Medhanye Alem, CVT Ethiopia’s clinical program director, recently presented at the Geneva Center of Humanitarian Studies’ new pilot a module, “Navigating the Complexities of Sexual Violence, Transactional Sex, and Forced Migration: Research and Practice.

Medhanye was asked to speak on the topic “Providing Rehabilitative Care to Internally Displaced Persons in the Aftermath of the Regional Conflict in Tigray,” focusing on survivors of sexual violence in the context of migration.

Below is an amended version of Medhanye’s presentation. 

The Need for Mental Health & Psychosocial Support (MHPSS) Intervention

The conflict in Tigray, Ethiopia, which erupted in November 2020, has led to widespread sexual violence, including rape, gang rape, sexual slavery and torture. Survivors have endured additional trauma through the killing of family members, physical beatings and ethnic-based slurs. 

The violence has inflicted both physical and psychological trauma on survivors. The situation was further aggravated by a complete shutdown of essential services—no electricity, banking, communication or supplies of basic necessities. 

These conditions severely hindered our ability to provide care, complicating interventions and strained an already dire situation for survivors.

In response, CVT adopted an approach that integrates mental health counseling, trauma-informed physiotherapy, social work, and psychiatric care for individuals requiring support with severe mental health conditions. 

This survivor-focused, multidisciplinary approach addresses the complex needs of survivors, particularly in response to gender-based violence.

Gender-based violence and clinical interventions

Gender-based violence (GBV) is an ongoing, global issue, and one that we see often with our clients. During assessments, CVT asks a specific question to identify the number of survivors who experienced sexual violence during migration. Based on data collected between 2021 and 2024, 318 out of 898 survivors reported being sexually assaulted directly on their migration route.

According to UNHCR, this sort of violence can include harms that are sexual, physical, mental or economic, and can be committed in public or in private. The agency also considers GBV to be both a life-threatening issue and a human rights violation.

Even so, the stigma and ostracization survivors face often prevent them from accessing essential services. This is especially true for men, as we’ve learned they often avoid seeking help due to the stigma, and express feelings of shame and powerlessness. To combat this, CVT implemented a survivor-centered, multidisciplinary approach to support holistic healing:

Trauma Rehabilitative Care

CVT’s trauma recovery framework is based on Judith Herman’s Trauma and Recovery (1992). The model stabilizes survivors through three key stages: 

• Safety/Stabilization (rebuilding trust)
• Grief/Mourning (processing trauma)
• Reconnection (restoring relationships with self, family, and community)

Survivors participate in 10-week group counseling sessions designed to help them process their trauma and rebuild social connections with fellow group members.

Addressing Body-Based Trauma

Physical trauma and chronic pain are common among survivors. Some examples include issues like pelvic floor prolapse, urinary incontinence, traumatic fistulas and psychosomatic back pain. 

To help them regain function and control over their bodies, survivors undergo ten weeks of physiotherapy designed to reconnect the mind and body.

Support for Children Born of Sexual Violence

Many survivors of sexual violence face difficulties in bonding with their infants, often neglecting them or avoiding breastfeeding. Our interventions focus on reassuring survivors through psychoeducation and trauma-informed care-giving. 

These psychoeducation workshops are also extended to those whose children have witnessed the horrors of the conflict

Single Session Therapy

CVT recently trained staff to offer brief, one-time therapy sessions designed to provide immediate professional support to IDPs (or internally displaced persons) on the move. This intervention helps address immediate psychological needs in a constrained time frame.

Other ways of engaging community

Outside of direct clinical care, CVT engages with refugee and IDP communities to aid in communal support, connect people to resources and offer psychoeducation where possible. Some examples of this work include:

Local Capacity Development

Engaging Local and IDP Paraprofessionals

IDPs are often in constant search of safety and resources such as food. To ensure sustainable service delivery, CVT trained paraprofessionals from both IDP and local communities to offer non-specialized MHPSS.

These paraprofessionals provide stabilization, psychoeducation and trauma resilience workshops, continuing to serve even as IDPs relocate.

Trauma-Informed Care Training

CVT has delivered trauma-informed care training to healthcare workers, government agencies like the Women’s Office (previously the Bureau of Women’s Associations) and relevant organizations. This training ensures that service providers are equipped with the skills and sensitivity required to support trauma survivors effectively.

Community Engagement

Religion and spirituality play a crucial role in the community. Many survivors of sexual violence experience shame, guilt or feelings of betrayal, believing they have sinned or broken their marital vows. 

To combat these deeply ingrained beliefs, CVT involves religious leaders in panel discussions, helping to normalize survivors’ experiences and create a supportive, healing environment.

Impact of CVT’s Interventions:     

CVT assesses the percentage of intensive mental health clients showing improvement in at least one area of psychological symptoms or functioning between intake and a six-month follow-up. 

This evaluation covers symptoms related to depression, post-traumatic stress, somatic issues, anxiety and behavioral functioning difficulties. In our most recent analysis, over 99% of clients showed improvement.

Challenges and Barriers

And yet, even with the success of the program, this work is not without its challenges.

In addition to ongoing stigma surrounding sexual violence, conflict-affected populations experience continuous movement and instability in their search for safety. This can provide complications, as services require a level of stability for survivors to effectively process their trauma.

Staff Well-Being

Because of the constant exposure to traumatic stories and volatile work environments, and increased vulnerability among staff, working with survivors of sexual violence in an ongoing conflict is emotionally challenging. 

Many staff members report an increased sense of vulnerability when listening to the devastating experiences shared during active conflict. And, many team members faced personal losses and direct exposure to war trauma. 

To support staff, CVT implemented regular support sessions and clinical supervision. Peer support groups were also established, fostering mutual assistance and well-being. Additionally, staff received remote counseling support from an external consultant to ensure comprehensive care.

Lessons Learned

Throughout our time working in CVT’s Ethiopia sites, we’ve learned a lot. Some major takeaways  include:

• the importance of building local capacity.
• the effectiveness of incorporating MHPSS into other vital services, such as medical services and protection.
• the vitality of staff support protocols.
• how addressing the body and mind together leads to better outcomes.

About The Author

Medhanye Alem

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