Cross-cultural perspectives on traditional healing: A qualitative study of Harari, Oromo, and Somali medical systems in East Hararghe, Ethiopia

Background: Traditional medicinal knowledge in Ethiopia is rapidly eroding, yet comparative qualitative studies across ethnic groups remain scarce. East Hararghe Zone hosts Harari, Oromo, and Somali communities with distinct healing systems. Purpose: This study aimed to qualitatively document, compare, and assess the traditional medicinal knowledge, disease classification, spiritual causation, intergenerational transmission, and market-based preservation among the three ethnic groups. Methods: A qualitative ethnographic design was employed. Data collection included 12 healer case studies (four per ethnicity), 12 Harar market observation days, semi-structured interviews, and Harari language translation. Thematic analysis was conducted using NVivo. Findings: Somali healers reported the highest spiritual causation (34%) and dream initiation (31%), followed by Harari (28% each), then Oromo (18% and 15%). Harari uniquely incorporated the lil (wind) disease category. Female healers held exclusive reproductive knowledge (e.g., Aloe harlana for postpartum bleeding). Active teaching occurred in only 44% of families; 56% relied on passive observation, declining due to school attendance. Harari youth fluency was 23%. The Harar market preserved knowledge through vendor quality grading (price premiums 2–3×) independent of individual healers. Conclusion: Distinct ethnomedical systems coexist with varying spiritual emphasis, gendered specialisation, and language vulnerability. Market mechanisms offer partial preservation. Recommendation: Implement Harari-language plant guides, elder‑youth apprenticeships, gender‑sensitive documentation, vendor certification, and integration of zar rituals into mental health services.