In-depth interview.

A self-developed semi-structured in-depth phenomenological interview was used to collect data from the participants. The questions were directed at the participants’ lived experiences, feelings, beliefs, and meaning about the phenomena and the setting. It addresses how the participants think and feel most directly by focusing on what goes on within the participants’ bodies, minds, time, and relationships. The interview questions include: What happened to you when the TPLF forces captured Chena? What are the feelings and thoughts you experienced after the sexual violence? Did you share your experience with anyone (family, friends, etc.)? How has the experience affected your body and relations with others etc.?

Follow-up questions were used to capture detailed stories. This allowed us to unfold the meaning of the participants’ experiences. As Creswell [17] described, the phenomenology study intends to understand the phenomena in the subject terms and explain the human experiences as the person herself experiences them.

Memoing.

Given the participants’ position to participate in the study without being audio/video recorded, we used field notes recording what the interviewers heard, saw, experienced, and thought while collecting and reflecting on the process using narrative exposure therapy. We gave this therapy while interviewing the victims by which we had prepared a rope, a flower and a stone where the rope represented a life line, the flowers represented memories that are considered good or situations that were supportive to the participant while the stone represented traumas and adverse experiences of the participant. After the stones and the flowers are assigned and labeled by the participants, they were asked detailed questions about each experience. The participants gave their consent that their answers could be recorded by a notebook. In each experience the participants were asked to talk about details of their feelings and sensations in each adverse experience. It should also be noted that all the interviews were carried out in Amharic, the local and the official national language.

Trustworthiness.

The following steps were taken to make sure the study’s credibility, transferability, dependability, and reflexivity. The interview guide was initially created by examining a substantial body of literature prior to performing the interview. Sensitive to cultural differences of the interview guide was checked. The interviews were done in Amharic, the mother tongue of the participants, by the lead psychosocial support team. The findings were totally based on participant descriptions rather than any researcher’s biases. This is backed by the final report, which further supports the study’s conformability and reflexivity by anecdotes of the participants. Additionally, the extensive data analysis procedure that demonstrates how the van Manen phenomenological analysis was completed using similarities and differences of the themes supports the internal coherence and validity of the themes and upholds the credibility of the study.

Participant 1.

Ement, the 15 years old girl, was raped in her own home by several TPLF soldiers. She described the movement as, “…at first, the TPLF soldiers arrived at our home unexpectedly. We cooked for them for some days. However, we wanted to escape. Thus, my mom and I tried to escape from them. They caught us and took me away. They told my mom to go alone. They told me that I would be staying with them or they would kill me. I did not get a chance to refuse since they were abusing me physically. They took me home. There I found some of my friends. They were also captives.”

Ement reported that she was raped by one of the soldiers and witnessed other girls being rapped by other soldiers in the same situation. The rape happened during the night, followed by severe verbal abuse and cursing. “In the middle of the night, they came to us and took one girl at a time. That night, the guy that caught me raped me.” Emnet escaped the place the following day alone since other girls were scared to death to join her in her decision. She said: “I told my friends that I plan to run away at any cost. They were scared, and they told me I might get killed, and they were afraid to do so. Then I waited until the Juntas were busy with other tasks. I was able to escape. As there was a jungle everywhere in Chena, I was able to run without being seen. It took me 5 hours to run and roll down from the mountains. I never felt any pain until I arrived at Dabat after 5 hours of running. I went to my aunt. Then I sent a message to mom that I was able to escape and that I was okay.”

Emnet finally managed to get back home and met her mother when the area got free from the Tigray invaders. This was not, however, a less harrowing experience for her. She said, “After Chena was free from the TPLF force, I went home. However, the house reminded me of all the abuse scenes.” The support she received from her mother was very much instrumental. It was beyond her imagination to experience all those sufferings in her life.

As the saying goes, "adding salt on a wound," Emnet did not believe her father was killed in the war. She stated the experience and all the associated feelings: “What was worse was that I found out that my dad was killed later. He went to fight with the TPLF force to protect his family and his community. However, he was not able to protect us. He died. I love my dad a lot. All I wanted was to study hard to make my dad proud of me. I was so sad because of the death of my dad. It still irritates me. I was not able to sleep for a month. Currently, I experience difficulty falling asleep if I recall my dad. I recall my dad calling my name with care and love. He always showed me love. He was never angry at me. I always recall him whenever I go to Chena. And it is hard for me to accept that he is gone and will never return. It irritates me that my family experienced double damage.”

