The unseen scars: prolonged grief among families of soldiers in Debark Town, North Ethiopia

Abstract

Background

Following the Northern Ethiopian conflict, many families in Debark Town, North Gondar, Ethiopia, are experiencing prolonged grief due to the disappearance of loved ones. The lived experiences of these families remain largely unexplored.

Objective

This study aimed to explore the lived experiences of families whose loved ones, soldiers, went missing.

Methods

Six female participants were selected purposively for semi-structured interviews. The data were transcribed, translated, and thematically analyzed using Van Manen’s four existential life world categories.

Findings

The study revealed significant psychosomatic distress, including physical and emotional health issues, social isolation, and disrupted family dynamics. Socioeconomic hardships worsened their suffering, and a lack of mental health support led to negative coping strategies. Participants expressed a strong need for counseling and psychiatric services.

Conclusion

Prolonged grief following a loved one’s disappearance is uniquely overwhelming and more complex than traditional grief. Future research should include diverse populations to explore the issue further.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-025-03563-6.

Background

Grief is a natural response to any form of loss, whether through death or other means [42]. It involves a mix of behavioral, emotional, physiological, and cognitive reactions, often causing overwhelming emotions such as shock, anger, guilt, and profound sadness. Grief can also affect physical health, making sleeping, eating, or thinking difficult. When these symptoms persist, it is termed as prolonged grief [16, 20, 47].

In cases of military deployment, soldiers sometimes go missing in conflict with rebels, leaving families in emotional turmoil. As time passes, hope fades, and the suffering of uncertainty remains [37]. Separation of deployed families due to conflict, displacement, and migration causes immense suffering for families, with many left without any news of their loved ones [2]. Families of soldiers face numerous challenges that often lead to adverse mental health outcomes for military spouses, children, and parents of deployed soldiers. Parents of deployed soldiers encounter unique struggles, including fear for their children’s safety, difficulties with separation, and communication barriers [12].

Families of missing soldiers, without getting any news, face unique and often more intense challenges than those dealing with the grief of confirmed death. The uncertainty of not knowing a loved one’s fate creates an overwhelming emotional landscape [23]. Because it is generally not formally recognized and offers no opportunity for closure, unconfirmed death is an especially stressful type of loss [6].In the same vein, the grief experienced by families of unconfirmed death is “locked-in grief,” which is characterised by a lack of closure, persistent hope, guilt, helplessness, perpetual suffering, and an emotional void impacting the loved ones of the missing [23]. This involves a vacillation between hope and despair that hinders acceptance of the loss. As a result, studies emphasized that there needs to be tailored interventions for families of missing soldiers as they experience anticipatory mourning and prolonged grief due to uncertainty [50].

A study on the mental health of wives in Bosnia and Herzegovina found that those with unconfirmed war-related deaths in their families experienced higher levels of traumatic grief and severe depression compared to those with confirmed deaths, even after accounting for other traumatic events and stressors [36]. This highlights the distinct negative mental health impact of unconfirmed loss in a war context. Persistent hope, absence of cultural and religious rituals, and community disenfranchisement contribute to the prolonged grief of parents of a missing soldier [19]. Families are faced with an emotional vortex related to a never-ending wait, and how the mourning is solved only when the missing person is found dead or alive [49].

Studies reveal that terror attacks and prolonged conflicts significantly impede grief resolution, leading to complex mental health issues and slow recovery among affected families. For instance, research on the 2011 Utøya attack and the decades-long war in Northern Sri Lanka highlights widespread unresolved grief [24, 46]. While protective factors like female leadership, cultural practices, and creative arts can aid healing in post-conflict settings, studies also pinpoint common stressors [13, 46]. For example, after the Utøya attack, fatigue was the most reported somatic symptom, particularly among females, and most bereaved individuals experienced insomnia [30]. Similarly, in Uganda, conflict, poverty, and ambiguity were found to complicate the grief process for relatives of missing persons [21].

The disappearance of a loved one carries a unique psychological burden compared to the death of a significant other. This difference stems from the profound uncertainty about the missing person’s fate, which leaves ambiguity about the permanence of their absence. The unresolved question of whether they will return deepens the emotional turmoil for those left behind, prolonging the grieving process and complicating closure. This uncertainty places a substantial psychological toll on families and loved ones, highlighting the need for greater understanding and support for those coping with such ambiguity [4].The ongoing cycle of hope, despair, and uncertainty post-disappearance highlights the importance of support that addresses the unique challenges of ambiguous loss [27].

Researchers found that military spouses use various coping strategies to manage grief during their partners’ deployment, including expressive activities, religion, emotional reappraisals, acceptance, and sometimes avoidance. These diverse approaches highlight the complexity of their emotional challenges [51]. “Bowlby’s attachment theory outlines four phases of mourning: numbing and shock, yearning and searching, disorganization and despair, and reorganization [52]. These phases describe the emotional journey after loss, from initial defense against pain to finding a way to move forward. In contrast, Kübler-Ross proposed a widely known, influential stage model of bereavement encompassing denial, anger, bargaining, depression, and acceptance, simplifying the complex grief process for individuals and families [3].

Generally, studies indicated that research examining military families’ psychological health and functioning is scarce [38, 40]. Few researchers indicated that military parents and spouses need self-care during deployment [29]. This is because there are unique challenges for military families during and after deployment that can be mitigated with strategies. This gap underscores the need for greater understanding of how individuals coping with ambiguous loss navigate their emotions with little support. It is crucial to address the unique challenges faced by those awaiting the return of their missing family members during deployment, offering empathy and guidance through their uncertain journey.

