Caring for Ethiopian Women in Conflict-Affected Communities

In Tigray, Ethiopia, MSI’s multi-disciplinary teams offer women and girls a lifeline—providing contraception, abortion and STI testing, delivering babies, and providing mental health support for survivors of gender-based violence.

A group of local women from the Tigray region make their way to their homes in a rural area near Abi Adi on May 5, 2023. (Edgar Gutiérrez / SOPA Images / LightRocket via Getty Images)

For two years, Tigray in northern Ethiopia was wracked by a brutal civil war that claimed 600,000 lives and left 2.7 million people internally displaced. During the fighting, rape was used as a weapon of war, and one in 10 women and girls of reproductive age experienced physical, psychological and sexual violence.

In 2022 alone, an estimated 5.8 million people were in need of support following gender-based violence (GBV). Yet, despite the widespread sexual violence inflicted on women and girls, MSI was the only organization providing sexual and reproductive care in Tigray during the conflict. 

Providing Holistic Support

Due to limited funding, our work began with one single midwife, who embedded herself in conflict-affected communities, providing life-saving sexual and reproductive health services free of charge to as many people as she could help. 

From one single provider, our mobile outreach teams grew and so did the support that we were able to provide. Traveling from camps for internally displaced people (IDPs), settlements and host communities to temporary clinics and GBV ‘one-stop’ centers, our multi-disciplinary teams offer women and girls a lifeline. In addition to providing contraception, abortion, STI testing and delivering babies, they also provide mental health support and referrals to ensure survivors of gender-based violence can access further comprehensive support. 

Operating from temporary psychosocial support (PSS) hubs, established by the government among displaced communities, they also provide individual and group counseling sessions, focusing particularly on the needs of young people.

When a peace agreement was signed in November 2022, we dared to hope that the assaults would stop and the need for our work would reduce. But one year on, sexual violence continues to be used to intimidate and terrorize women and girls who have been displaced by the conflict. 

At the end of this month, funding for our outreach teams in Tigray will come to an end, and unless new donors step in, our services will be limited to one solitary static clinic.

Transformative Care 

On a recent visit to Mekelle, the capital of Tigray, I met Rahwa*. She had been forced to leave her home in Western Tigray during the conflict and had been living alone in an IDP center for several months. Rahwa had been raped by multiple men but was too frightened to report the crimes fearing reprisals from the perpetrators.

Upon examination by MSI’s outreach team, Rahwa discovered she was seven weeks pregnant. She received confidential, non-judgmental counseling and decided to end the pregnancy.

She told me: “I experienced cruel and harsh treatment for months in western Tigray, following the conflict, and I was forcefully displaced alone six months ago fearing for my life. After I missed my period, I suspected I was pregnant. I worried day and night, and I contemplated suicide. I had no money to visit the doctor and I considered visiting a traditional healer to end my pregnancy. But thanks to God, he brought MSI here to save my life. From now on, I can protect myself and start thinking about the future. Thank you for saving my life and giving me new hope.”

An Uncertain Future

Rahwa is one of tens of thousands of women and girls that MSI’s mobile teams have supported in Ethiopia since the conflict began, but without further funding, this work is at risk. Pressure on the U.K.’s official development assistance (ODA) budget over recent years has led to severe cuts to global sexual and reproductive healthcare and meant the scale of our work in Ethiopia has already been reduced. 

In times of crisis, the need for sexual and reproductive healthcare rises, while access falls—and Tigray is no exception.

At the end of this month, funding for our outreach teams in Tigray will come to an end, and unless new donors step in, our services will be limited to one solitary static clinic in Mekelle, which cannot hope to provide care for the sheer number of IDPs in the surrounding areas.

In times of crisis, the need for sexual and reproductive healthcare rises, while access falls—and Tigray is no exception. The ongoing violence is robbing women of their bodily autonomy; it is clear that sexual and reproductive health will remain an urgent need among displacement-affected communities, particularly in those areas that were hard to reach or inaccessible during the conflict.

I am so proud of our outreach teams who are working tirelessly to meet the overwhelming needs of those who have been caught up in this conflict. But without more funding, the contraception, safe abortion and post-abortion care services that our outreach teams provide are at risk—and so are the health, lives and futures of the women of Tigray. 

*Name has been changed to protect her identity.

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Abebe serves as country director at Marie Stopes' Ethiopia program. Before that he served several years as country director of MSI's Zimbabwe program, Population Services Zimbabwe. He has over 20 years of experience in community development and public healthcare programs, including maternal and child health, family planning and reproductive health, malaria prevention, and HIV/AIDS programming.