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Background Rape is the most common act of violence against women during wartime which is considered interpersonal, social and political violence because survivors usually suffer from stigma and discrimination in the community. Sexual violence is a serious threat to women’s health. The psychological and medical consequences of rape during the conflict period are not well documented. Therefore, this study investigated the psychological and medical consequences of rape among survivor in the northern Ethiopia conflict, which occurred since 2020–2022. Methods A retrospective cross-sectional survey supplemented with a qualitative data was conducted among survivors of rape recorded until June 2022. Health institutions that provide maternal and child health services in the study area were included. All rape victims who received medical care following the incident were included. Victims who were found in active war areas or rape care recorded before wartime were excluded. To understand the experience of raped women’s psychological consequences related to sexual assault we conducted 23 in-depth interviews. Thematic analysis was used to conduct qualitative interpretation. Results The mean age of the participants was 31.66 (SD ± 20.95) years. One-third of 92(33.9%) of the survivors were diagnosed positive for sexually transmitted infections. Chlamydia 54 (58.4%) and HIV 32(34.8%) were the most frequently diagnosed infections. Among the rape survivors, one-tenth 29(10.7%) of them were positive for pregnancy, and induced abortion was done for 13 (44.8%) women who got pregnant due to sexual assault. The armed groups not only have sexual interests but inhumane individuals and consider rape as their way of expressing abjection to civilians. Survivors of raped women are confronted with social rejection and exclusion in the community that aggravates the traumatic process. Because of shame and fear, rape survivors often do not seek help but have to be offered support proactively. The victims claimed that they didn’t able to return to their previous life and considered their future in peril. Conclusion Conflict has a multidimensional devastating life effect, especially on women’s health. The victims experienced many physical and psychological consequences. Hence, resolving conflicts with peaceful discussion has numerous benefits for civilians.
A retrospective cross-sectional survey supplemented with the qualitative study will be conducted among victims of rape recorded until June 2022 since the invention of the Tigray People Liberation Front (TPLF) in Amhara region, Ethiopia. This study was conducted in North Wollo and Wagihmera Zones, Northeast Ethiopia which was highly affected by the TPLF terrorist group. Amhara region is one of the eleven regional states found in Ethiopia which is invaded by the TPLF. North Wollo Zone is located about 521 km from Addis Ababa, the capital city of Ethiopia; and Waghemira Zone is an administrative zone in eastern Amhara having six districts with Sekota Town, the capital of the zone, is 720 km north of Addis Ababa, Ethiopia. Quantitative data were collected from healthcare institutions that provide medical consultation, screening, and treatment of sexually transmitted infections (STIs), diagnosis and management of unwanted pregnancies, and other medical care for survivors. Health institutions that provide maternal and child health (MCH) services during the invasion and/or immediately after the area was freed from the invaders in the two zones of the Amhara region were visited. We followed a phenomenological approach to understand and describe raped women’s experiences during the armed conflict in northeast Ethiopia. According to an Amnesty International report, more than 70 women were raped in Nifas Mewcha town within 15 days stay of TPLF’s soldiers in mid-August 2021 [8]. Based on this data we estimated there may be around 349 raped women, who seek and access health service, in the two zones but only 271 victim women’s file was accessed in the health service during the study period. We initially planned to conduct around 20 interviews to understand the experience of raped women’s medical and psychological consequences related to sexual assault. The recruitment was performed by the first author in collaboration with the local women and children’s affairs office. However, we eventually continued to do 23 in-depth interviews (IDI) to achieve maximum saturation. All rape victims whether having received any medical care following or not during the TPLF invention were included. The study period was from May 15/2022 to June 5/2022. Victims who are found currently under invaded areas were not included. Cases of rape that occurred before this date were excluded. Rape is a criminal, aggressive and violent act to have sexual intercourse with a person without her consent. Health institutions that provide MCH services in the study area were included. The sample size in each health institution was proportionally allocated based on the number of survivors assessed in the selected health institutions. Two woredas from Wagihimera Zone (Sekota town, Gazegibla woreda,) and four Woredas from North Wollo Zone (Woldia Ketema, Meket Ketema, Raya Kobo woreda, Habru Woreda) were randomly selected. Survivors who did not visit health institutions were recruited to participate in a qualitative study using snowball sampling. Survivors’ age, marital status, level of education, and medical information were abstracted from medical records using a structured checklist modified from different literature focused on sexual abuse and its consequences during the armed conflict. The interviewer was recruited from the local area and selected based on previous experience of working with survivors and/or researching sensitive issues such as sexual violence. Following the quantitative portion, the principal investigator conducted in-depth interviews with one assistant from the respective health institution by using an in-depth interview guide. It explores the psychological consequences of the northern Ethiopia conflict on women, and a tape recorder was used to facilitate the conversation. During the data collection process, we follow the WHO and local COVID-19 prevention protocols. Pre-testing and training for data collectors and supervisors were done to ensure the quality of the data. Data confidentiality, participant rights, informed permission, the purpose of the study, interviewing techniques, and questionnaire completion was the main topics of the training. Interviewers and data collectors were trained on research aims, methodology, recruitment, interviewing techniques, and ethics. In addition, daily debriefings were held with the interviewers during data collection. To assure the validity of the checklist tools and in-depth interview guide questionnaires we conducted a pretest. Variables including age, marital status, education level, and time to medical care access (in terms of the delay from the incident of rape to seeking care) were assessed and presented through descriptive statistics. Medical consequences due to rape include sexually transmitted infections, traumatic pelvic pain, fistulas; postrape pregnancies and others were also reported in a table with their frequencies. Data were recorded and analyzed by using SPSS version 23 software. All in-depth interviews were audio-recorded. Then, to get a feeling of being whole, we listened to the recorded audio and chose units or segments that were relevant to our research goals. The data were transcribed verbatim by two investigators separately and translated into English respectively. After comparing each translation and checking the consistency, the data were coded. The segments were the meaning units that made up the various components of the phenomenon’s essential structure. We listened to the data and reread our notes before categorizing everything into broad groups. We regularly compared categories and looked for patterns and themes as they appeared during the investigation. We used our findings with the context to synthesize, modify, and structure our understanding of several thematic sections of the phenomenon. Thematic analysis was used to conduct qualitative interpretation. The ethical clearance was obtained from the Institutional Review Board (IRB) of Woldia University with protocol number WDU/IRB001. A formal letter prepared by the university’s research and development office was given to the selected health institutions. Moreover written consent was obtained from each respondent and aware of their right to withdraw from the study at any time during the interview period. Written informed consent was obtained from a parent or guardian for those under 18 years old participants. Interviews were conducted in private rooms with only the interviewer, and confidentiality was assured. We identified all recorded interview files with a unique code, understandable only to the corresponding author. The dissemination of the finding was not to be referring to a specific respondent but the general source population.
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