For the past year, Ethiopian federal troops have been fighting against troops loyal to the Tigray People’s Liberation Front (TPLF) in a conflict that has killed thousands of people and displaced over 2 million. Last month, armed conflict escalated in Ethiopia’s embattled Tigray, Amhara and Afar regions. And this week, Ethiopia’s government called for citizens in Addis Ababa to prepare to defend the capital as rebel groups reportedly seized towns along the road to Addis Ababa.
A month ago, the Ethiopian government alleged that United Nations officials had meddled in the country’s affairs and expelled seven of them. This move may complicate civilians’ access to humanitarian assistance, as the threat of famine looms.
When the current Tigray conflict began, an estimated 100,000 Eritrean refugees were living in Tigray, fleeing government repression in that country. Though Ethiopia’s Prime Minister Abiy Ahmed won the 2019 Nobel Peace Prize for ending a 16-year dispute with Eritrea, these refugees still fear being targeted by the Eritrean regime if they return home.
Ethiopia’s Tigray conflict reflects unresolved ethnic tensions
Many Eritreans were caught in the new conflict
The Eritrean government, long an enemy of the TPLF, has fought in the current conflict alongside Ethiopian federal troops. Eritrean forces stand accused of human rights violations in Tigray. In July, U.N. High Commissioner for Refugees Filippo Grandi highlighted profound impacts on Eritrean refugees in the region.
Beyond the physical danger these refugees now face, how is their mental health?
To learn about refugees’ mental health needs, two of the authors conducted a representative survey in January 2020 of over 600 adult Eritreans in Mai Ayni and Adi Harush, the two largest refugee camps in Tigray. Here are four things we learned.
Eritreans flee to Ethiopia to escape torture and repression
Adults in Eritrea must complete an 18-month period of National Service, which can include both military and civil duties. But recruits are often made to serve indefinitely, amounting to forced labor. U.N. sources reveal widespread arbitrary detention, torture, extrajudicial killings and sexual violence within the conscription system.
Thousands flee annually, making Eritrea the world’s ninth-largest refugee-producing country. Nearly 10 percent of Eritreans live under asylum outside the country; only Syria and South Sudan exceed this proportion of refugees. Approximately 174,000 Eritrean refugees live in Ethiopia, most in Tigray.
In our survey, Eritrean refugees reported high rates of torture. Given a definition based on the U.N. Convention against Torture, 46 percent of respondents reported they had been tortured, and 80 percent believed many in their community had been tortured. These alarming figures are mirrored in firsthand accounts of human rights violations perpetrated by the Eritrean government.
Aid shortages and targeting by combatants put refugees in further danger
Nongovernmental organizations scaled back operations in Tigray at the start of the pandemic, worsening conditions for refugees. When armed conflict began in November 2020, the lack of security and lack of camp access led U.N. and most other aid organizations to pull out completely.
Eritrean refugees faced abuses by soldiers of the regime they had escaped. Two camps came under direct attack from Eritrean troops, who reportedly looted aid and burned structures and crops. Subsequently, Eritrean refugees abandoned those two camps. Many fled to Mai Ayni and Adi Harush camps.
In Ethiopia’s digital battle over the Tigray region, facts are casualties
Thousands are reportedly missing — and refugees have reportedly been killed, abducted or forcibly returned to Eritrea. In July, the U.N. urged all sides to stop using refugees to “score political points.”
Past trauma and chronic stressors are linked to poor mental health
In line with existing research, our survey found that past torture and chronic stressors are common in the camps. Past traumas and ongoing stressors are linked to frequent symptoms associated with post-traumatic stress disorder and depression.
Though all respondents had survived difficult experiences, those who reported being tortured described symptom frequency 19 percent higher than those who did not report being tortured. Nearly a quarter of refugees we surveyed reported serious symptoms of depression and PTSD during the previous two weeks. This is probably an underestimate because the stigma of mental illness among refugees reduces willingness to report symptoms.
Almost a third of those surveyed said emotional problems disrupt their lives. They mentioned daily stressors of securing basic needs like food or shelter but tended to emphasize the stress of trying to leave the camp, worries about people back home and grief over the loss of loved ones. Respondents often did not know whether their loved ones were alive.
Many are now less trusting of aid organizations
After the conflict started and aid agencies withdrew, refugees took their safety into their own hands. Many attempted to leave the camps, and some tried to escape to Ethiopian cities. Though aid groups have since attempted to return to Tigray, humanitarian staffers based there have said that some refugees report feeling betrayed by these organizations. In July, refugee representatives in Mai Ayni apparently requested that aid groups be denied reentry to camps.
Given the history of refugee victimization, this reaction is understandable, and even predictable. Humans depend upon one another for survival. Our brains have evolved sensitive neural systems to recognize and respond to signs of betrayal or abandonment, whether by other people or institutions.
Beyond their personal traumas, many Eritrean refugees also survived repeated betrayals by their own government, making them particularly sensitive to failures by humanitarian organizations in Ethiopia.
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Psychologists describe the effects of living under constant threat as continuous traumatic stress. Each new traumatic experience reinforces the survival-focused neural system, making it more efficient and overwhelming alternate responses. The rejection of undependable aid, in this light, would be a rational response to this loss of control.
What happens now?
Aid organizations constantly weigh the safety of their staffs against the needs of local populations, including refugees — particularly during periods of conflict. Organizations make decisions with life-or-death implications quickly and often communicate unidirectionally to refugees, leaving them to create their own narrative about the intentions behind those decisions.
Eritrean refugees will probably remain in Ethiopia for the foreseeable future, and histories of trauma and betrayal will color their relationships with Tigrayans, the Ethiopian government, the U.N. and aid organizations. Improving these relations and protecting vulnerable Eritreans will probably require sustained mental health programming — and a trauma-informed approach to assistance.
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Sarah Peters, PhD, is a political scientist who conducts applied research and evaluation in humanitarian settings in Ethiopia and the Middle East.
Shannon Golden, PhD, is a sociologist who conducts applied research and evaluation about human rights, mental health, and forced migration in East Africa and the Middle East.
Liyam Eloul is a technical adviser in mental health for humanitarian projects in the Middle East and East Africa.
Craig Higson-Smith, PhD, is a research psychologist with 25 years’ experience in the field of rehabilitation of survivors of torture and war.