In November 2020, clashes erupted between the Ethiopian National Defense Forces and the Tigray People’s Liberation Front, sparking a prolonged conflict in northern Ethiopia. This violence triggered severe abuses, escalating tensions, and instability. As the conflict spread to neighboring regions like Amhara, it caused a massive humanitarian crisis, leading to widespread displacement and loss of homes, livelihoods, and loved ones [1]. The crisis has torn many families apart, increasing the number of unaccompanied and separated children and wives.

In the study area, Debark Town, families endure deep uncertainty and pain as their loved ones are deployed in the Northern Ethiopian conflict. News of casualties, injuries, and disappearances amplifies their distress, especially for parents, spouses, and siblings who are left uncertain of their family members’ fates.

In Ethiopian culture, the celebration of the dead is an extended process. The handling of the body, organization of the funeral, and the commemoration of the deceased all follow culturally defined rituals [17]. Mourning as a natural reaction to the loss of a loved one, encompassing the entire process of grieving and ultimately reaching acceptance [14]. A significant cultural and religious tradition is performed in north Ethiopia, Debark that involve strict death rituals and ceremonies. When a family member’s death is confirmed, these ceremonies, observed from the first day to years later, serve as a vital coping mechanism for families and society to process and conclude their grief. This process facilitates healing and a return to normal life. This indicates that religious and cultural ceremonies can be detrimental in this process, and the importance of psychological and social support to prevent significant clinical outcomes for the families. On the other hand, if a deployed soldier’s death is not confirmed, these crucial rituals are not performed in the name of his/her missing. Consequently, families, particularly wives, children, mothers, and siblings, experience prolonged grief due to the inability to finalize the loss through customary spiritual and cultural practices.

There is dearth of scientific studies that indicate mental health and psychosocial status and support are given to families of deployed soldiers in Ethiopia. Hence, this study aims to investigate the unseen scarce of prolonged grief of families of deployed soldiers whose death status is unconfirmed for years.

Research Questions

1. How do family members of soldiers in Debark Town experience and express prolonged grief?

2. What factors play a role in maintaining grief of families of soldiers over an extended period?

3. What are the mental health and social support needs as perceived by families members of soldiers?

4. What coping strategies do families of soldiers employ to manage their prolonged grief?

Method

Research approach and design

The study examined the prolonged grief experienced by soldiers’ families in Debark town, Amhara regional state, Ethiopia, focusing on factors that contribute to the maintenance of grief, the mental health and social support needs of the families, and their coping strategies. An interpretive phenomenological qualitative design was used, as it allows for an in-depth exploration of personal lived experiences [15], offers insights from individuals closely connected to the issue [44], and facilitates the examination of subjective experiences and complex phenomena through detailed analysis of rich qualitative data from small samples [15].

Since this study focuses on unresolved grief, addressing the participants’ personal experiences through IPA produces an interpretative analysis closely tied to their accounts. This approach also supports the idiographic commitment to detailed case-by-case analysis of personal experiences, ensuring that the experiences of each individual are preserved in the final report. Consequently, both convergence and divergence within the study sample are articulated [43]. Which is challenging to address via other qualitative methods such as grounded theory and narrative inquiry.

Participants

Participants for the study were selected from Debark Town, located near the war front in the North Gondar Zone of Amhara regional state, Ethiopia, where many soldiers were recruited. Participants in this study were selected using a purposive sampling technique aimed at identifying individuals experiencing long-term unresolved grief due to the disappearance of close family members. Rather than using clinical diagnostic tools to screen for prolonged grief disorder, the selection was based on referrals from the local community structure, including Kebele/District administration and community leaders. The local bodies were instrumental in identifying individuals who had experienced the disappearance of a loved one for over two years and continued to exhibit signs of emotional distress and functional disruption. Then the first author, a clinical psychologist made a pre-assessment of the families’ situation in a home to home visit to identify families experiencing prolonged grief.

A total of six female family members were selected, including two wives, two mothers, one sister, and one grandmother, as recommended for Interpretative Phenomenological Analysis (IPA) studies [41]. In IPA, the goal is to explore individual lived experiences in rich detail, and the sample size of six was considered to be adequate to achieve data saturation within the scope of this exploratory research. Despite providing guidance, there is no right answer to sample size but suggest 4–10 interviews for phenomenological research [45]. On the other hand, as per the pre-assessment study, female family members (wives, mothers, grandmothers, & sisters) are the most affected part of society for prolonged grief for unconfirmed death of soldiers in the war at Northern Ethiopia during April 15, 2024, and August 2024 where the conclusion of the 3-year and 7-month war, which spanned from November 4, 2020, to November 2, 2022.

Furthermore, it was not the researchers’ intention to include only female participants for the interviews. Rather, this was a reflection of the field conditions during data collection, as male family members of the missing soldiers were largely unavailable. Those who were approached were either reluctant or unwilling to participate due to the sensitive nature of the topic.

Next, the demographic information is presented in Table 1.

Table 1.

