Tigray, Ethiopia – “I was angry all the time,” says Bezunesh, spinning wool in her small mud house in Bora, a remote district of deep valleys, sloping mountains and small terraced farms in Ethiopia’s northern region of Tigray.

It has been a few years since the mother of eight, whose real name we are not using to protect her privacy, suffered the worst attack of her life – and the trauma of what happened still haunts her.

Tigray was under brutal siege by both the Ethiopian and Eritrean armies between November 2020 and November 2022. According to the African Union, more than 600,000 civilians were killed, and millions were displaced. At least 120,000 women and girls were raped during what regional health authorities say was a systematic campaign of sexual violence used as a weapon of war.

A survey-based study by Mekelle University in Tigray found that at least 570 women had been raped in Bora alone. Of them, 34 are HIV-positive, two died by suicide, and several are permanently disabled.

However, the number of sexual assaults is believed to be much higher as the stigma against victims in this religious and conservative district is so strong that many women preferred not to report them for fear of being ostracised by their families.

Bezunesh too – who describes experiencing trauma that experts say is common among sexual violence survivors – never directly says she was raped, instead talking in general terms about the last few years.

“Before the war, we had a good life. My husband was a farmer, and I was taking care of the household and our eight children. But then the war started,” she told Al Jazeera.

“My husband was killed on the eve of [the Ethiopian] Christmas in January 2021, when 175 of our people were massacred [by the Ethiopian army]. They went house-to-house and indiscriminately killed people.”

After the attack, Bezunesh said, the trauma was so great that “some women couldn’t sleep, they felt like their head was about to explode”.

Others, likely struggling from post-traumatic stress, “were getting lost, thinking they were going to the church or to visit a friend and suddenly finding themselves in another place”.

“Myself, I was extremely stressed, quarrelling with my children, people and even animals,” Bezunesh added.

A few months after the Ethiopian army ransacked the village, it was the turn of Eritrean soldiers.

Blen, a mother of four and teacher whose full name we are not using, was among those attacked. She can no longer bear children as a result. Like Bezunesh, she also does not speak directly about her assault, focusing instead on friends and neighbours.

“They robbed, raped, beat us, and killed more than 30 people. They slaughtered our cows and ate them, and took our donkeys for loads. They came back three times to rape my neighbour. Now she sits at home all day long, alone. She is quiet and all her hair has fallen off. She looks barely human,” said Blen.

“Women never thought that something like that would happen to them,” explained Elizabeth Kidane, a Tigrayan medical student who is helping support survivors.

“They feel so ashamed that they cannot talk with their children, their parents, their husbands.”

Though they were disassociating and experiencing trauma after their attacks, many of the victims “feared they were going mad or being cursed, or punished for some terrible sins”, she said.

Women-to-women circles

The women needed help. But in the absence of psychological support during the war – as the health service had collapsed and even essential humanitarian aid barely trickled in – a small group of women in and outside Tigray tried to come up with a plan.

This core group included a nurse, a social worker, a medical student, an aid worker and the head of the Daughters of Charity, a well-respected charity with deep roots in the communities.

Some of these women had heard of a grassroots approach, called HAL (helpful active listening) circles, which had helped Rwandan genocide survivors to heal, and thought that this method might help Tigrayan women as well.

HAL is an easy and cheap approach that does not require any professional expertise and can quickly reach a large number of survivors. It involves training some women from the community, who seem more resilient, to provide basic psychosocial support to other survivors in women-to-women circles. It was developed immediately after the genocide in Rwanda by the late Professor Sydney Brandon, a then-retired psychiatrist who worked for many years in the United Kingdom’s Royal Air Force.

The core group contacted two Rwandan women who were involved in the Rwandan HAL project. Over the following months, they learned from them how the HAL circles worked, how to develop the programme and training material, and how to adapt the Rwandan model to the Tigrayan context. They first shared knowledge online and then in person when it was safer to travel.

“I shared my experience with women in Tigray and thought about how we could adapt the programme to their situation,” said one of the two women, Adelite Mukamana, a Rwandan genocide survivor and psychologist. “For example, in Rwanda, women couldn’t speak publicly about what had happened to them, but they used to do it privately; in Tigray, the shame was so overwhelming, that women couldn’t even talk in private.”

In Rwanda, the women-to-women groups have helped survivors regain their humanity and self-esteem, Mukamana said. “One of the signs of sexual violence is a feeling of shame and guilt. But if women can manage to talk and see that the shame belongs to the persecutor, it really helps them. The perpetrator wanted to dehumanise them, but the group helps them to reclaim their humanity, to feel understood, validated and respected,” she explained.

