- Ethiopian security forces have committed widespread attacks amounting to war crimes against medical professionals, patients, and health facilities in the Amhara region.
- Civilians are bearing the brunt of fighting between the Ethiopian military and Amhara militia known as Fano, which began in August 2023.
- Ethiopia’s international partners should call for accountability and an end to attacks on healthcare and should resume increased scrutiny of the rights situation in the country.
(Nairobi) – Ethiopian security forces have committed widespread attacks amounting to war crimes against medical professionals, patients, and health facilities in the country’s northwestern Amhara region, Human Rights Watch said in a report released today.
The 66-page report, “‘If the Soldier Dies, It’s On You’: Attacks on Medical Care in Ethiopia’s Amhara Conflict,” documents how Ethiopian federal forces and a government-affiliated militia have attacked medical workers, healthcare facilities, and transports in at least 13 towns since the outbreak of fighting between Ethiopian federal forces and Amhara militia known as Fano in August 2023. Ethiopia’s international partners should call for accountability and an end to attacks on healthcare and should resume increased scrutiny of the rights situation in the country.
“Ethiopian federal forces operating with near impunity are unsurprisingly disregarding civilian lives by attacking medical facilities that are providing desperately needed care,” said Laetitia Bader, deputy Africa director at Human Rights Watch. “So long as the government feels no pressure to hold abusive forces to account, such atrocities are likely to continue.”
Between August 2023 and May 2024, Human Rights Watch interviewed remotely 58 victims and witnesses to abuses as well as medical professionals and aid workers. Human Rights Watch also reviewed satellite imagery and verified videos and photographs following an apparent government drone strike on an ambulance in November.
Human Rights Watch found that Ethiopian forces endangered or disrupted the functioning of hospitals. Soldiers beat, arbitrarily arrested, and intimidated medical professionals for providing care to the injured and sick, including alleged Fano fighters. The soldiers also unlawfully attacked ambulances and medical transports, interfered with access to humanitarian assistance, and denied the Amhara population the right to health.
In January, Ethiopian soldiers detained and interrogated a medical professional for several days in a military camp. “The colonel [interrogating me] called me a ‘Fano doctor,’” he said. “He started asking why I was giving treatment to the Fano. He said [the Fano] are not humans … they are monsters.”
Federal forces have obstructed access to medical facilities, including by wrongfully arresting patients on mere suspicion of a Fano affiliation, causing widespread fear for those that may seek or need treatment.
International humanitarian law, also known as the laws of war, prohibits attacks on civilians and civilian objects. In addition, it affords special protections to health facilities, medical professionals, patients, and ambulances. Even during an armed conflict, international human rights law remains in effect and contains core obligations for countries to maintain minimum essential levels of the right to health.
The fighting in Amhara has disrupted the delivery of medical supplies, leading to acute and prolonged shortages of essential medicines in hospitals and health centers, affecting their ability to provide adequate care.
Doctors and health staff have worked under dire and difficult conditions. “We have shortages of oxygen and medication, and since there is no power, we are struggling,” said one doctor working in a hospital in November 2023. “The blood bank has stopped collecting blood. ... Yesterday, we had to tell an expectant mother’s family to come with 20 liters or any amount of fuel they can bring so we can operate on them using the generator.”
Doctors seeking to replenish depleted hospital supplies have aroused the suspicion of government forces and in some cases have come under attack, affecting their ability to provide care to patients in a safe environment. On November 30, an apparent drone strike on a clearly marked ambulance in Wegel Tena town killed at least four civilians, badly wounded one, and destroyed much-needed medical supplies. “Psychologically, hospital staff are disturbed and living in fear of another attack,” a doctor said. “All the medications in the ambulance burned. We had used the little budget we had left to procure the medications.”
Humanitarian aid agencies working to fill gaps in medical supplies and equipment have also faced an increasingly difficult operating environment since August 2023. Their work has been affected by ongoing fighting, attacks on aid workers, towns frequently changing control, and movement restrictions, including difficulty moving to Fano-controlled areas. Nine aid workers have been killed in Amhara since the fighting started, at least four of them since January.
In March, Amhara regional health officials acknowledged that the ongoing conflict in the region between government forces and Fano militias have caused extensive damage to the healthcare system, though they claimed that “extremist forces” had pillaged 967 facilities and seized 124 ambulances.
Human Rights Watch wrote to Ethiopian authorities in June concerning the organization’s findings. The Ethiopian government has not responded.
Since the United Nations Human Rights Council failed to renew the UN-mandated inquiry on Ethiopia in October 2023, there has been limited international monitoring of the human rights situation in the country. Independent journalists have also had little access to the Amhara region. As part of its global mandate, the UN Office of the High Commissioner for Human Rights released a report on the human rights situation in Ethiopia on June 14, saying that Ethiopian federal forces and the Fano militia had been involved in numerous violations of international humanitarian law, resulting in over 2,000 civilian casualties in the Amhara region.
The Ethiopian government should immediately end attacks on medical professionals, patients, health facilities, and transports in the Amhara region. Ethiopian authorities should also work to strengthen the country’s legal framework to protect health care by passing specific legislation that protects healthcare workers, medical professionals, and health facilities.
International donors have acted to rehabilitate damaged health facilities in Amhara and other conflict-affected areas, but concerned governments have not publicly condemned attacks by Ethiopian federal forces nor urged the government to hold those responsible for abuses to account, Human Rights Watch said.
Ethiopia’s international partners, notably the African Union and the European Union, should press for resumed international scrutiny of the human rights situation in Ethiopia in multilateral forums. They should also increase support for health services in Amhara, ensure robust independent human rights monitoring in their agreements with the Ethiopian government, and publicly denounce restrictions on aid and attacks against aid workers.
“Foreign governments and international organizations have sought to return to ‘business as usual’ with the Ethiopian government despite the absence of normality on the ground,” Bader said. “Continued civilian suffering from the conflict in Amhara means much greater international scrutiny is needed in Ethiopia.”