In Emmet’s view, what was more painful was not experiencing the sexual violence per se but the social stigma she faced afterward. The stigma ranges from child shepherds to adult community members who knew about the fact that the Tigray rebel forces raped her. Such stigma forced her to move from her village to another area where no one knew her condition. She said: “In addition to the sexual abuse, the community started laughing at me. Whenever I pass by our neighborhood, they will loudly call me የጁንታ ትራፊ “leftover of the junta,”I hated myself because of my experience of abuse. I hated the community. I was stressed and irritated.”

In all these ups and downs, Emnet gives credit to her mother. She said, “My mom was my strength. She told me that I could have been more hurt if they had done the same thing to her. And she told me that I sacrificed myself to save her.” Unfortunately, Emnet was forced to leave her mother to escape the community stigma. She stated: “I love being around her, but the shepherds and the community were harsh. Thus, I was not able to resist. Because of that, I moved to a different community called Wokin. It is not easy to live in Wokin. Yet I felt better since I was far from the people that were insulting and mocking me. I do not want to see the village now. It has too many bad memories for me.”

Finally, Emnet got relieved after she had the opportunity to do a medical check-up. She was happy for a couple of reasons. One is that she did not conceive, and the other is that she met several other women victims of rape and got a sense of “I was not alone.” She said:

“The first time that I felt safe was when I was able to have a medical check-up at Debark hospital and when they told me that I was okay. I felt okay after meeting with women with similar experiences. I understood it was not only me, and I was not the target, but rather the community was a target.”

Participant 2.

Rebeka is a 56-year-old woman and a mother of seven children. She stated that she was home with her five children when the Tigray rebel forces arrived at Chena. Her husband was on the war front fighting the TPLF forces. She describes the moment and the brutal sexual violence that happened to her by seven TPLF soldiers “They broke into my home. They all raped me until I was not able to move my body. They did anal sex, also. My children were watching all the scenes. I was not able to be fully conscious until the next day.” Rebeka developed a serious physical health problem due to this horrific experience. For her, the most painful part was the psychological wound that came from the crime and the inhuman reaction to her. She said, “After that time, I cannot control my urine and stool/ordure. It is not the rape that hurt me nor their ethnic slurs and beating; my children watched all this, and I cannot work and feed them now. I am old enough to be a grandmother, but I could not protect my kids. At my age, I do not know how to express what I feel about being a victim of seven men and developing Fistula on both sides.”

For Rebeka, the experience of this horrific violence brought significant shame to her family to the level where she is more concerned about her children’s psychological health and dignity than her own health. Two of her adult children, who live in a different place, immediately joined the militia upon hearing what happened to their older mother. She states they were so angry and directly went to the battlefield without informing her. “I am stressed because I cannot take care of my children. I know God does have a reason for everything that happens in life. I am not irritated, but I am sad because of the condition of the children. They have no one to take care of them. Their grandmother is old, and she also needs support. I left them now with her. But she is not able to take care of them. I know I should be hospitalized, but where will I leave my kids, and who will take care of them? Yet, I thank God because they did not kill my children or me.” Rebeka was in the process of arranging medical treatment in Gondar city through the Amhara emergency fund during the interview.

Participant 3.

Tesfa, a 10^th grader before the war, had been moved to the nearby village with her family when they heard about the Tigray rebel force approaching their village. However, she and her family return home after a couple of days of searching for food. She says, “We were forced to get back home since we never took anything from home because we were shocked by their arrival. But when we returned, they used our house as a camp. Until they were defeated, they were kind to us. They always tell us that they will not harm civilians, especially farmers. We believed them. They tricked us. “The Tigray rebel force used their house as a camp for 16 days until the Ethiopian government force made a counterattack and defeated them. Tesfa said that the TPLF forces who had settled in their house became aggressive and attacked the village on their last days. She said: “On Nehasie 28 (September 4), they changed into a beast and attacked us. They harassed us, cursed us. They said that the Amhara special force had raped their children, sisters, and elders, and they would take revenge. One of the guys came to me. He beat me everywhere in my body and cursed me. He shouted at me, saying, “your people raped a monk, your people killed a child, your people raped little girls, your people, and this is a price that you should pay as revenge for your people’s action,” when I begged him to leave me. He spat on me and told me that he would cut my body into pieces holding a knife around my neck. He bit me with an oyster of the weapon. I was unable to defend myself. He raped me while he was biting me and cursing me. And he told me that he will take me with him, and I am his wife from now on.”

When she was asked how she was feeling and doing at the interview, Tesfa replied:

“The memory of the knife and the weapon always distracts me more than the rape. I cannot sleep at night because I have nightmares about being stabbed by a knife and struggling to escape. I will start running in the middle of the night, saying run, they are here; run for your life. Every night in my dreams, I will find myself hiding and running away from the TPLF. I always wake up crying. And my family will hold me and calm me down. I used to walk for five hours on foot to Debark every day to sell some goods and get money for my education. But I cannot do that anymore. The flashback of being spat at, cursed, strangled, and threatened by the knife and the weapon is a painful memory for me more than the rape itself.”