Demographic information table

Participants	Age	Occupation	Marital status	Educational status	Relation to the missing Soldier
Participant 1	25	Vendor	Married	Grade 10 completed	Wife
Participant 2	40	Retailer	Married	Illiterate	Wife
Participant 3	43	Housewife	Widowed	Illiterate	Mother
Participant 4	34	Housewife	Married	Illiterate	Sister
Participant 5	56	Cleaner	Widowed	Illiterate	Mother
Participant 6	65	Housewife	Widowed	Illiterate	Grand Mother

Data collection tools

In this study, semi-structured interviews were the primary data collection method, as they are commonly used in IPA research for in-depth, one-on-one conversations [34]. The interview guide question includes five sections: demographic information, participants’ lived experiences, factors contributing to prolonged grief, perceived mental health and social support needs, and coping strategies. The interview questions include statements such as, “How has your daily life changed since your loved one went missing?” to explore participants’ lived experiences, “Are there any social or cultural factors that you feel have prolonged your grief?” to understand contributing factors, “What types of mental health and psychosocial services would be most helpful to you?” to explore perceived mental health and social support needs, and “Can you share some ways you’ve found helpful in coping with your grief?” to identify about their coping strategies. The semi-structured interview guide was initially developed based on the study’s research questions and a review of relevant literature on the phenomenon under investigation. Two experts in qualitative research and clinical psychologists reviewed the guide to ensure the clarity, relevance, and appropriateness of the questions for Interpretative Phenomenological Analysis (IPA). Their feedback led to minor revisions in wording and sequencing to enhance the flow and depth of responses. The English versions of the guides are attached as a supplementary material in the submission system.

Data collection procedure

After receiving ethical approval from the College of Social Sciences and Humanities, University of Gondar Institutional Review Board (IRB), the first author, who is a native Amharic speaker, established a rapport with the participants and explained the purpose of the research. All participants agreed to take part in the study. Literate participants provided written informed consent, while illiterate participants gave oral consent. Next, a pre-assessment of the families’ situations was conducted with community leaders and local administrative bodies. Home visits were made to identify women’s families experiencing prolonged grief. Data collection took place during these home visits in a private and comfortable setting, with interviews lasting an average of 1.5 h. Field notes, memos, and audio recordings were taken to ensure accuracy and facilitate cross-validation.

Data analysis

This study employed thematic analysis, which involved several stages. First, the researchers familiarized themselves with the data by transcribing, translating, and reading the transcripts multiple times. Next, open, inductive coding was used to break the data into meaningful segments, which were grouped to form potential themes. The third step identified relationships and connections between the initial codes and grouped themes. The fourth stage involved developing sub-themes, where the researchers categorized and further analyzed the data to represent participants’ experiences. Each theme was then explored deeply to understand its meaning and interpretation. Following this, the researchers synthesized the findings and identified patterns across themes, resulting in a coherent narrative on the essence of participants’ experiences [7, 33, 48]. Finally, a write-up presented the identified themes, sub-themes, and supporting quotes. This process is conducted manually. Peer debriefing was employed throughout the process to enhance the rigor and trustworthiness of the analysis. Regular discussions were held to refine codes and ensure consistency in theme development. A phenomenological reflection was included after conducting a cross-case analysis based on [50] life-world existential categories—lived time, lived space, lived body, and lived human relationship [39]. This analysis was served as a framework for deeper interpretation and meaning-making. These categories were not used to generate themes but served as lenses for interpretive depth, helping us understand the participants’ lived experiences more holistically.

Findings of the study

The findings of the study are categorized in four major themes: participants’ lived experiences, factors contributing to prolonged grief, perceived mental health and social support needs, and coping strategies. Each of these themes has subthemes.

The lived experience of prolonged grief in the context of military families: the reality diaries of families

This section of the findings is presented under the following sub- themes: Echoes of Grief and Psychosomatic Expression, Shift in Family Dynamics and Roles, From Wholeness to Heartache, and Socio-Economic Life.

Echoes of grief and psychosomatic expression

The data revealed that unresolved grief was experienced as profoundly overwhelming and distressing, significantly impairing participants’ overall well-being, including their cognitive, emotional, behavioral, and physical functioning. The manifestation of symptoms varied across individuals, with each participant describing their experiences in relation to their personal perceptions of grief, the psychological and somatic symptoms they endured, and the extent to which these challenges interfered with their daily functioning.

Participant 3 described her grief over the loss of her son by saying:

“The unresolved grief for me is like dying while still alive. I couldn’t sit properly for weeks, and I even had to be physically restrained to stay seated. I was unconscious for a week. Since my son went missing, I haven’t been the same. In two years, I lost my beauty, my health, my wealth, and my family. The situation became even more complicated after my husband’s death.”

The grief experienced by military families, particularly those who don’t know the whereabouts of their loved ones, is profound and overwhelming. Participant 4 shared her pain over the disappearance of her soldier brother, saying,

“Since my little brother went missing, my life has been ruined. I feel like I’m living below alive and above dead.” She described how thoughts of him disrupt her daily life: “When I think of him, I can’t sleep, I lose weight, and it feels like my body is burning. I cry so much that I get headaches, and my skin seems burned due to my gastric pain and anger. I feel pain in my chest and back, and when I see his belongings, like a photograph, I can’t even hear people calling my name.”

Grief also leads to chronic health issues for families. Participant 2 shared, “I cry a lot because of my husband’s fate. I get angry easily, which causes severe hypertension, nerve problems, and constant headaches.”

Unresolved prolonged grief also leads to confusion and disorientation. Participant 3 described one such experience:

“One day while walking home, I saw a soldier with an elderly woman who seemed to be his mother. Suddenly, I found myself in a cafeteria with them, not realizing until they stared at me that I had unknowingly followed them and lost my way home. Another time, I shouted in the market, thinking I had lost my umbrella, only to realize it was in my hand. I felt so embarrassed.”

