Army attacks health care in Amhara conflict

Protect medical staff and patients; hold those responsible accountable

• Ethiopian Security forces have carried out widespread attacks against medical personnel, patients and health facilities in the Amhara region that amount to war crimes.

• Civilians have borne the brunt of the fighting between the Ethiopian military and the Amhara militia known as Fano, which began in August 2023.

• Ethiopia’s international partners should demand accountability and an end to attacks on the health system. They should also take a closer look at the human rights situation in the country.

(Nairobi) – Ethiopian Security forces have carried out widespread attacks amounting to war crimes against medical personnel, patients, and health facilities in the Amhara region in the northwest of the country, 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 troops and a government-affiliated militia have attacked medical personnel, health facilities, and transportation in at least 13 cities since fighting broke out between Ethiopian federal troops and the Amhara militia known as Fano in August 2023. Ethiopia’s international partners should demand accountability and an end to attacks on health care, and re-examine the human rights situation in the country.

“It is not surprising that Ethiopian federal forces, operating with near impunity, disregard the lives of civilians by attacking medical facilities that provide urgently needed care,” said Laetitia BaderDeputy Africa Director at Human Rights Watch. “Unless the government feels pressure to hold perpetrators to account, such atrocities are likely to continue.”

Between August 2023 and May 2024, Human Rights Watch interviewed 58 victims and witnesses of attacks, as well as medical and relief workers remotely. Human Rights Watch also reviewed satellite imagery and verified videos and photographs following an alleged government drone strike on an ambulance in November.

Human Rights Watch found that Ethiopian forces threatened or disrupted the operation of hospitals. Soldiers beat, arbitrarily arrested, and intimidated medical personnel who were caring for the injured and sick, including suspected Fano fighters. Soldiers also unlawfully attacked ambulances and medical transports, prevented access to humanitarian aid, and denied the Amhara people their right to health.

In January, a doctor was detained and interrogated by Ethiopian soldiers in a military camp for several days. “The colonel (who interrogated me) called me a ‘Fano doctor,'” he said. “He asked me why I was treating the Fano. He said (the Fano) were not human… they were monsters.”

Federal forces have obstructed access to medical facilities, including by wrongfully arresting patients based solely on suspicion of a Fano connection, causing great fear among those seeking or needing treatment.

International humanitarian law, also known as the law of war, prohibits attacks on civilians and civilian objects. In addition, it provides special protection for health facilities, medical personnel, patients and ambulances. Even during an armed conflict, international human rights law remains in force and contains core obligations for countries to respect the minimum standards of the right to health.

Fighting in Amhara has disrupted the supply of medical supplies, leading to acute and prolonged shortages of essential medicines in hospitals and health centers and compromising their ability to provide adequate care.

Doctors and medical staff are working in dire and difficult conditions. “We have a shortage of oxygen and medicines and since there is no electricity, we are struggling,” said a doctor working at a hospital in November 2023. “The blood bank has stopped donating blood. … Yesterday we had to tell the family of a pregnant mother to come with 20 liters or as much fuel as they can bring so that we can operate on her with the generator.”

Doctors attempting to replenish depleted hospital supplies aroused the suspicion of government forces and in some cases were attacked, affecting their ability to treat patients in a safe environment. On November 30, an apparent drone strike on a clearly marked ambulance in the town of Wegel Tena killed at least four civilians, seriously injured one, and destroyed much-needed medical supplies. “The hospital staff are mentally disturbed and live in fear of another attack,” said one doctor. “All the medicines in the ambulance are burned. We had used up what little budget we had left to procure the medicines.”

Humanitarian aid organizations working to fill gaps in the supply of medical equipment have also faced increasingly difficult conditions since August 2023. Their work is hampered by ongoing fighting, attacks on aid workers, frequently changing controls in cities and restrictions on movement, including difficulties crossing into Fano-controlled areas. Nine aid workers have been killed in Amhara since the fighting began, at least four of them since January.

In March, health authorities in the Amhara region acknowledged that the ongoing conflict in the region between government troops and Fano militias had caused significant damage to the health system, but also claimed that “extremist forces” had looted 967 facilities and seized 124 ambulances.

Human Rights Watch wrote to the Ethiopian authorities in June with reference to the organization’s findings. There was no response from the Ethiopian government.

Since the United Nations Human Rights Council failed Although the United Nations-mandated investigation into Ethiopia is scheduled to resume in October 2023, international monitoring of the human rights situation in the country has been limited. Independent journalists have also had little access to the Amhara region. As part of its global mandate, the Office of the United Nations High Commissioner for Human Rights published a report on the human rights situation in Ethiopia on 14 June, stating 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 stop attacks on health workers, patients, health facilities and transportation in the Amhara region. Ethiopian authorities should also work to strengthen the country’s legal framework to protect health care by adopting specific laws that protect health workers, medical personnel and health facilities.

International donors have taken action to repair damaged health facilities in Amhara and other conflict-affected areas, but affected governments have neither publicly condemned the attacks by Ethiopian federal troops nor called on the government to hold those responsible for the human rights abuses to account, Human Rights Watch said.

Ethiopia’s international partners, particularly the African Union and the European Union, should push for a resumption of international scrutiny of the human rights situation in Ethiopia in multilateral fora. They should also increase support for health services in Amhara, ensure strong independent human rights monitoring in their agreements with the Ethiopian government, and publicly denounce aid restrictions and attacks on aid workers.

“Foreign governments and international organizations have attempted to return to ‘business as usual’ with the Ethiopian government, despite the lack of normality on the ground,” Bader said. “Continued suffering of civilians from the conflict in Amhara means that Ethiopia needs much greater international oversight.”

© 2024 Human Rights Watch