By Felagot Taddese Terefe, MD, Assistant Professor of OBGYN

Along the heavy cost suffered by the people of Tigray because of the 2020–2022 Tigray war, the continued use of sexual and gender-based violence (SGBV) in other parts of the country calls for a grave concern. In Amhara , the ongoing suffering of women and girls steams from two main events : (i) the spread of conflict from Tigray to Amhara (during the war and after the November 2022 Cessation of Hostility Agreement (CoHA) was signed in Pretoria to end the Tigray war) and (ii) the enduring conflict between the Federal government of Ethiopia and Fano militia which started in August 2023. The fact that the situation in Amhara has continued for several years and is a result of multiple conflicts should alarm government institutions, advocacy groups, humanitarian organisations, and health professionals alike. As I underlined in my first piece, the scale and normalisation of SGBV, the lack of accountability of perpetuators as well as the unaddressed treatment needs of victims continue to trouble me as a mother, women and a gynaecologist.

Sexual violence in Amhara during and post the Tigray war

The July 2025 Report published by Physicians for Human Rights (PHR) and the Organization for Justice and Accountability in the Horn of Africa (OJAH), in addition to Tigray, documented sexual and gender based violence (SGBV) that took place in Amhara between February 2021 and July 2024. The assessment was based on a review of 50 patient medical records and health worker interviews. The healthcare workers stated that most patients they treated were children (aged 13 to 17 years old) and young adults (aged 18 to 25 years old) – with a median age of 19. The reported sexual violence took several forms ranging from touching and groping of breasts and genitalia; rape (oral and anal sex or using different tools); sexual slavery; sexual exploitation and abuse; to forced pregnancy termination. The incidents were committed in homes, on roads, in other public places, and even during displacement, making no place safe for girls and women. Multiple perpetrator rapes involved two to four attackers and gang rape committed against children exposed them to diseases like hepatitis, different sexually transmitted infections (STIs), HIV as well as unwanted pregnancy.   

With the act of the SGBV, victims also experienced various forms of physical violence. Based on the review of the medical records, the PHR/OJAH Report found the use of force with hands in 18% of the cases, the use of guns in 16% and the use of sticks in 12%. The use of such forces and physical beatings have resulted in short and long-term injuries and disabilities. Another aspect of the violence with a lasting psychological trauma comes from forcing family members witness the assault of their loved ones – e.g., women being raped in front of their husbands, mothers and others. In some cases, several members of one family experienced violence at the same time. One case worker in Amhara reported observing a case where two sisters were victims of sexual violence reportedly committed by members of a group affiliated with Tigray People Liberation Front (TPLF).

Interviewed healthcare workers reported treating victims that experienced violence perpetuated by both unarmed and (various) armed actors. The top three armed actors mentioned include Tigray Forces (79% of the time), the Ethiopian military (35%) and Amhara Special Forces (24%). The Report noted that “the absence of justice and accountability for the atrocities committed during the Tigray conflict has fuelled resentment and impunity, creating fertile ground for escalating violence.” Health workers reported, in 41% of the cases they treated, patients indicated that perpetrators cited vengeance or vindictive motives related to the violence in Tigray as the reason for the sexual violence. The aggressors, it is reported, used phrases like “this is how we revenge”, “we will erase you from the earth”, and “you are animals”, etc. Other motives include ‘intent to kill’, ‘intent to traumatize or violate personal dignity’, ‘intent to infect with STIs and HIV’ and ‘intent to displace or remove from their land’. To add to one’s surprise, the medical records showed 44% of the violence covered to have been committed by civilians, while 20% was linked to the military. Adding to this, in 20% of the cases covered, the aggressors were known to the victims – i.e., family members or intimate or ex-partners – who took advantage of the situation.

The consequence: SGBV endured by victims resulted in short and long-term physical and psychological trauma with a potential long term public health and social cohesion implications. According to the Report, about a third of the reviewed medical records show the experience of physical injury, such as genital injuries, burns, fistula, bruising, lacerations, bone fractures, etc. In severe cases of child victims, health workers recounted the loss of life. Further, reported negative reproductive outcomes included unwanted pregnancies where victims were forced to have the babies due to inaccessibility of timely abortion services, contraction of STIs, including HIV, etc. Moreover, victims suffered psychological trauma in the form of ‘depression, anxiety, suicidal ideation, sleep disturbance, dissociative symptoms, and PTSD.’ Psychological trauma is also sustained by family members that witnessed violence against their wives, mothers, sisters, etc. Equally significant are the social consequences faced by survivors of SGBV, as those who reported the violence experienced retaliation, divorce, estrangement from family, loss of financial security, and other forms of social stigma.