In summary, the study highlights the profound psycho-somatic effects of prolonged grief experienced by participants whose loved ones went missing. Using a hermeneutic phenomenology approach, it shows that grief is not just an emotional experience but a pervasive force that affects every aspect of their lives, including thoughts, emotions, behaviors, and physical health. Participants reported intense psychological distress, including fear, anxiety, anger, and suicidal thoughts. They also experienced physical symptoms such as insomnia, headaches, gastric pain, and chronic conditions like hypertension, diabetes, nerve problems, and significant cognitive impairments like forgetfulness. This grief manifests as a holistic sickness, deeply intertwined with their daily lives, leaving them debilitated and isolated.

Shift in family dynamics and roles

This refers to the changes experienced by families of missing soldiers, where prolonged grief leads to shifts in family relationships and the roles of each family member. These changes are often accompanied by separation and conflict within the family unit.

Participant 2 described the transformation in her family dynamics and the role shift, as well as the confusion that accompanied it, in the following way:

“We’re a family of five, and my oldest daughter had to quit school because she couldn’t concentrate anymore. She cried constantly, thinking of her father, even though she was a top student. The pain of his disappearance has become too overwhelming for her. I’m trying to play both the mother and father roles, but it’s difficult. I can’t replace the love and guidance their father provided. He was kind and wise, raising his children with affection and discipline, but never harshly. Now, I have to bear this responsibility, and I find myself yelling and sometimes punishing them, which breaks my heart.”

Participant 5 shared how prolonged grief led to family separation and a shift in roles, resulting in new burdens of responsibility:

“When my husband died, I had to raise our four children alone, even though I wasn’t strong enough. My son, now missing, quit school in sixth grade to work as a laborer and support us. When the war began, he joined to protect us but never returned. His brothers searched for him but found nothing. Seeing me cry constantly, they became angry and hopeless. One joined the military, another ran away to Dire Dawa to work and study, and the third is struggling through law school alone. Now, I feel like I’ve lost all my children. What kind of curse is this?” [Long cry….]

The grief experienced by these families from the loss or disappearance of loved ones deeply affects their family dynamics, causing role shifts, conflicts, and emotional distress. The absence of key family members forces others, often children, to take on new responsibilities too early, leading to confusion and resentment. This disrupts the nurturing roles once held by the lost loved ones, resulting in harsh behaviors and strained relationships. Prolonged grief also intensifies feelings of isolation, mistrust, and exploitation within families, further damaging their emotional and psychological well-being. The study shows how prolonged grief not only changes familial roles but also deepens emotional wounds, weakening both individual and family cohesion.

From wholeness to heartache

The other reality diaries of families of missing soldiers are the stark contrast between their current lives and the lives they once knew. Participants described how the deployment and subsequent disappearance of their soldier family members radically altered their existence. The grief of having missed soldier family members has overshadowed their daily lives, replacing the shared memories of both good and challenging times with an overwhelming sense of loss and hardship.

The interviewees’ stories reflect a profound yearning for the past, a time when, despite life’s challenges, they were grounded by the presence and support of their soldier family members. In this context, Participant 6 shared her experience:

“Before my son left me, I was a happy grandmother, surrounded by kind, humble, and empathetic grandchildren. They always took care of me, and we played and laughed together. But now, since their soldier brother went missing, everything has changed. My life has become one of constant crying. No one is here to bring me the things I need from the market, and the joy I once had is gone.”

Participant 1 also spoke of the complexities caused by prolonged grief, saying:

“Sometimes, I feel like I’m living a different life, as though I’ve been recreated. I often wish I could go back and live with my husband again, just like we used to… How can you stop crying and live happily when you’re forced to live an empty life, stripped of joy and hope, without the presence of your loved ones?”

In the nutshell, the grief felt by these families signifies a dramatic transformation from lives once full of wholeness and joy to an overwhelming sense of emptiness. Participants reflect on their pasts, when the presence of their soldier loved ones provided stability, happiness, and purpose. However, the sudden disappearance of these family members has immersed them in profound sorrow and isolation. What was once a life enriched by love and shared experiences has been replaced by a void, where memories of fulfilment only deepen their sense of loss, leaving them to navigate a world that feels devoid of the hope and joy they once knew.

Socio-economic life

This study reveals that participants have described significant changes in their lives, characterized by extreme poverty and social isolation. The loss of a family member, especially the primary breadwinner, has resulted not only in financial hardship but also in a disruption of social connections, leaving these individuals to face their grief in solitude.

Participant 2 shared her personal struggles in both economic and social aspects after the loss of her husband, stating:

“My life fell apart after my husband went missing. My oldest daughter and I are struggling to feed the family. I mostly avoid participating in social events because I have no interest or motivation, and I fear social criticism—people pointing their fingers at me.”

Participant 1 shared her experience of poverty and loss of social capital after her husband’s disappearance, stating;

“Since my husband went missing, I have been living in extreme poverty, struggling to meet basic needs. There are days I can’t feed my children, and with no one to help, my social connections are deteriorating. I am grieving intensely with my children, aged three and five.”

Participant 4 shared the burden of supporting her soldier brother’s children, leading to poverty and social isolation: “After my brother’s deployment, I became responsible for his children, which has left us all in poverty. I struggle to provide food for both my own and his children, and seeing them suffer breaks my heart.”

Participant 6 also discussed the impact of grief on her social life, saying,

“It’s been almost three years since I attended any social event. I stay at home, leaving only for hospital visits. My house is falling apart, and I have nothing to eat—living only by the mercy of God.”

