Spirituality is central to health and healing in Ethiopia, yet no comprehensive synthesis of the literature exists. This scoping review maps the evidence on spiritual health, beliefs, practices, and healthcare integration gaps in Ethiopia. To systematically identify, characterize, and thematically analyze empirical studies on spiritual health and spirituality in Ethiopia, and to identify evidence gaps for policy and research. Following JBI methodology and PRISMA ScR guidelines, we searched PubMed, Embase, CINAHL, Scopus, and Web of Science, PsycINFO, Google Scholar, and thesis repositories from inception to December 2025. Primary studies in English addressing any aspect of spiritual health in Ethiopia were included. Data extraction and thematic analysis (Braun & Clarke, six phase) were performed independently by two reviewers. Thirty one studies (1968–2026) were included. The literature is predominantly qualitative (55%) and focused on mental health (74%). Ethiopian Orthodox Christian contexts dominate (71%); Muslim (33% of population) and indigenous spiritual traditions are severely under represented. Thematic analysis yielded five themes: (1) spiritual causal frameworks for illness (spirit possession, divine punishment, ancestral spirits); (2) spiritual healers as primary mental health providers; (3) holy water (tsebel) as a central healing modality; (4) spirituality as a coping resource; and (5) profound gaps in healthcare integration—moderate nursing spiritual care competence (mean 3.45/5), only 21.5% of nurses trained in spiritual care, and no national collaboration policies. Ethiopia’s formal healthcare system operates parallel to, not in partnership with, the spiritual healing systems used by the majority. The evidence base is narrow, fragmented, and lacks longitudinal or interventional studies. Prioritize research on Muslim and indigenous spiritual traditions, pastoralist regions, and faith integrated interventions. Develop national guidelines for respectful collaboration, mandate spiritual care training in nursing curricula, and formally recognize holy water sites as mental health entry points.