Sexual violence in the conflict between the Ethiopian army and Fano militia (August 2023 onwards)

In August 2023, the Ethiopian government attempted to disarm regional military groups, starting from Amharan regional state. Believing this move will put them in a vulnerable position vis-à-vis other armed groups, the Fano militias (“an Amharic word roughly translated as volunteer local fighters”) launched a resistance against the Federal government, which led to a conflict. Since the outbreak of the conflict between the Ethiopian army and Fano, reports though largely undocumented suggest that thousands of women and girls in the Amhara region have been subjected to sexual violence. In its November 2025 piece, BBC News supports this claim based on data gathered by talking to victims and healthcare workers. Its findings unveil “thousands of reports of rape between July 2023 and May 2025, with victims as young as eight and as old as 65.”

BBC’s data review from 43 health facilities (representing about 4% of health facilities in Amhara) found 2,697 reports of rape with victims under 18 constituting 45%. Recognising a potentially high underreporting driven by fears of stigma and of discovering an unintended pregnancy or HIV infection, a senior health expert cautioned that these figures may represent only “the tip of the iceberg”. For example, a 23 year old survivor from South Gondar said she avoided seeking medical care out of fear of discovering her HIV status after government soldiers raped her when entering her home for a routine operation. The investigation found over 50% of the victims contracted sexually transmitted infections (STIs) and many were left with unwanted pregnancy. The SGBV survivors experienced additional physical and psychological trauma.    

The prevalent human rights violation reported in the Amhara region is linked to both sides of the conflict although advocacy groups such as Amnesty International point to evidence that the Ethiopian army is responsible for most of the human right violations. “In June 2024, the UN Office of the High Commissioner for Human Rights reported that the Ethiopian National Defence Force, which includes the army, had perpetrated sexual violence, including against minors, in the Amhara region during the conflict with Fano militia.”[1] BBC’s investigation also uncovered that most of the sexual violences were reported in urban areas which are controlled by the army. This should, however, be read cautiously as urban dwellers would likely have better access to health facilities. Healthcare workers interviewed indicated the general reluctance of the SGBV survivors who sought medical treatment to reveal the names of the aggressors or seek justice, partly, due to the collapse of law and order in the region – making it hard to document the identities of the aggressors.

Conditions for survivors have been further aggravated by the conflict-induced breakdown of basic public infrastructure, rendering access to health facilities unsafe. A medical professional noted that conflict-related transport disruptions and road blockages prevent many victims from accessing prompt medical care. For many survivors, delayed access to care meant missing the critical window for lifesaving treatment for STIs, including HIV and pregnancy prevention. Health professionals in the region already anticipate an increase in HIV cases in Amhara.

The looming crisis

Out of the SGBV cases in Amhara covered by the PHR/OJAH Report whose incidence date was registered in the medical files, 34% took place in 2023, while 12% took place in 2024. 59% of the healthcare workers interviewed also reported treating SGBV cases after the end of the war in Tigray and the signing of the CoHA. As the region continues to be ravaged by the Ethiopian military-Fanou militia conflict, it is safe to expect a rise in the number of sexual violence victims. The absences of efforts and measures, on the part of the government, to make perpetuators accountable and deter future similar behaviours gives license to normalising violence in communities. Available evidence implicates the Ethiopian military to violence cases in a nonnegligible degree in the Report, healthcare works interviewed said the Ethiopian military was identified in 35% of cases, while the BBC investigation found high number of SGBV reports in cities controlled by the military. Despite that, the federal government had issued neither a public acknowledgement nor take an official action against the aggressors.      

To this date, there has also not been any coordinated response to help survivors and affected communities recover from the trauma. Towards the end of 2024, it was reported that over 969 health institutions in the region ceased operations as a result of the conflict.[2] The worsening situation since then makes the desperately needed medical and psychological support a luxury, shattering the last hope of survivors. The mental health treatment needs of victims and psychosocial trauma experienced by communities, if left unaddressed for long, will have a long-lasting impact on both individual and communal living.

If we fail to act, to ensure accountability, restore health systems, and prioritize survivor centered care we are not merely neglecting individual victims; we are permitting the systematic destruction of women’s health and autonomy. As health professionals, we must continue to document, treat, advocate, and demand justice. Silence is not neutrality. In this context, silence is complicity. Therefore, addressing GBV in Ethiopia demands a unified commitment from governments, institutions, civil society, and global partners to strengthen accountability mechanisms, enhance protection, and ensure equitable, survivor centered care.

[1] Ethiopia’s Amhara conflict: The forgotten war destroying women’s lives – BBC News

[2] Amhara Universities Forum Raises Alarm Over Rising Sexual Violence, Disease Outbreaks Amid Conflict. Alongside destruction of health facilities, it is reported that health workers have been targeted by conflicting parties.