The interviewees reveal that families of missing soldiers are experiencing severe socio-economic decline, marked by extreme poverty, social isolation, and a deep sense of abandonment. The loss of primary providers has left them struggling to meet basic needs, while grief has further hindered their ability to work and maintain social relationships. Their lives are dominated by hardship and profound loss, both economically and socially.

Factors that prolong and sustain grief

This section of the findings is presented under the following sub-themes: Uncertainty, Personal and psychological factors, Socio-economic factors, and Cultural factors.

Uncertainty

A key factor worsening participants’ grief is the profound uncertainty they face. Interviewees shared that being trapped between hope and despair intensifies their grief, making it harder to cope. In this regard, Participant 6, the grandmother of the missing soldier, expressed her anguish:

“I don’t know where my beloved grandson is—whether he’s been eaten by animals, lost his limbs, or is suffering in a prison. My children were decent, kind, and strong in their faith, yet I feel abandoned by God, left to endure this deep grief in my old age, maybe because of some sin I haven’t confessed. Why isn’t the government telling us where my grandchildren are? I’m stuck between life and death, crying alone. Why don’t they care about us?”

Participant 3 shared her efforts to find her son, her hopes, and disappointments from false promises made by the government and others:

“I’ve done everything I can, spending my husband’s death compensation to search for my son. My only hope is his return. When I hear of a soldier being released from prison, I ask if they’ve seen my son, hoping they can provide information. People avoid talking to me because they know I’ll go anywhere for answers. I even planned to search in Tigray, where intense fighting is taking place, but my family won’t let me, giving me only empty hope. Now, I no longer believe my family about my child’s whereabouts.”

Participant 4 also expressed how the uncertainty of her brother’s fate intensifies her grief:

“The last call I received from my brother was brief. He said, ‘Our phones have been taken, and this is a woman’s phone we’re using. Don’t call her again; it’s risky. I’ll call you, don’t worry.’ Since then, the uncertainty is tearing me apart. I don’t know if he’s dead or alive. This uncertainty brings me no peace… I constantly think of him, wondering if animals have eaten him or if he’s injured somewhere, too afraid to come home.”

Hope and uncertainty greatly prolong the participants’ grief, trapping them in a painful limbo. The constant doubt about whether their loved ones are dead or alive prevents closure, leaving them torn between hope and despair. This lingering hope that their loved ones may return deepens their sorrow, making it hard to heal or accept the loss. The unresolved nature of their situation becomes a heavy burden, intensifying and extending their grief.

Personal and psychological factors

Personal and psychological factors play a significant role in prolonging the grief of participants. These factors, tied to their personal lives, thoughts, emotions, and behaviors, intensify their sorrow. Participant 1 expressed the confusion she feels:

“I often feel lost in my situation. Who am I? Am I married? I don’t know where my husband is. Am I widowed? I don’t know if he’s dead. I’m not single because I still wear his wedding ring. This confusion is a constant source of pain and weighs heavily on my heart.”

Regret is another psychological factor that prolongs grief. Participant 5 shared her sense of guilt:

“I have two major regrets since my son was deployed. First, I blame myself for burdening him beyond his age, which pushed him to join the military. Second, he was deployed while I was away on a spiritual journey. I wish I had been home to beg him not to go.”

Intrusive thoughts also contribute to prolonged grief. Many participants described how they cannot control or stop their minds from imagining harmful scenarios. Participant 1 explained how these uncontrollable thoughts affect her:

“Since my husband went missing, I can’t stop thinking about horrific things happening to him. It’s terrifying and often leaves me shocked and fearful. Sometimes I even cry thinking about his suffering.”

In summary, Personal and psychological factors, including confusion, regret, and intrusive thoughts, greatly prolong the participants’ grief. They grapple with their identities, self-blame, and persistent, uncontrollable thoughts of suffering, which prevent them from finding mental peace or closure.

Socio-Economic factor

The socio-economic challenges faced by participants have significantly deepened their grief, as the loss of loved ones has not only left emotional scars but also led to poverty, social isolation, and a profound sense of abandonment.

Participant 1 shared her economic struggles, contrasting her life before and after her husband’s disappearance.

“She explained how they once ran a grocery store and lived comfortably, but now, she struggles to survive by selling tea, coffee, and soft drinks. Her family faces financial difficulties, and her daughter experiences shame at school, which breaks her heart. She often wonders if their situation would be different if her husband had not gone missing.”

Participant 3 reflected on how the disappearance of her son and the loss of her status as the wife of a high-ranking officer left her grieving and isolated. Once respected, she now lives in a monastery, having exhausted her money in search of her son, and her children have left her. Despite having wealth, she can no longer manage it and struggles to cope with the grief.

Participant 4 spoke about how the disappearance of her brother affected his children, who now live in poverty without support, while she struggles to raise her own children. She feels heartbroken seeing her brother’s children suffer.

In summary, the socio-economic hardships stemming from the disappearance of their loved ones have greatly prolonged the participants’ grief. Families have been thrust into poverty, social isolation, and a sense of abandonment, experiencing judgment and discrimination from their communities. Many have lost their homes and livelihoods, making survival a constant struggle. The lack of social support has intensified their grief, leaving them feeling powerless and isolated.

Cultural factor

Cultural influences play a significant role in prolonging grief for families of missing soldiers. The overwhelming nature of their grief often makes it difficult for families to engage in cultural mourning practices, such as traditional funeral rituals. Additionally, societal attitudes toward the youth, particularly those who are unmarried or without children, complicate the grieving process. These attitudes prevent full expression of the loss and intensify the emotional burden.