With Mukamana’s help, the core group developed guidance for the survivors who would facilitate the HAL circles. In Bora, this guidance was used to train 48 facilitators over five days in supportive communication skills, the effect of trauma on bodies and minds, signs of psychological distress, identifying triggers and healthy ways of coping with the effects of trauma.

“The material is easy to understand and culturally appropriate. Being a facilitator doesn’t require any educational background, just to be a survivor, have empathy, be known in the community, be strong and trustworthy,” said Kidane, who is part of the core group.

A safe place

To fund the first HAL programme in Tigray, the core group lobbied foreign embassies in Addis Ababa. With support from the French Embassy, and then the Irish Embassy, the project was piloted from December 2021 to December 2022 in a safe house and a refugee camp in Mekelle, the capital of Tigray. An expansion phase with UK funding has been under way in Bora since February 2023.

In Bora, the circles are open to women who were raped, but also those traumatised by the war after having lost their homes or families – so that coming to the circles does not necessarily identify a woman as a victim of sexual violence.

Each facilitator leads a group of 10 women during six three-hour sessions over three months. During the sessions, women are not expected to share their stories of sexual assault and violence, but rather how they experience the resulting trauma.

They are told by the facilitator what trauma does to one’s mind and body, using metaphors of things that are familiar to them. For example, they explain how the mind “breaks” when women try to act as if nothing has happened: “It’s like when you bend a thin stick further and further, and it breaks.” They are then told about possible ways they can try to cope, using metaphors as well.

The Daughters of Charity has prepared a safe place for the women in a fenced compound in Fire Sewuat, the main administrative village at the centre of the Bora district.

There are a few papaya and guava trees, a UNHCR tent serving as a handicraft centre and several small rooms on three sides of a small courtyard, three of which are for HAL groups. The HAL rooms are made to look like a typical living room with mattresses, chairs and sets for the traditional coffee ceremony.

“It is culturally how women deal with sad news: they come together to talk to their sisters, drink coffee and comfort each other,” said Kidane.

“I attended the HAL circle sessions and this really changed me. It is what gave me strength and hope,” said Bezunesh. “The sessions helped first because of the listening, sharing and knowing we were not alone. At the beginning, I was shy and not sure about going to the meetings, but later on, I was very eager,” she added with a smile.

“The changes are very visible – in the ways we interact with our family, how we handle our children properly. It is even visible in our walking. We don’t get lost any more, and we walk more confidently. We also like these sessions because they are like our coffee ceremonies, and there is music if we want, and often we end a session by dancing.”

‘Needs are beyond our capacity’

The HAL Bora project has now reached 1,320 survivors and will close down in March 2025, unless more support can be found after funding from the UK ends.

Still, many women are continuing their circles on their own.

“After our HAL group completed the six sessions, we now get together to meet and help each other to face new challenges using what we learned from the session,” said Sarah, a mother of five whose full name we are not using. “We also save money together and loan it to each other on rotation to help build our businesses.”

Like Sarah’s, many of the HAL circles are now evolving into long-term self-help cooperatives and microfinance groups, some of which have been recognised by the local government, which now consults them on some decisions affecting women. “That way, they get to participate in decisions that affect them. This is something unprecedented, but impactful,” Kidane said.

Interviews with survivors done at the end of the pilot phase in Mekelle by the Daughters of Charity showed that women found the HAL approach helpful in reducing post-traumatic stress and in stopping self-blame, shame and guilt. They also felt they had become more resilient and better able to seek solutions to other pressing needs.

The pilot project highlighted the importance of addressing other concerns the women have, including access to food, physical health, safety and family issues. With that insight, the Daughters of Charity has been providing participants with some food and emergency cash support, hygiene items and handicraft material, and also linking some with small business support initiatives.

An independent assessment done by consultants for the French Embassy, which funded the pilot phase, also praised the project for “breaking down the stigma and taboo surrounding sexual violence and promoting the creation of new links of solidarity between victims”.

Yet, in spite of these tangible achievements, the project is far from meeting the huge needs in the region. “We need food … Kids are stunted. We are in the middle of a famine caused by drought and the devastation of war,” Kidane said, listing out some of the challenges.

Locals in Bora need help to recover and Kidane says the core group has been meeting with the district administration to find ways to scale up their outreach programme.

“The needs are well beyond our capacity to help,” she said.

Where women are concerned, the toll of the last few years has been particularly heavy, and more needs to be done, she feels.

“In our culture, women are considered as less,” Kidane said. “It is expected that the husbands would leave their wives if they have been raped.”

To help change attitudes, “community-based healing sessions, creating awareness on mental health … [working] with service providers, teachers and religious leaders” is needed.

“We need to work with the whole community and understand the healing process,” she said, “but it will take years.”