-scale human rights violations occurring in Ethiopia, OJAH recognized the need for standardized and rigorous documentation efforts to ensure justice for survivors and accountability for perpetrators. This is where PHR came in.

Since 2021, OJAH has worked in partnership with PHR to document and preserve data on violence and crimes, and expose sexual violence in Tigray. PHR provided OJAH with capacity development training on international standards for documenting atrocities, the use of standardized forensic certificates to document sexual violence, and provided technical support based on extensive experience working in conflict zones around the world. OJAH used the standardized tools and methods introduced by PHR to improve their documentation with the hope of ensuring future justice for survivors and accountability for perpetrators.

PHR and OJAH’s partnership led to the publication of a landmark report, “Broken Promises: Conflict-Related Sexual Violence Before and After the Cessation of Hostilities Agreement in Tigray, Ethiopia.”  This study exposed how conflict-related sexual violence was perpetrated in a widespread and systematic way in Tigray even after the signing of the truce in 2022. The irrefutable evidence of atrocities put the Ethiopian government, the African Union, the UN, and the global public on notice. The world knows about these heinous crimes because of the extraordinary bravery and expertise of OJAH and their partners.

“Without OJAH’s leadership, evidence would be lost, survivors would be silenced, and prospects for accountability would be dim,” said Payal Shah, director of the Program on Sexual Violence in Conflict Zones at PHR.

Based on mutual respect and benefit, the collective work between PHR and OJAH exemplifies the power of collaboration between prominent international human rights groups and emerging African-led organizations. Last month, OJAH was honored for its work at PHR’s annual gala for their expertise, courage, and resilience.

Despite the success of their partnership with PHR, OJAH’s journey has not been without challenges. Extreme scrutiny by the Ethiopian government on those investigating human rights has forced the organization to operate discretely and carefully to ensure that their field team is able to work safely.

Health care workers in Ethiopia have been targeted, attacked, and even killed simply for trying to fulfill their ethical duties to save lives and ease suffering. In a remarkable display of courage and commitment to care, health care workers in Ethiopia attended remote training sessions during the height of the conflict. They continued to learn even when one session was cut short by a drone strike.

Today, health care workers in Ethiopia continue to face the threat of violence, blockades, communications shutdowns, and food insecurity. Yet, OJAH reports that the resilience among the professionals remains high.

“Our colleagues are struggling, but they have not given up,” said an OJAH representative.“They continue to care for their patients and communities, in the face of overwhelming challenges. We must not forget their sacrifices.”

Looking Ahead: The Road to Accountability and Justice

OJAH continues to gather and analyze robust evidence, compiling cases and legal dossiers against perpetrators of atrocity crimes from all parties to the conflict in Ethiopia. OJAH also advocates with policymakers to ensure the evidence they gather has meaningful and legitimate outlets to pursue cases against perpetrators. After lobbying by the Ethiopian government led to the premature termination of the mandates of commission of inquiry established by the UN Human Rights Council and the African Union, there are no independent international accountability mechanisms available to accept evidence of violations in Ethiopia.

Looking toward the future, OJAH hopes to center their work on the needs of victims and survivors of conflict-related sexual violence. A key objective for the organization is to break the cycle of conflict and impunity. An OJAH representative shared with the PHR team, “Typically, conflict leads to human rights violations, atrocities and other crimes. When justice and accountability are absent, impunity prevails, perpetuating further conflict.” This was evident during the war in Tigray and ongoing conflicts across the country, where meaningful local or international accountability was lacking. Peace agreements were prioritized and used as a trade-off for credible and effective justice and accountability.

As similar crimes and atrocities play out on repeat in Ethiopia and other regions, OJAH continues to work to break the cycles of violence. They are a pioneer in the broader mission to ensure justice is served and perpetrators are held accountable — not only in Ethiopia but also in all conflict areas in the Horn of Africa.

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