Participant 2shared her experience saying,

“Seeing my husband’s body and mourning with others is a privilege I can’t experience. As a soldier’s wife, my life is filled with stress and worry. I wish I could mourn with my family and community.”

Another cultural factor contributing to prolonged grief is society’s deep sorrow for those who are missing without children or marriage. Families of missing soldiers without children often feel the pain more acutely, as there is no one to carry on their legacy. Participant 6 expressed;

“The pain of my son’s disappearance is unbearable, but what makes it worse is that he has no children to carry on his legacy. I wish I could have his child with me so I wouldn’t feel his absence.” Similarly, Participant 3 shared, “My son was like a child to me. It deepens my grief knowing he didn’t leave me with a child to carry on his name, even though he was too young to have one.”

Cultural factors prolong grief by preventing participation in traditional mourning rituals and imposing societal expectations. Grief is further deepened by cultural beliefs that emphasize leaving a legacy through children, with participants mourning not only the loss of their loved ones but also the absence of descendants to carry on their legacy. These cultural barriers intensify and lengthen the grieving process. Furthermore, Families of missing soldiers in Ethiopia, particularly the women—wives, sisters, and grandmothers—suffer from prolonged grief due to cultural traditions. In Ethiopian society, men traditionally hold key roles in family social and cultural events. For instance, during important social gatherings like a wedding or an “Edir” (a community-based association that manages death rituals), men are the primary facilitators and key participants. When a male goes missing, his female family members are often excluded from these important social and cultural engagements. This is because these roles were typically filled by the missing male family member. As a result, these women experience social isolation and are often stereotyped, which exacerbates their grief. This situation is less common in Western cultures, where men’s roles in social engagements and rituals are not as rigidly defined.

Mental health and social support needs of the families

This section of the findings is presented under the following sub- themes: Need for psychological services and psychiatric examination, and desire for validation, recognition, and advocacy.

Need for psychological services and psychiatric examination

The study explored the availability of mental health and psychosocial services for grieving individuals and their awareness of these services. Findings reveal that most participants are unaware of how or where to access mental health support. Despite this, many expressed a strong, though unarticulated, need for counseling and psychiatric evaluation to manage their grief.

Participant 3 shared her experience as follows;

“The only person I want to meet is someone who brings me good news about my son. But my well-being is poor. When I see or hear anything reminding me of him, my hands and legs shake, I sweat, and I hear sounds that aren’t real. I need help to forget these problems and need a psychiatric evaluation.”

Participant 1 also highlighted her need for psychological support expressing;

“I need someone to help me. I need a place where I can talk about my husband and cry without judgment, a safe space to release this pain. I feel burdened by everything, and there’s no one to support me. I don’t know where to find psychological services or who to talk to.”

Participant 6, shared her view on her need for treating unresolved grief;

“In my understanding, grief is something you address by mourning with others. I initially sought medical help for my hypertension, diabetes, and heart problems, but I hesitated to mention my grief to the doctors. I worry they might be surprised and just tell me to avoid anger or cry it out, as they usually do. Is there any professional treatment available for grief like mine?”

The study found that individuals experiencing prolonged grief are unaware of available mental health and psychosocial services. Despite needing support like counseling and psychiatric evaluation, participants often lack knowledge on how to access these services, revealing a gap in awareness and accessibility of professional help for grief management.

Desire for validation, recognition, and advocacy

The participants expressed a deep need for validation, recognition, and advocacy regarding their psychological, economic, social, and physical challenges. They seek acknowledgment not only for their personal struggles but also for the sacrifices made by their missing soldier family members. The uncertainty surrounding the fate of their loved ones has left them in a state of distress, emphasizing the need for advocacy, which includes raising awareness about their hardships and seeking information on the soldiers’ whereabouts. These families want support and recognition from society and the government.

Participant 3 highlighted her need for validation of her psychosomatic suffering in this way;

“My heart aches every day, and the grief has taken a toll on my body. I need someone to recognize what I’m going through, to understand that my son’s contribution to this country should not be forgotten.”

Participant 2 shared how she feels unseen in her pain;

“My husband gave his life for this country for almost 17 years, and now his family is left to pick up the pieces. I feel like I’m screaming into the void—no one hears me. I need understanding for what he did and for what I’m enduring now.”

The study shows that families of missing soldiers strongly desire validation, recognition, and advocacy for their suffering. Participants seek acknowledgment of their psychological, economic, and social challenges and recognition of their loved ones’ contributions. They call for support from society and the government to address their pain and help find their missing family members, highlighting frustration with the lack of support compared to past levels of assistance.

Coping strategies used for prolonged grief

The interviewees identified various coping strategies for prolonged grief, including avoidance, self-blame, irritability, denial, and staying busy. Some used expressive coping, such as crying and talking about their loss. Religious methods like praying, using holy water, and visiting religious figures or witches were also common. Rituals, such as preserving belongings and crying with them, were frequently mentioned. The study highlights the diverse coping mechanisms, with women often finding temporary relief through emotional expression and shared sorrow, such as attending funerals.

