Integrating care for sexual and gender-based violence survivors in newly-restored sexual and reproductive health facilities in Amhara, Ethiopia

Principal Investigators: Professor Negussie Deyessa (EPHA/Addis Ababa University), Professor Jacqueline Broerse (VU)

Research Snapshot: How conflict-affected health systems fail gender-based violence survivors

This mixed methods study in two conflict-affected districts in Ethiopia found significant gaps at all levels of the health system in access to and provision of survivor-centred care for women and girls who have experienced gender-based violence.

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What did the study set out to achieve?

The research aimed to:      

• Investigate the prevalence of GBV, experiences of stigma, poor mental health, healthcare needs of survivors and barriers to service use.
• Assess existing GBV services and healthcare worker capacity.
• Propose an integrated approach to high-quality GBV care delivery;
• Develop insights for research, policy and practice on SRH and GBV health systems in conflict-affected areas.

Ultimately, the study aimed to contribute to alleviating the negative health and social effects of GBV by increasing understanding of it in the conflict-affected region of Amhara, Ethiopia. It sought to explore the needs of women and girls to understand how high quality services for GBV survivors can be made available and accessible.

The research aimed in the short term to develop service delivery models and protocols outlining competencies for integrated GBV care. As a result of the research the team developed GBV guidelines to be validated with stakeholders, and an e-learning module to train healthcare providers in survivor-centered knowledge, attitudes, and practices.

What were the key findings?

• Around 25% of women and girls experienced lifetime intimate partner violence (IPV), and a similar proportion experienced gender-based violence GBV during conflict with sexual, physical, and emotional IPV, frequently overlapping.  
• South Wollo had higher IPV rates, while North Wollo showed more severe mental health impacts(post-traumatic stress disorder, anxiety, depression).  
• Over 70% of survivors faced stigma and adverse norms from communities and staff, and only3.5% sought formal health care due to fear, shame, costs, and limited access. Many survivors turned to non-formal services, traditional healers, religious leaders, or family because they mistrusted formal services.
• Health facilities lacked infrastructure, medications and supplies, and protocols for GBV care; providers reported low confidence, and harmful attitudes toward GBV and gaps in knowledge and skills were found in staff, indicating a need for training.
• Existing GBV policies displayed gaps in terms of inclusivity. Guidelines were weakly disseminated and insufficiently resourced for implementation.

What does this mean for policymakers and practitioners?

The study emphasises the need for policymakers and practitioners to act urgently. Policies and guidelines must be reviewed and revised to be inclusive of diverse survivor needs, considering the mental and physical health needs of conflict-driven GBV and IPV. This must be supported by adequate funding and multisectoral coordination, including local and national policymakers and practitioners. Engaging the community in gender advocacy is vital to addressing stigma, reducing harmful norms, and supporting survivors in seeking care. Addressing structural barriers, such as infrastructure gaps and transport limitations; improving facility supplies; training health workers in survivor-centered case management; and strengthening referral systems.