Regarding the question about what is available to support her, Tesfa’s response shows the lack of emotional support and the challenge of dealing with the social stigma about rape. She said:

’’There is no one that I can talk to. I do not have friends that will keep my secret and share my pain. I cannot tell people what happened to me. I cannot even talk to my family about what I have been through. I wish I were not born at all. I wish I had died right there when he raped me. My family tells me that I disgraced them. And the other members of the community, even my mate, call me “Leftover of the Junta, የጁንታ ትራፊ’’ everyone curses me and laughs at me.”

While Tesfa deals with this horrific story, she cries for help and approaches the crisis intervention team that traveled to their village to provide her with some support. She said, “I was supposed to hide what happened to me. But I sought help, and I came here. I cannot go back to the community with all their judgment.”Tesfa was asked about her experience after the war. Her response shows that her life was ruined due to the sexual violence that happened to her, including losing her dream and hope for her future. She stated, “I was engaged before the TPLFforce-controlled Chena. I was planning to get married after finishing my studies. But my engagement is canceled. I cannot face my family and the community. I cannot bear to be reminded of that day.”

Physiological effect.

Some of the main themes from the data analysis reflect the victims’ lived body experience, including suffering from a mass of physical consequences. The physical symptoms reported by the victims include developing fistula, persistent ongoing pain, headache, weakness, and losing physical strength. Such physical sufferings are not uncommon given the goal of wartime rape and sexual violence as weapons of war targeted to humiliate communities by raping women and girls at gunpoint, beatings, and physical torture. Physical effects such as traumatic gynecologic fistulae are commonly reported [20]. A systematic review of 20 studies drawn from six countries, of which 18 were from five African countries, reported traumatic genital injuries/tears, pregnancy, rectal and vaginal fistulae, sexual problems/dysfunction, and sexually transmitted diseases [9]. Such physical effects are also reported to be long-standing [21].

Psychological effect.

Even though the data from this study is limited to showing the whole psychological dimension of the victims’ experiences, it is clear that emotional symptoms that could lead to psychological problems are endorsed in their report. The research participants’ ongoing psychological pain reported included flashbacks, nightmares, memory loss, difficulty sleeping, and intrusive thoughts consistent with post-traumatic stress disorder (PTSD) symptoms. They also shared their experience of being easily triggered and feeling scared quickly, hopeless about their future, and the psychological consequence of losing their dignity. The family members of the victims are also at considerable risk of psychological crisis. One of the participants shared that her youngest children, who witnessed her gang rape, were crying and traumatized by the experience.

In contrast, her adult children, who heard about their mothers being raped, developed a wave of explosive anger. They went directly to the battleground and joined the military group to fight against TPLF. These psychological effects entail wartime rape and sexual violence, resulting in vast and long-ranged mental health impacts.

The present study’s findings are consistent with 14 out of 20 studies in a systematic review (Ba & Bhopal, 2017), where mental health outcomes of rape and sexual violence among civilians in conflict settings were reported. The most frequent outcomes include post-traumatic stress disorder, anxiety, and depression. Our findings are also comparable with a study conducted on adolescents in eastern Congo. Participants who considered sexual violence a non-consensual sexual experience reported more traumatic hyper-arousal and intrusion symptoms than those labeling the sexual violence as rape [22]. Furthermore, a study conducted on victims of war rape and sexual violence after 20 years of the Bosnia and Herzegovina war reported mental and general health conditions to grave concern. A substantial proportion of the victims have been suffering from clinically relevant PTSD symptoms, depression, and anxiety, with the majority, reported the rape experience ultimately affected their present life [21]. A rape survivor from the Kosovo war explains how deeply the psychological victims suffer. She says, “Rape is a wound that will burn your soul. It will make you ashamed in front of your family. You will carry it all of your life” [23].

Stigma.

In Amhara culture, with strong customs and taboos regarding virginity, sex, and sexuality, there is nothing highly stigmatized than rape. This study shows that their own community and villagers viewed them as dirty, unclean, and damaged. Hence, the participants suffer from disownment and isolation. Two of the three participants were forced to leave their own village because of the stigma. Thus, the women’s stories in this study unfold how rape as a weapon of war has a broader social phenomenon that furthers the women’s suffering by re-victimizing and lifting them to feel even more shame and guilt for being raped. In this connection, Adama Dieng, Active Special Representative of the Secretary-General on Sexual Violence in Conflict, once stated that “Aggressors understand that this crime attacks individual and collective identity, social relationships, and status.” And “Victims who might survive rape often did not survive its social repercussions.” He also adds, “Many were literally dying of shame, forgoing medical and legal help to avoid humiliation” [32].

