From “emaciated” refugees to scorched crops on the verge of harvest, famine threatens survivors of more than two months of fighting in Ethiopia’s Tigray region.

The first aid workers to arrive after pleading with the Ethiopian government for access describe debilitated children dying of diarrhea after drinking in rivers. The stores were looted or exhausted weeks ago. A local official told a January 1 crisis meeting of government and aid workers that starving people had asked for “just one cookie.”

More than 4.5 million people, almost the entire population of the region, are in need of emergency food, participants said. At their next meeting on Jan. 8, a Tigray administrator warned that without help, “hundreds of thousands of people could starve,” and some had already done so, according to minutes obtained by The Associated Press.

“There is an extremely urgent need – I don’t know what more words in English to use – to scale up the humanitarian response quickly because the population is dying every day as we speak”, Mari Carmen Vinoles, head of the unit of emergency for Doctors Without Borders, told the AP.

But pockets of fighting, resistance from some officials, and outright destruction stand in the way of a massive food delivery effort. Sending 15-kilogram (33-pound) rations to 4.5 million people would require more than 2,000 trucks, according to meeting minutes, while some local stakeholders are reduced to walking.

The specter of hunger looms large in Ethiopia, which has become one of the world’s fastest growing economies in decades since images of famine in the 1980s sparked a global uproar. Drought, conflict and government denial contributed to the famine, which swept through Tigray and killed an estimated 1 million people.

The largely agricultural Tigray region of around 5 million people already had a food security problem amid a desert locust outbreak when Prime Minister Abiy Ahmed announced on November 4 fighting between his forces and those of the provocative regional government. Tigray rulers dominated Ethiopia for nearly three decades, but were sidelined after Abiy introduced reforms that won him the Nobel Peace Prize in 2019.

Thousands of people have been killed in the conflict. More than 50,000 people have fled to Sudan, where a doctor said the new arrivals were showing signs of famine. Others take shelter in rough terrain. A woman who recently left Tigray said she slept in caves with people bringing in cattle, goats and the grain they had managed to harvest.

“It is a daily reality to hear people die with the consequences of the fighting, the lack of food,” a letter from the Catholic Bishop of Adigrat said this month.

Hospitals and other health centers, essential in the treatment of malnutrition, have been destroyed. In markets, food is “not available or extremely limited,” according to the United Nations.

Although Ethiopia’s prime minister declared victory at the end of November, his military and allied fighters remain active amid the presence of troops from neighboring Eritrea, a bitter foe of the now fugitive officials who once ruled the region. .

Fear keeps many people from going out. Others are fleeing. New Tigray officials say more than 2 million people have been displaced, a figure the US government’s Humanitarian Assistance Office calls “staggering.” The UN says the number of people affected by aid is “extremely low”.

A senior Ethiopian government official, Redwan Hussein, did not respond to a request for comment on Tigray’s colleagues warning of the famine.

In the northern Shire region near Eritrea, which has seen some of the worst fighting, up to 10% of children whose arms were measured met diagnostic criteria for severe acute malnutrition, with dozens of ‘affected children, a UN source said. Sharing the concern of many aid workers over the threat to access, the source spoke of anonymity.

Near the town of Shire are camps housing nearly 100,000 refugees who have fled Eritrea over the years. Some of those who have entered town “are emaciated and begging for help that is not available,” UN High Commissioner for Refugees Filippo Grandi said on Thursday.

Food has been a target. Analyzing satellite images of the Shire area, a UK-based research group found that two warehouse-like structures in the United Nations World Food Program complex in a refugee camp had been “very specifically destroyed” . The DX Open Network couldn’t tell by whom. He reported a new attack on Saturday.

It is difficult to verify events at Tigray as communication links remain poor and almost no journalists are allowed.

In the towns of Adigrat, Adwa and Axum, “the number of civilian casualties is extremely high in the places where we have been able to access,” said Vinoles, head of emergencies at Doctors Without Borders. She cited the fighting and the lack of health care.

Hunger is “very worrying”, she said, and even water is scarce: only two of the 21 wells still work in Adigrat, a town of over 140,000 inhabitants, forcing many people to drink from the water. river. With sanitation, disease ensues.

“You go 10 kilometers (6 miles) from town and it’s a complete disaster,” with no food, Vinoles said.

Aid workers find it difficult to assess the scale of the need.

“Not being able to leave the main highways always raises the question of what is happening with people who are still banned,” said Panos Navrozidis, director of Action Against Hunger in Ethiopia.

Prior to the conflict, Ethiopia’s national disaster management body classified some Tigray woredas, or administrative areas, as priority hot spots for food insecurity. While some already had a high number of malnutrition, “two and a half months after the onset of the crisis, it can be assumed that thousands of children and mothers are in immediate need,” Navrozidis said.

The Famine Early Warning Systems Network, funded and operated by the United States, says parts of central and eastern Tigray are likely in Emergency Stage 4, one step below famine .

The next few months are critical, said John Shumlansky, representative of Catholic Relief Services in Ethiopia. His group has so far given 70,000 people in Tigray a three-month food supply, he said.

Asked that fighters use hunger as a weapon, a concern among aid workers, Shumlansky dismissed it by the Ethiopian defense forces and police. With others, he didn’t know.

“I don’t think they have anything to eat either,” he said.