Discussion

The lived experience of family of missing soldiers

The present study found that those families of missing soldiers experience Echoes of grief and psychosomatic expression that is expressed by overwhelming and distressing, significantly impairing participants’ overall well-being, including their cognitive, emotional, behavioural, and physical functioning. However, the study indicated that the experiences varied across individuals, such as the personal perceptions of grief, the psychological and somatic symptoms they experience, and the extent to which these challenges interfered with their daily functioning. According to the study participants, unresolved prolonged grief also leads to confusion and disorientation. The present study also found that families of missing soldiers experience a significant shift in their family dynamics and roles. This leads to conflicts, emotional distress, and exploitation within families. For example, children are often forced to take on new responsibilities too early, which causes confusion and resentment. The study also revealed that the sharp contrast between the families’ current lives and the lives they once had, which can be described as a journey “from wholeness to heartache.” This is to mean that a dramatic transformation from a life once full of joy to an overwhelming sense of emptiness. Furthermore, the study shown that the socioeconomic well-being of these families is severely affected, characterized by extreme poverty and social isolation. This is to mean that the loss of a family member, especially the primary breadwinner, has resulted not only in financial hardship but also in a disruption of social connections, leaving these individuals to face their grief in the state of being alone.

Previous research has shown that the emotional stress during and after deployment significantly impacts family functioning, as explained by family stress theory and the theory of systemic stress [32]. Similarly, grief, whether from death or separation, triggers profound emotional suffering [49]. These studies also indicated that families of missing soldiers experience ambiguous loss, a combination of prolonged and traumatic grief. Lack of closure and an emotional vacuum, combined with vacillation between hope and despair, hinder acceptance of the loss [23]. These results in an emotional vortex that can only be resolved when the missing person is found or when its death is confirmed [49]. As the result of such prolonged grief, families of missing soldier have been associated with increased healthcare visits and symptoms like shock, anxiety, and insomnia [18, 35]. Studies indicated that wives of missing soldiers in Bosnia and Herzegovina who their missing husbands’ deaths were unconfirmed suffered from more severe traumatic grief and depression than those with confirmed deaths. This finding highlights how the lack of closure can intensify mental health struggles [36]. This finding from Bosnia and Herzegovina suggests that providing official confirmation of deaths could be a crucial step in supporting the mental health of affected individuals in Ethiopia.

Previous studies indicated that the disappearance of a loved one disrupts family dynamics, often causing role shifts and emotional distress. This disruption weakens family cohesion and triggers conflict, often resulting in social isolation [4, 21]. The sudden or violent death of a soldier also presents unique challenges for surviving military family members, with spouses reporting negative effects on their relationships with both their immediate family and their deceased partner’s family [28].Furthermore, families experience a dramatic shift from stability and joy to sorrow and emptiness as they navigate the pain of loss and isolation.

Factors that prolong and sustain grief in families of missing soldiers

The present study revealed that Uncertainty, Personal and psychological factors, Socio-economic factors, and Cultural factors prolonged and sustained grief of the families of missing soldiers. Study participants reported that they were trapped between hope and despair that intensifies their grief, and making harder to cope. Supplementing this, the present study found that the constant doubt about whether their loved ones are dead or alive prevents closure, leaving them torn between hope and despair. Furthermore, the study found that personal and psychological factors such as confusion, regret, self-blame and intrusive thoughts play a significant role in prolonging the grief of families of missing soldiers that interfere with their personal lives, thoughts, emotions, and behaviours. In relation to socioeconomic factor, the present study shown that the socio-economic hardships stemming from the disappearance of their loved ones have greatly prolonged the participants’ grief. Families have been into poverty, social isolation, and a sense of abandonment, experiencing judgment and discrimination from their communities. This can be evidenced that study participants have lost their homes and livelihoods, making survival a constant struggle, and lack social support that has intensified their grief, leaving them feeling helplessness and isolated. The present study also found that culture plays a key role in prolonging and sustaining the grief of families of missing soldiers or those whose deaths have not been confirmed. The cultural factors includes cultural expectations that male family members are supposed to accomplish specific roles, the lack of closure regarding the death of a missing soldier in customary, spiritual, and cultural practices, and the attitude that the family’s legacy cannot continue (this is especially common for missing soldiers who have no children).

Previous studies found that several factors contribute to prolonging and sustaining grief in families of missing soldiers, including uncertainty, personal and psychological challenges, socio-economic difficulties, and cultural influences [31].With this regard, families of missing persons experience unique psychological and social challenges, as the uncertainty of their loved one’s fate creates a distinct emotional landscape that intensifies grief [23].Previous studies highlighted that hope plays a crucial role in sustaining prolonged grief, as families, particularly women; experience an emotional vacuum that fuels the search for closure [23].

Previous studies have found that grief is prolonged and sustained in families of missing soldiers when it cannot follow a culturally prescribed path due to unconfirmed death, silence, or a lack of systemic support [14]. In the study area, a significant cultural and religious tradition is performed that involves strict death rituals and ceremonies for confirmed death. These rituals help families accept and find a sense of closure regarding the death of the missing soldier.

Mental health and social support needs of families of missing soldiers

The present study found that families of missing soldiers need mental health and social support that include access to psychological services and psychiatric evaluation, the need for validation, recognition, and advocacy. Participants of the study indicated that they were unaware of available mental health resources, and struggle to access counseling and psychiatric support. This indicates that there exists a significant gap in awareness and accessibility of mental health and social support in the study area. Additionally, the present study found that families of missing soldier seek validation for their suffering and recognition of their loved ones‘(missing soldiers) contributions, calling for more societal and governmental support to address their grief.

Researchers emphasized that strength-based, family-centred interventions can reduce psychological health risks and improve resilience of families of missing soldiers [5, 25]. However, economic, local government, and psychosocial barriers often prevent families from rebuilding their lives and addressing these needs require sustained community and governmental commitment [25]. Families of missing soldiers find comfort when their communities recognize their hardship, and the supports by mobilizing state authorities can reduce grief and alleviate family distress [10]. In the same vein, family members of missing soldiers often rely on friends for support during early bereavement, though this dependency, in the absence of formal counseling, may increase the risk of complicated grief [8, 9, 28]. Studies highlighted the importance of better supporting the mental health and resilience of military families, particularly through service providers and professional support networks [11].