Besides the exclusion, the stigma also impacts the victim’s future. For example, society views the victim as a person with damage and incapable of a future relationship. In one of the participant’s cases, we can see that the wedding plan and the marriage arrangement are also canceled because of the stigma attached to a rape victim. Other studies also showed that disclosing a sexual assault to a romantic made survivors ashamed and belittled by their partners [33]. Studies in the Kivu region of Eastern DRC also showed that many men should reject their wives after rape [34].

Lack of governmental or community support.

Another risk factor that unfolds in this study is the victim’s lack of society or government support. The lack of legal victim protection for women against verbal, physical, and emotional abuse produces more fear among the victims and slows down their healing process. The victims report that they experienced exclusion in a social context and have to stand up to protect each other from community-based exclusion. In our study, the story of one of the participants, a mother of seven children, shows that her suffering is only magnified because she was left to support her children alone while dealing with Fistula and being ostracized in dealing with a traumatic recovery. Participants shared the lack of or limited healthcare access after the rape in the area and the stress that comes along with it. To get the medical treatment, she was forced to leave her children to her elderly mothers, who might not be able to take care of herself, let alone her grandchildren. Our finding is similar to wartime rape and sexual violence victims of various countries such as Kosovo [23], Sierra Leon [35], and Syria and South Sudan [36], where victims face a lack of government support, lack of transitional justice, lack of reintegration into their communities and marginalization.

Societal silencing behavior (Unspeakability).

The participants of this study also revealed that either their own family or the community didn’t come to them openly to discuss what happened to them, which led them to keep silent about it. This absence of communication and speaking openly of this horrific action made them feel disowned by their own community. According to scholars in the field, silencing the experience of sexual violence signifies psychological repression [37]. Furthermore, the inability to discursively frame the nature of this horrific experience seems to contribute to the silencing behavior. One of the participants described that even though her experience is not hidden from her family and friends, no one knows how to talk about it. She felt some indescribable fear from the silence. Similarly, a study on the impact of disclosure of rape reported that rape victim women who break the silence and speak out about their experiences at the beginning quickly consider this decision and choose to stop speaking [38]. This may be due to blame from others, being denied help, or being told to stop talking about their rape experience [36].

1. Research Q #3 What protective factors appear or need to be constructed in the environment of girls and women victims of war rape and sexual violence?

In this study, protective factors are viewed as factors that appear in the environment that help or cultivate the likelihood of survival, recovery, and healing of girls and women who are victims of war rape and sexual violence. These factors can exist at the individual, familial, community, and societal levels. Three major themes emerge from the analysis data that might answer the question about protective factors. These themes include individual and familial-resilience behavior, faith and spiritual practice, and medical and professional support.

Personal and familial -resilience.

The victims’ story reflects the strength that already existed at the individual and family level. One of the participants revealed that the support she got from her mother helped her keep moving regardless of the horrific experiences. Such support also builds self-resilience in her. Similarly, their wisdom sheds light beyond the dark when mothers are resilient. Mary Barra beautifully explained this, saying, “When I was a young girl, and something difficult happened, I would look to my mother for comfort and guidance” [39]. The resilience of the participants of this study is indicated in their meaning-making of the event. For example, two participants believed that this horrific event was an attack on their country, ethnicity, and community more than an attack targeting their individual selves.

Faith and spirituality.

A terrible life experience such as wartime rape increases the risk of mental health problems. Research shows that faith and spirituality may prevent the negative impact of such adverse experiences [40]. One of the three participants described the connection of faith and spirituality to the experience. She believed that she had been called to this suffering at 56 years old but was given the ability to take it day by day. All of the study participants identified themselves as Ethiopian Orthodox Tewhido Christians. They believed their faith was a way to escape the psychological and physical pain they were dealing with after the war and war rape. Our findings are comparable with research findings on these issues. For instance, faith and spirituality were found to be instrumental coping strategies in persons under challenging circumstances, such as female aid workers working in conflict zones [41], for preventing and recovering from substance abuse [42], and have an impact on mental health conditions.

Medical and professional support.

Physical conditions such as children born out of Traumatic fistulae [20], as well as psychosocial conditions such as mental illness [21] and stigma [23], are commonly reported problems in wartime rape and sexual violence. Participants of the present study had to rely on the medical and professional community, which played a vital role in restoring healing for them. Although it was difficult for the participants to access medical facilities immediately after experiencing rape and gang rape due to the war, they could get support from health professionals after their community got free from the rebel forces. The participants extended words of tribute to organizations such as the Amhara Emergency Fund that facilitated the medical support. The psychosocial support group from the University of Gondar and Debark University also played a pivotal role.