Last fall, NPR interviewed Ethiopian doctors in the northern region of Tigray. They spoke of a health-care system ravaged by a civil war that had consumed their country for nearly two years at that point.

The Tigray People's Liberation Front was battling the Ethiopian government forces and their allies, including neighboring Eritrea. Both sides accused the other of starting the war. Across Tigray, hospitals, clinics and health facilities lay in ruins. One physician said of his patients: "Seeing the hopelessness in their eyes, and being the one to tell them that you cannot help them, that they are going to die soon, as a physician is very heartbreaking."

Last November, the civil war ended with a ceasefire, nearly two years to the day after it began. NPR followed up on the situation in northern Ethiopia, and on a new report indicating that despite the cessation of hostilities, a devastating strain of violence has continued.

The warring sides in the conflict agreed in November to a peace deal, but a new report finds that widespread sexual violence continues to victimize women and girls in northern Ethiopia.

"Sexual violence is being used as a tactic to harm populations, to terrorize populations," says Dr. Ranit Mishori, Senior Medical Advisor with Physicians for Human Rights (PHR), one of the groups co-authoring the report. "The cases are very brutal and quite horrifying."

The use of sexual violence by armed forces during the civil war in Ethiopia has been reported previously by the U.S. State Department and Amnesty International. But this new publication shows that as recently as June, months after the peace agreement was signed, sexual violence against women and girls has not stopped.

"The report highlights the really systematic, widespread and non-random nature of these attacks," says a staff member with the Organization for Justice and Accountability in the Horn of Africa (OJAH), the co-authoring group of the report. This woman, who is from Ethiopia, asked that NPR not use her name because she fears speaking out could make her or her family a target of reprisal.

"In the vast majority of the cases," she says, "there were multiple perpetrators. It was often accompanied by [additional] physical violence."

"We are talking about mothers who have been raped in front of their family," says her colleague, who works as a reproductive health researcher at the Ayder Comprehensive Specialized Hospital in Tigray and who asked to remain anonymous for similar reasons.

The findings in the report were drawn from more than 300 medical records at multiple health facilities across Tigray. All but one detailed conflict-related sexual violence involving girls and women from ages 8 to 69. Nearly half of these accounts occurred after the ceasefire.

In some cases, family members were killed. Many of the survivors faced medical complications, including "really severe physical scars, reproductive organs being damaged," says Dr. Mishori. "These things can impact women's lives for decades. And then we had individuals with obviously severe trauma and mental health issues, PTSD and depression and anxiety."

There were also numerous unintended pregnancies and HIV infections. Medical treatment for the victims has been slow or non-existent due to Tigray's crumbling health-care system.

In a statement, the World Health Organization said, "we condemn and deplore these acts. Victims and survivors in Tigray need urgent help in addressing their physical and mental health needs. We are alarmed by the increasing use of sexual violence as a weapon of conflict globally."

As for who is to blame for this particular violence, Dr. Mishori says, "most of the survivors pointed the finger at people wearing military fatigues. So while it's hard to know exactly who they were, from the records, they were all members of military or paramilitary groups."

The report concludes that these groups were most likely associated with the governments of Ethiopia and neighboring Eritrea. NPR reached out to both governments for comment, but neither has responded.

In February, however, when Eritrean President Isaias Afwerki was asked at a news conference about alleged rape and other abuses in Tigray by his country's forces, he called it a "fantasy."

He added, "I have no intention in interfering in this matter in spite of the disinformation campaign going on. For those who come to promote their agendas in the region, we say enough is enough."[

(It's should be noted that that last year, Amnesty International released a publication describing rapes and murders perpetrated by the opposing side as well, the Tigray People's Liberation Front.)

The authors of the new report say the women who have been assaulted require urgent humanitarian aid and medical and psychosocial support.

In addition, "there is a need for much more attention to the brutal violations of international law that are occurring as part of this conflict," says Lindsey Green, a senior program officer who studies sexual violence at Physicians for Human Rights.

She says that the UN's International Commission of Human Rights Experts on Ethiopia will dissolve in September, and she worries it won't be renewed. She argues that this is one of several organizations that need to continue conducting "independent and impartial monitoring and reporting. There needs to be much more focus and demand for greater efforts for accountability, both from the United Nations and the African Union."

The researchers who compiled this new report say that it captures just a sliver of this kind of violence. The staffer from the Organization for Justice and Accountability in the Horn of Africa says she hopes it will shine a light on the suffering of people in a part of the world she says doesn't get enough attention or help.

"There are some lives and losses that are taken more seriously than others," she says.