Armed Conflict Severely Affected Children’s Health and Dishonored an Education Opportunity in Ethiopia’s Tigray Region: Strategies for Effective Intervention

The impact of armed conflict on children’s health, education, and development is significant and lifelong. Children caught up in a war are more likely to be subjected to violence, be uprooted, or lose their parents or guardians, which are traumatic experiences (Bürgin et al., 2022). Ethiopia’s Tigray war, which began on November 4, 2020, and lasted until November 3, 2022, was an armed conflict of the Tigrayan Defense Forces on one side and the coalition of the Ethiopian National Army, regional paramilitary groups, and the Eritrean Army on the other side. Unquestionably, this conflict has been one of the worst in Ethiopian history, and it has brought about a serious economic and humanitarian crisis in the region (Tedla & Kahsay, 2023). The humanitarian crisis has resulted in the deaths, displacement, and suffering of hundreds of thousands of people. Healthcare institutions in the area have reportedly suffered from lack of medicine and a shortage of health professionals, following complete damage of the health sector (Daniel, 2022). The war severely restricts access to essential health services, particularly child health services. Results from a community-based cross-sectional survey recently conducted with 4,381 children (less than a year old) indicate that 39 percent of infants did not receive any basic vaccinations. The war was one of the main factors for the shortage of vaccine coverage in children, and as a result unimmunized children were reported to be vulnerable to preventable diseases (Tsadik et al., 2023).

Studies on the impact of war on child health and development show that one in 10 children develop physical and emotional health problems that persist throughout their life (Kadir et al., 2019). Various psychosocial programs, education practices, and intervention approaches are required to support war-affected children (Denov & Shevell, 2019).

According to a U.S. Department of State (2022) report on human rights practices in Ethiopia, approximately 1.39 million Tigray children were out of school following the horrific war. The Tigray war began after interruption of school education caused by the global COVID-19 pandemic. Disrupted education during conflicts negatively impacts children’s academic progress, resulting in learning gaps that are challenging to address. The consequences of limited education opportunities can extend to reduced future economic opportunities and weakened societal development (UNICEF, 2015).

Many schools in the Tigray have been shut down, looted, and occupied by military groups and vehicles; according to a Tigray Education Bureau (2021) report, the overall material damage of the education system was assessed, and the war has taken a horrific toll on the education system in the region, which took away from the Tigrayan children their right to learn and left a long-term effect on the future generations. An assessment of 2,054 schools (primary, middle, and high schools and training colleges) has revealed that more than 88 percent of classrooms have been damaged. From the same report, about 85 percent school computers, 63.5 percent textbooks, 79.9 percent plasma screens, 84.5 percent laboratory devices, 96.5 percent of desks, 95.9 percent black boards, and 92.5 percent teaching models were destroyed by the forces (Tigray Education Bureau, 2021). This analytical study highlights the level of war-induced damage on the educational resources (see Table 1), and it summarizes the total number of victims affiliated with the education sector in the region (see Figure 1).

Figure 1:

Summary of Total Victims Who Had an Affiliation with the Education Sector in the Region

Note: Woreda is a third-level administrative division, after region and zone.

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Millions of children are psychologically traumatized not only because they stayed away from school, but also due to the airstrikes, drone attacks in major residential areas, and loss of their parents during the war, which potentially led to prolonged trauma. A long exposure to violence, displacement, or separation from family during a war results in severe psychological consequences for children, such as PTSD, anxiety, depression, and other trauma-related mental health disorders (Hoppen & Morina, 2019; Morina et al., 2020). The risk of mortality and morbidity among children rises during and after conflicts, primarily due to access barriers to healthcare and disruption of essential services; moreover, children affected by war often struggle with social and emotional development (Hoppen & Morina, 2019).

Various effective social work education intervention approaches have been implemented to support children and adolescents affected by armed conflict. The following are examples of individual-level interventions with war-affected children (see Betancourt et al., 2013, for a complete review): (a) In Israel, as postconflict psychological first aid, a school-based intervention called ERASE-Stress aims at developing resilience for addressing mental health through psychoeducation, skill training, and practices to understand traumatic experiences and to develop self-esteem for accessing social support. (b) Multiple family group interventions were used in Kosovo. (c) Peer and school-based intervention through engagement of children in activities such as traditional dance, art, sports, drama, and puppetry; and universal school-based programs have been implemented in Uganda. (d) Selective or indicated school-based programs have been used in Bosnia. (e) Communal games, poetry, guest speakers, drama, and group debate have been offered at youth clubs in Serbia. (f) School-based cognitive–behavioral therapy for kids exhibiting mental health symptoms among war-affected refugees and asylum seekers has been offered in the United Kingdom. Similar interventions have been employed in Nepal, Burundi, Sri Lanka, and Gaza. Furthermore, a school-based curriculum to reduce psychosocial trauma and promote social healing in war-affected children from Croatia was also reported (see Betancourt et al., 2013). Numerous studies indicate that the community-level support and intervention have a significant effect on children who have experienced violence or war, for example as implemented in Angola. Methods for delivering messages of healing and reconciliation have been used in the mass media, including radio and television among affected communities, and such an approach was tested in Sierra Leone, Angola, and Mozambique (as discussed in Betancourt et al., 2013). Community-based rehabilitation programs and interventions designed to keep war-affected children healthy was also reported as an effective intervention approach (see Betancourt et al., 2013).

Mental health support system and awareness in Ethiopia is lacking, especially in Tigray, and an emphasis is not given either to identify the level of health crisis or implementing support programs and policies by the regional and national authorities. No intervention has been reported in the region to address the problem. Rare postwar studies have been conducted on the malnutrition status and immunization services among children. However, the impact of the conflict on the social, emotional, and mental health of children is not investigated yet, and this column highlights how severe the damage could be and invites other researchers to investigate the depth of the problem. To mitigate the ongoing crisis and support the children in need, mental health professionals and social workers must employ intervention approaches that are tested and have shown effective outcomes among children of war in different countries.

Therefore, experiences of intervention mechanisms—how to support children affected by conflict—should be adapted and practiced. In addition, implementing the following activities can help to address the short and long consequences of the war on schoolchildren and adolescents: A committed effort between the Ethiopian ministry of education, Ministry of Women and Social Affairs of Ethiopia, Tigray region education bureau, Tigray region bureau labor and social affairs bureau, local educators, local education leaders, counselors, and community representatives is required to manage a postwar health crisis and, more important, to focus on implementing the following steps: (a) Rebuilding and rehabilitating educational infrastructure, including constructing safe classrooms, training teachers, and providing necessary educational resources. So far, there are ongoing supports given to schoolchildren to get educational resources by humanitarian organizations such UNICEF, Save the Children, Health Professionals Network for Tigray, Tigray Development Association, and individuals and communities living within Ethiopia and abroad. (b) Establishing child protection mechanisms and psychosocial support programs to address the psychological trauma experienced by children. (c) Collaborative efforts between government agencies, international organizations, and nongovernmental organizations to ensure sustainable support for children’s health and education in postconflict scenarios. There are initiatives and plans by the interim government in Tigray to collaborate with those organizations, but there are still limitations in bringing meaningful results. (d) Building community resilience through interventions that promote social cohesion, community involvement, and supportive networks can help protect children from the negative effects of war. (e) The overall impact of the war on schoolchildren and adolescents should be an area of investigation by researchers in the country and elsewhere to unravel the repercussion of war on children’s health.

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