The conflict in Tigray, Ethiopia between the government of Ethiopia and the Tigray People’s Liberation Front (TPLF), with involvement from Eritrean military forces and numerous ethno-regional militia groups, has been marked by widespread conflict-related sexual violence. Reports of conflict-related sexual violence as a significant element of the conflict surfaced both before and after the signing of the Cessation of Hostilities Agreement (CoHA) in November 2022 by the government of Ethiopia and the TPLF. This report – prepared by a joint research team composed of professionals with medical and public health training and expertise in Ethiopia and Physicians from Human Rights (PHR) – finds that, since the start of the conflict in November 2020 until June 2023, military actors have perpetrated brutal and widespread acts of conflict-related sexual violence in Tigray and that these acts have not ceased following the signing of the CoHA.

A medical and human rights research team reviewed 305 randomly selected medical records from multiple health facilities in Tigray, Ethiopia, with the goal of documenting types and patterns of conflict-related sexual and gender-based violence perpetrated against civilians in Tigray between November 2020 through June 2023. Of the 305 records reviewed, 304 records included reports of conflict-related sexual violence, overwhelmingly affecting women and girls, with survivors of conflict-related sexual violence ranging in age from eight to 69.

Key Findings

The medical records reviewed paint a stark picture of the systematic and widespread infliction of conflict-related sexual violence by government armed forces and militias. All parties to the conflict failed to prevent and halt conflict-related sexual violence and to ensure that survivors are able to report and seek care for the devastating injuries caused by these acts.

Sexual violence was often perpetrated by groups, and at times involved captivity and use of weapons. Analysis of this data revealed that rape committed by multiple perpetrators accounted for the majority of documented acts (76%; n=233), followed by rape committed by a single perpetrator (22%; n=68). The incidents examined in this review most commonly were carried out in groups, with a median of three perpetrators. It is noteworthy that there were 10 records in which patients reported experiencing captivity during the occurrence of multiple-perpetrator rape, consistent with enslavement and sexual slavery. The incidents frequently involved perpetrators who used weapons or other forms of violence concurrently with sexual-violence acts. 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. Most commonly, survivors identified perpetrators as speaking the Tigrigna language (66%), which is spoken in both Eritrea and Tigray. Survivors also largely identified perpetrators as appearing to belong to military and paramilitary groups (96%) and were previously unknown to the survivors (99%). While not all records indicated the affiliation of perpetrators, in 143 instances survivors identified at least one perpetrator as being from the Eritrean military, which reportedly operated in alignment with Ethiopian government forces during the 2020-2022 conflict period.⁸ 30 percent of perpetrators were identified as speaking Amharic. In 16 instances survivors identified perpetrators as being part of the Ethiopian military. More specific data about other identifying features (e.g., color of military uniform, insignia, identifying speech patterns such as accents) was not available in these records.

Survivors have serious health needs from conflict-related sexual violence, but face delays in reporting and seeking medical care. The medical records reflect serious physical and psychological consequences of conflict-related sexual violence, both short- and long-term, including mental health issues such as post-traumatic stress disorder (PTSD) (13%) and depression (17%), unintended pregnancy self-reported by the survivor (8%), 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% of patients tested for pregnancy at the time of examination were positive) or contraction of HIV (11% of patients tested for HIV were positive).

The data also showed significant delays in seeking medical care. There was a median period of five months between the reported incident and survivors presenting at health facilities. Although it is unclear what caused the delays (e.g., stigma, fear for one’s safety, ongoing conflict affecting transportation and access to health facilities), such delays suggest an underreporting of cases of conflict-related sexual violence.

Conflict-related sexual violence is ongoing, even following the CoHA. The medical records reviewed showed many instances of conflict-related sexual violence occurring after the November 2022 CoHA: 169 incidents of conflict-related sexual violence occurred before the signing of the CoHA in November 2022 and 128 incidents occurred after November 2022. The scale and nature of these violations has not materially changed since the peace agreement was signed, except for the notable fact that 95 percent of conflict-related sexual violence experienced by children and adolescents under 18 years old occurred following the signing of the CoHA.