Coping strategies for prolonged grief of families of missing soldiers

Finally, the present study revealed that coping strategies for prolonged grief among families of missing soldiers were avoidance, self-blame, irritability, denial, and emotional expression. For example participants employed expressive coping mechanisms, such as crying or discussing their loss, while others turned to religious practices, including praying and seeking guidance from religious figures. Rituals, like preserving belongings, were also common, with women particularly using emotional expression and shared sorrow, such as attending funerals, for temporary relief.

Previous research highlights similar coping strategies, such as social support, which is crucial for alleviating loneliness and isolation [28]. While some mental health support systems were considered effective, others were not. For instance, wives of missing soldiers often rely on social support and religious practices, like praying, to cope with their prolonged grief [22, 26]. These researchers also highlighted that establishing support groups that provide a safe space for shared experiences is essential to help families connect and manage their grief more effectively. To the researchers’ knowledge, there are no social supports and religious practice platforms for missing soldiers whose deaths have not been confirmed in the study area. This condition leaves the families of missing soldiers to experience unseen scars that debilitate their recovery from their grief.

Conclusion

The study found that families of missing soldiers experience prolonged grief, leading to psychosomatic distress, emotional turmoil, and physical health issues like insomnia and hypertension. This grief disrupts family dynamics, causing conflict, role changes, and social isolation. The uncertainty surrounding their loved ones’ fate, compounded by psychological and financial struggles, leaves these families in a persistent state of limbo. Accordingly, this study calls for a multi-pronged approach to providing support. First, it is crucial to offer professional mental health support through initiatives such as organizing training programs for community mental health workers. Furthermore, policymakers in Ethiopia, particularly in the study area, must design national-level grief counseling frameworks specifically for families of missing soldiers. Finally, establishing associations for these families could provide a vital platform for advocacy. These associations would be instrumental in pushing for the training and policy frameworks needed from key stakeholders, including the Ministry of Health, Ministry of Social Affairs, Ministry of Defense, and various local and international NGOs.

Recommendations and implications

Unresolved grief should be addressed as a public mental health concern through coordinated efforts by policymakers, mental health professionals, and community organizations. Policymakers should establish national guidelines and integrate grief care into primary and community health services. Mental health professionals are advised to implement culturally sensitive interventions and multidisciplinary approaches. Future research can focus on diverse populations (including males and children). In addition, the researchers recommend that the level and characteristics of grief be studied based on the experiences of missing soldiers’ family roles, such as wives, mothers, sisters, and grandmothers.

Regarding implications to mental health services and its practical value in Ethiopia, as the findings primarily indicated that cultural factors—particularly those related to social abandonment and the lack of death confirmation (lack of closure)—were key contributors to prolonged grief among families of missing soldiers. Therefore, the researchers recommended that government bodies should promptly confirm the deaths of soldiers to facilitate closure. This can be achieved through proper documentation of soldiers’ status during and after the war.

Another major finding of the study highlighted a lack of awareness regarding where psychosocial and mental health services can be accessed. Consequently, it is implied that religious leaders, NGOs, and government institutions collaborate to raise awareness through advocacy and campaign for the availability of psychosocial and mental health services for the families of missing soldiers.

Limitations of the study

This study is not without its limitations, which should be considered when interpreting the findings. First, the small sample size of our qualitative study, while appropriate for an in-depth phenomenological approach, limits the generalizability of the findings to the broader population of families of missing soldiers in Ethiopia. Second, the gender homogeneity of our sample, which consisted entirely of female participants, means our findings primarily reflect the experiences and coping mechanisms of mothers, wives, and sisters. They may not be representative of the experiences of male family members. One of the limitations of the study can be that the researchers couldn’t be fully transparent about participants’ details. This is because we were required to protect their anonymity as part of consent for research participation and publication. Finally, a potential translation bias exists. Interviews were conducted in Amharic and subsequently translated into English for analysis and presentation. While great care was taken to preserve the original meaning, some cultural issues and specific emotional expressions may not have been reflected in the process. Future research should aim to address these limitations by including a more diverse sample that incorporates male family members and could employ a larger sample size or a mixed-methods design.

Abbreviations

IPA

Interpretative Phenomenological Analysis

Authors’ contributions

H.Y. worked on designing, literature review, and validating interview guide questions, W.A worked on data collection, data entry, and transcription, and M.T. worked on the literature review and data analysis, and all the authors prepared the manuscript.

Funding

There is no funding for the study.

Data availability

The datasets used and analyzed during the study are available from the first author on reasonable request.

Declarations

Ethical approval and consent to participate

This study protocol was approved by the Institutional Review Board of the University of Gondar, College of Social Sciences and Humanities- College Research and Ethics Review Committee (Ref. C/S/S/H/R/P0095/05/2016 on May 15, 2024). The study was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. All participants provided their consent to take part in the study. They were also informed of their right to decline to answer any questions that caused discomfort or to take a break whenever needed. One of the participants signed the informed consent form to participate in the study. The other five gave their oral consent and then signed their fingerprints on the friction ridges of their fingers, which is common in our system for illiterate (those who cannot write and read) study participants.

Consent for publication

Participants in the study were informed, and they gave their consent for the publication of the study’s findings, including their direct quotes.

Competing interests

The authors declare no competing interests.