Hundreds of health workers across Tigray have documented mass rape, sexual slavery, forced pregnancy and sexual torture of women and children by Ethiopian and Eritrean soldiers, in systematic attacks that amount to crimes against humanity, a new report has found.
The research, compiled by Physicians for Human Rights and the Organization for Justice and Accountability in the Horn of Africa (OJAH), represents the most comprehensive documentation yet of weaponised sexual violence in Tigray. It reviewed medical records of more than 500 patients, surveys of 600 health workers, and in-depth interviews with doctors, nurses, psychiatrists and community leaders.
The authors outline evidence of systematic attacks designed to destroy the fertility of Tigrayan women and call for international bodies to investigate the crime of genocide.
The attacks described by healthcare workers are extreme in their brutality, often leaving survivors with severe, long-term injuries.
“Having worked on gender-based violence for two decades … this is not something I have ever seen in other conflicts,” said Payal Shah, a human rights lawyer and co-author of the report. “It is a really horrific and extreme form of sexual violence, and one that deserves the world’s attention.”
Survivors treated by health professionals ranged from infants to elderly people. The youngest was less than a year old. More than 20% of health workers said those they treated for sexual violence included very young children (1-12 years); and 63% treated children under the age of 17.
Dr Abraha Gebreegziabher, chief clinical director of Ayder hospital in Tigray, told the Guardian his hospital treated thousands of rape survivors, at times admitting more than 100 a week.
“Some [trends] stand out during the war,” he said. “One is gang raping. Second is the insertion of foreign bodies, including messages and broken rocks or stones … Then, the intentional spread of infection, HIV particularly,” he said. “I am convinced, and see strong evidence, that rape was used as a weapon of war.”
In June, the Guardian revealed a pattern of extreme sexual violence where soldiers forced foreign objects – including metal screws, stones and other debris – into women’s reproductive organs. In at least two cases, the soldiers inserted plastic-wrapped letters detailing their intent to destroy Tigrayan women’s ability to give birth.
The new research included interviews with a number of healthcare workers who independently reported treating victims of this kind of attack.
Many of the survivors said soldiers expressed their desire to exterminate the Tigrayan ethnicity – either by destroying Tigrayan women’s reproductive organs, or forcing them to give birth to children of the rapist’s ethnicity.
One psychologist who treated a teenage girl said: “Her arm was broken and became paralysed when the perpetrators tried to remove the Norplant contraceptive method inserted in her upper arm, and this was aimed to force pregnancy from the perpetrator. [They said]: ‘You will give birth from us, then the Tigrayan ethnic[ity] will be wiped out eventually.’”
Other women were held at military camps, some for months or years, and gave birth to the children of their assailants while in captivity.
Legal analysis of the medical record data and health worker testimony found conclusive evidence of crimes against humanity, including mass rape, forced pregnancy, and enforced sterilisation, Shah said.
Women were frequently assaulted in public, by multiple attackers, and in front of family. The attacks included significant breaches of taboo in Tigray, including anal rape and attacks on menstruating women. The resulting stigma meant that some survivors were divorced by their husbands, rejected by families, or socially excluded.
“This form of violence is being imparted in a way that is intended to cause trauma, humiliation, suffering and fracture and break communities,” Shah said. “This is going to have generational impacts.”
Many survivors are still living in displaced persons’ camps. A number of clinics providing for survivors have shut due to the closure of USAID.
“The very fabric of these women’s personalities and sense of self has been shattered,” one psychiatrist said.
A significant portion of health workers had treated children. Many were too young to understand what had happened, one nurse said: “Most of them don’t know what rape is. They do not know what the consequence is.”
For girls who became pregnant, some as young as 12, the health risks were significant. “Their bodies are not fully developed to handle the demands of pregnancy,” a reproductive health coordinator working with child survivors said.
Ayder hospital treated a number of children, Abraha said, many of whom developed long-term conditions, including fistula.
As well as direct victims of sexual attacks, health professionals described treating children who had experienced “forced witnessing”, where they were made to watch parents and siblings being raped or killed, causing severe psychological trauma.
Health workers in Tigray face significant risk for speaking publicly about sexual violence by government-affiliated forces. One surgical worker, who spoke on condition of anonymity, told the Guardian that the youngest patient he had treated for sexual attacks was three years old.
“It is very difficult to think of the worst [cases],” he said. At Ayder hospital, Abraha said medical staff experienced acute psychological distress and nightmares as a result of what they had witnessed.
“We hope that many people will hear [about this] across the surface of the Earth. If justice can be served, maybe consolation will follow.”
The report covered the conflict and post-conflict period to 2024, and concluded that weaponised sexual violence has continued since the ceasefire, and expanded to new regions.
“The perpetrators must be punished, and the situation must be resolved,” one health worker said. “True healing requires justice.”
Anbassa*, a human rights worker in Ethiopia who helped conduct the surveys, said: “No one is accountable.” The failure to hold perpetrators to account meant human rights abuses continued, he said, with atrocities now being committed in the nearby regions of Amhara and Afar.
“If this conflict continues, this impunity that happened in Tigray, the aftermath of this one will continue, [and] conflicts are going to erupt to other regions.”
* Name changed
In the UK, Rape Crisis offers support for rape and sexual abuse on 0808 802 9999 in England and Wales, 0808 801 0302 in Scotland, or 0800 0246 991 in Northern Ireland. In the US, Rainn offers support on 800-656-4673. In Australia, support is available at 1800Respect (1800 737 732). Other international helplines can be found at ibiblio.org/rcip/internl.html