Issue No. 229

The Hidden Mental Health Crisis in Tigray 

While armed conflict in Tigray may have ended in November 2022, the wide-ranging psycho-social scars of the destructive war persist. Families that should be grieving are having to worry about where their next meal comes from, and parents who buried their children are facing the prospect of others starving. Hunger and starvation alone are terrible to endure, let alone on top of displacement, systematic gender-based violence, and the myriad harms inflicted on Tigray and its people. Two years of armed conflict saw widespread human rights violations by Ethiopian and Eritrean forces, including, but not limited to, massacres of civilians, the indiscriminate shelling of towns and villages, and the displacement of well over a million people. The war and the region's limited recovery have created a hidden mental health crisis of immense scale.
 
Significant numbers of Tigrayans have reported experiencing heightened fear and anxiety, depression, and Post-Traumatic Stress Disorder (PTSD), among a litany of other mental health problems. Support has been far too limited, however, in large part due to the region's eviscerated health system and minimal international aid. Over 70% of health facilities were looted or vandalised during the war, according to Médecins Sans Frontières. Today, according to local officials, there are just 8 psychologists for Tigray, which had a pre-war population of over 7 million. The overwhelming majority have subsequently gone without professional support, particularly in remote woredas. Many of the religious and cultural bodies that offered a space for contemplation and retreat were also targeted. Priests, scribes, and imams were killed, and holy sites were desecrated.
 
As so often is the case, Tigrayan women and children bore the brunt of the armed conflict. Children were subject to and witnessed horrific acts, with 72% surveyed by the Luminos Fund reporting witnessing nearby shootings and 44% seeing dead bodies. A third further said that they had seen someone being killed in front of them. Statistics alone cannot do justice to what these children endured and the memories that will likely last a lifetime. Forced displacement, sexual violence against girls and teenagers, and malnutrition have all further gravely impacted an entire generation's development and psycho-social well-being. And during the multiple rounds of mass displacement and violence, many children were also separated from their loved ones. One report by UNICEF in June 2021 revealed that more than 6,000 children had been displaced from their families. The true number is likely far, far higher, as the report predates Eritrean and Ethiopian forces' final offensive against Tigray in August 2022.
 
The heavy bombardment of Mekelle and other cities and villages across Tigray has also left thousands of children with enduring psychological trauma. Many lost limbs from drone strikes and shelling, while the remnants of unexploded ordinance continue to pose a particular threat to children. Some of the worst affected children remain unable to move or speak because of the psychological impact of their experiences.
 
The targeted campaign of sexual violence against Tigrayan women and girls has left 10s of 1000s with complex mental and physical scars. According to Tigrayan authorities estimates, at least 120,000 women were raped. One survey by the British Medical Journal in July 2023 surveyed over 5,000 women in Tigray, reporting that nearly 8% said they had been raped. Of this number, more than two-thirds had been gang-raped. Again, the true number of total assaults is likely to be far higher because of the stigma attached to sexual violence and the areas surveyed. Survivors who have received some treatment from mental health professionals have reported experiencing suicidal ideations. Others are living with the physical impacts of brutal assaults, including with HIV, having been deliberately infected by invading soldiers. And those raising children borne of rape are facing particular ostracism by their communities and even within their own families. The triple threat of rising hunger, unaddressed sexual violence, and continued displacement is making recovery particularly difficult for displaced women.
 
The psychological impact of hunger is too often minimised – but it is no less devastating. The looting of farms and factories by Ethiopian and Eritrean forces and the burning of crops and livestock eviscerated the region's food chains. Consequently, much of Tigray's social fabric was, and remains, gravely eroded as millions went hungry during the intense blockade. Families were forced to rely on neighbours until their supplies also ran out, while others were left to scavenge weeds and berries from trees. This damage remains a significant driver in the humanitarian crisis consuming Tigray today, with hundreds of people having starved to death in recent months. According to the Luminos Fund study, 70% of Tigrayan children live in fear of dying from famine, with children from western Tigray reporting the highest levels of psychological trauma.
 
Meanwhile, those in the diaspora who lost loved ones or have still been unable to locate them continue to mourn. The trickle of information coming from still-occupied areas of western and northern Tigray means that many are forced to endure a painful limbo, not knowing the fate of their family members or being able to afford them their proper burial rites.
 
The collective trauma of Tigray and the relative silence of the international community in contrast to, say, the ongoing Israeli invasion of the Gaza Strip is galling. Far too little attention has been paid to Tigray, which is still enduring a ‘frozen conflict’ over 15 months on from the Pretoria agreement. The Ethiopian government is responsible for the protection and security of all its citizens-- including those in Tigray. Yet critical humanitarian aid is still not reaching large parts of the region, including areas occupied by Amhara and Eritrean forces. Fully implementing the Pretoria agreement and rapidly scaling up the humanitarian, political, and psych-social support for Tigray is a moral necessity.

By the Ethiopian Cable team