Conclusions

The scale of cases, pattern of incidents, and description of perpetrators suggest that these incidents of conflict-related sexual violence were both widespread and systematic. The findings of this investigation are consistent with other publicly available reports and are indicative of the use of rape and other forms of sexual violence as a tool of war against civilian populations to terrorize communities and inflict grave harms.

This data points to the high likelihood that military forces, likely associated with the Ethiopian and Eritrean governments, have caused 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 and in international jurisprudence. These violations have caused survivors significant harm, leading to an urgent need for medical and psychosocial support.

It is imperative that the international community actively ensure that perpetrators of these crimes and human rights abuses are held to account and that survivors can receive both access to justice as well as necessary medical aid and reparations to support recovery and rehabilitation. Particularly in light of the deteriorating security situation in Amhara and concerns about atrocity prevention, it is critical to send a clear message that there will be accountability for human rights abuses. The research findings unequivocally indicate that there is a need for ongoing independent monitoring and documentation to ensure survivors can report the abuses they suffered, have their experiences documented, and have evidence for accountability gathered in a timely manner and properly preserved.

Recommendations

While Ethiopia is mandated to undertake a transitional justice process under the terms of the CoHA, benchmarks for monitoring have yet to be released publicly and it is unclear whether accountability will be incorporated as of the time of publication of this report. The findings of our report point to past and ongoing involvement of forces aligned with the Ethiopian government in carrying out conflict-related sexual violence. Consequently, there is significant reason to doubt the credibility of investigations, documentation, and accountability and justice processes left solely to the oversight of the national government. In light of these findings, which are being published as the risk of future human rights violations is increasing due to intensifying conflict in other parts of Ethiopia, there is an urgent need for international and regional action in addition to national efforts to ensure credible monitoring, documentation, investigations, prosecutions, and justice for the grave violations committed.

This report is being released at a time when several independent investigative mechanisms seem likely to be closed, despite evidence of ongoing violence in violation of the CoHA and international human rights and humanitarian law. Following the CoHA, there have been serious concerns about the status of the UN International Commission of Human Rights Experts on Ethiopia (ICHREE)–the Human Rights Council-mandated mechanism for investigation and documentation of human rights violations and atrocity crimes in Ethiopia. The Commission is expected to provide a summary report to the UN Human Rights Council in September 2023, but there are strong indications that ICHREE’s mandate may not be renewed beyond that time, in part due to pressure from the Ethiopian government to defer to national mechanisms including the CoHA-mandated transitional justice process. Similarly, the Commission of Inquiry (COI) established by the African Commission on Human and Peoples’ Rights to investigate violations of international human rights law and international humanitarian law and identify perpetrators for purposes of pursuing justice and accountability also faced opposition by the government of Ethiopia. The COI’s mandate was recently terminated, prior even to the publication of a single report of its findings and recommendations.

Based on the data presented in this report, Physicians for Human Rights and Ethiopian partners 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; 
2. Ensure unfettered, continued independent and impartial monitoring of and reporting on ongoing conflict-related sexual violence, including the situation of children and adolescents; 
3. 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 
4. Facilitate access to physical and mental health services and other forms of rehabilitation for all survivors of conflict-related sexual violence, without discrimination.

To realize these recommendations, we call for the following measures by specific actors:

To the Ethiopian government and federal regional authorities:

• Rigorously and immediately implement all recommendations of the UN International Commission of Human Rights Experts on Ethiopia in their reports to the UN Human Rights Council (A/HRC/51/46);
• Cooperate fully with investigations by all UN, regional, local, and international non-governmental human rights monitors, including to ensure unrestricted access to all regions of Ethiopia and protection from reprisal for their work;
• Direct the Ministry of Justice and the Ethiopian Inter-Ministerial Task Force on Accountability and Redress of Violations to suspend, investigate, and bring to justice members of Ethiopia’s armed forces who have overseen or participated in violations of international human rights law and international humanitarian law, including those violations and abuses that may amount to war crimes or crimes against humanity, in accordance with international and regional standards and national law;
• Ensure that survivors of sexual violence, and communities disproportionately impacted by sexual violence, are meaningfully engaged in designing transitional justice efforts, that they can participate without risk of retaliation, and that their perspectives, safety, and needs are prioritized;
• Allow unfettered access to humanitarian aid, including medical services, without discrimination, including to members of vulnerable populations and specifically survivors of conflict-related sexual violence; and
• Ensure appropriate redress and reparations for and provide free, timely, and adequate medical, psychosocial, and legal services to all survivors of conflict-related sexual violence without discrimination, fully respecting their privacy and ensuring their protection against reprisals.

To all parties to the conflict, including the governments of Ethiopia and Eritrea:

• Halt all forms of violence, including rape, enslavement and sexual slavery, and other forms of conflict-related sexual violence; protect civilians; and condemn sexual and gender-based violence, as mandated under international human rights law and humanitarian law as well as agreed to by the parties to the CoHA;
• Publicly condemn and issue orders to prevent and cease immediately all abuses, including all forms of sexual and gender-based violence, and facilitate investigation and prosecution of these abuses and justice for survivors;
• Exclude from any peace agreement the provision of amnesty or immunity for serious violations of international law; and
• Comply with the obligation of each party to a conflict to allow and facilitate the delivery of impartial humanitarian relief consignments for civilians in need of supplies essential to their survival.

To the international community:

• Actively support the renewal of the mandate of the International Commission of Human Rights Experts on Ethiopia (ICHREE);
• Ensure well-resourced, ongoing impartial, independent documentation of and public reporting on human rights and international humanitarian law violations since the onset of hostilities on November 3, 2020, including by supporting a succession plan for ICHREE should the mandate not be renewed. This includes a plan for preservation of evidence marshaled by ICHREE as well as the designation of a similarly empowered investigative mechanism;
• Promptly support the investigation of and accountability for those credibly implicated in serious rights abuses in Ethiopia under international law, including through universal jurisdiction;
• Condition non-humanitarian funding for the government of Ethiopia on its demonstrable, measurable progress in providing accountability and justice for atrocity crimes, including public acceptance of this commitment and the establishment of clear benchmarks and timelines for implementation;
• Monitor and ensure full compliance with the commitments and obligations agreed to in the CoHA;
• Ensure that domestic accountability and justice processes are only endorsed if they are impartial, transparent, non-discriminatory, inclusive of survivors of the conflict, including survivors of sexual violence, and ensure their safety and rights in engaging such processes;
• Fund and provide technical support to strengthen knowledge of the transitional justice process among survivors and build capacity among health, law enforcement, and justice sector actors to support investigations and prosecutions of conflict-related sexual violence and facilitate access to remedies and reparations for survivors of sexual violence; and
• Prioritize survivor-centered, trauma-informed care and rehabilitation for survivors of conflict-related sexual violence in humanitarian support to Ethiopia, with specialized care for children and adolescents.

To the Office of the United Nations High Commissioner for Human Rights and the Ethiopian Human Rights Commission Joint Investigation Team (JIT): 

• Ensure that all parties to the conflict implement in particular recommendations #5 and #6 of the JIT’s 2021 report, specifically to “[e]nd all forms of sexual violence against women and girls, men and boys, including targeting of civilians on the basis of their gender or ethnicity;” and “[i]ssue clear, public, and unequivocal instructions to all armed forces and groups, that all forms of sexual and gender-based violence (SGBV) are prohibited and punishable on the basis of direct and command responsibility, including superiors who ordered or failed to prevent or stop violations.”

To the African Commission on Human and People’s Rights:

• Promptly reconsider the decision to terminate the mandate of the Commission of Inquiry and ensure that its mandate concludes, at least, with a report of its findings and recommendations.