NAIROBI, Kenya — In parts of Ethiopia’s Tigray region, there are people who go for days with nothing to eath but green leaves.
At a health center recently, a mother and her newborn, weighing just 1.7 pounds, died from hunger. In each of the more than 20 districts in which one aid group works, people have starved to death.
For months, the United Nations has warned of famine in this embattled corner of northern Ethiopia, calling it the world’s worst hunger crisis in a decade. Now, internal documents and witness accounts reveal the first starvation deaths since Ethiopia’s government in June imposed what the U.N. calls “a de facto humanitarian aid blockade.”
Forced starvation is the latest chapter in a conflict where ethnic Tigrayans have been massacred, gang-raped and expelled.
Months after crops were burned and communities stripped bare, a new kind of death has set in.
“You are killing people,” Hayelom Kebede, former director of Tigray’s flagship Ayder Referral Hospital, recalled telling Ethiopia’s health ministry in a call earlier this month. “They said, ‘Yeah, OK, we’ll forward it to the prime minister.’ What can I do? I just cry.”
He provided The Associated Press with photos of some of the 50 children receiving “very intensive care” because of malnutrition — the first such images to emerge from Tigray in months.
In one, a small child stares into the camera, a feeding tube in his nose, a protective amulet in the pronounced hollow of his throat.
Medicines have nearly run out, and hospital staffers haven’t been paid since June, Hayelom said. Conditions elsewhere for Tigray’s six million people are often worse.
The blockade and the starvation that comes with it mark a new phase in the 10-month war between Tigray forces and the Ethiopian government and its allies.
Now, the United States has issued an ultimatum: Take steps to stop the fighting and let aid flow freely, or a new wave of sanctions could be imposed within weeks.
STARVATION WORSENS AMID ETHIOPIA BLOCKADE OF TIGRAY
Phil Holm, Cara Anna / AP
The war began as a political dispute between the prime minister, 2019 Nobel Peace Prize-winner Abiy Ahmed, and the Tigrayans who had long dominated Ethiopia’s repressive national government. Since November, witnesses say, Ethiopian forces and those from neighboring Eritrea looted food sources and destroyed health centers.
In June, the Tigray fighters retook the region, and Ethiopia’s government publicly declared a ceasefire, citing humanitarian grounds. In reality, though, the government has sealed off the region tighter than ever, fearing aid will reach the Tigray forces.
More than 350,000 metric tons of food aid are positioned in Ethiopia. But very little can reach Tigray. The government is so wary that humanitarian workers boarding rare flights to the region have been given an unusual list of items they cannot bring: dental flossers, can openers, multivitamins, medicines.
The list also banned means of documenting the crisis, including hard drives and flash drives. Photos and video from Tigray have disappeared from social media since June as aid workers and others, facing intense searches by authorities, fear being caught with them.
Ethiopia’s prime minister and other senior officials have denied there is hunger in Tigray. The government has blamed Tigray forces and insecurity for troubles with aid delivery. It also has accused humanitarian groups of supporting, even arming, the Tigray fighters.
The prime minister’s spokeswoman Billene Seyoum would not say when the government would allow basic services to the region, saying that the government “has opened access to aid routes by cutting the number of checkpoints from seven to two and creating air bridges for humanitarian flights.”
But medical supplies on the first European Union air bridge flight were removed during government inspection, and such flights can’t even carry the large-scale food aid needed.
In the most extensive account yet of the blockade’s toll, a humanitarian worker, speaking on the condition of not being named out of fear of retaliation, told the AP that deaths from starvation are being reported in “every single” district of the more than 20 in Tigray in which one aid group operates. The group had run out of food aid and fuel.
“There are devastating reports coming from every corner,” the aid group wrote to a donor in August. “If no urgent solution is found, we will lose many people due to hunger.”
In April, even before the current blockade was imposed, the same group wrote to the donor that “reports of malnourishment are rampant” and that 22 people in one sub-district had starved to death.
“People’s skin color was beginning to change due to hunger; they looked emaciated with protruding skeletal bones,” the aid group wrote.
In August, another staffer visited a community in central Tigray and wrote that the number of people at risk of starvation was “exponentially increasing” in rural and urban areas. In some cases, “People are eating only green leaves for days.”
The staffer described speaking with one mother who said that, since June, her family had been living on borrowed food and, for the past month, had eaten only bread with salt. She worried they would die.
“The administrator of the [sub-district] has also told us that there are many families who are living in similar conditions,” the staffer wrote.
Some toilets in the crowded camps are overflowing because there’s no cash to pay for their cleaning, leaving thousands vulnerable to outbreaks of disease, a visiting aid worker said. People who ate three meals a day now eat only one. Camp residents rely on the charity of host communities who often struggle to feed themselves.
“People have been able to get by but barely,” the aid worker said. “It’s worse than subsistence, let’s put it that way.”
At least 150 people starved to death in August, including in camps for displaced people, the Tigray External Affairs Office has said. The International Organization for Migration, the U.N. agency which supports the camps, could not confirm that number.
Food security experts estimated months ago that 400,000 people in Tigray face famine conditions — more than the rest of the world combined. But the blockade means experts can’t collect the needed data to make a formal declaration of famine.
Such a declaration would be deeply embarrassing for Ethiopia, which in the 1980s seized the world’s attention with a famine so severe, also driven by conflict and government neglect, that one million people died.
Since then, Africa’s second-most populous country had become a success story by pulling millions from extreme poverty and developing one of the world’s fastest-growing economies.
Now, amid the war, malnutrition rates are near 30% for children under 5, according to the U.N. World Food Program, and near 80% for pregnant and breastfeeding women.
Tigray forces have entered the neighboring regions of Amhara and Afar in recent weeks, and some accuse them of carrying out acts of retaliation, including closing off supply routes. The Tigray forces deny that, saying they aim to pressure Ethiopia’s government to lift the blockade.
The U.N. human rights office says abuses have been committed by all sides, though witness accounts indicate the most widespread atrocities have been against Tigrayan civilians.
There’s little help coming. The U.N. says at least 100 trucks with food and other supplies must reach Tigray every day to meet people’s needs. As of Sept. 8, fewer than 500 had arrived since July on the only accessible road into the region. No medical supplies or fuel have been delivered to Tigray in more than a month, the United States says, blaming “government harassment” and decisions, not the fighting.
Major international aid groups like Doctors Without Borders and the Norwegian Refugee Council have had their operations suspended, accused of spreading “misinformation” about the war. Nearly two dozen aid workers have been killed, some while distributing food.
“It is a day-to-day reality to see human sufferings, starvation,” Abune Tesfaselassie Medhin, the Catholic bishop of Adigrat, wrote Sept. 3, appealing for help from overseas and warning of catastrophe.
The need for food will continue well into next year, the U.N. says, because the limited crops planted amid the fighting are likely to produce only between a quarter and at most half of the usual harvest.
Grim as they are, the reports of starvation deaths reflect only areas in Tigray that can be reached. One Tigrayan humanitarian worker pointed out that most people live or shelter in remote places such as rugged mountains. Others are in inaccessible areas bordering hostile Eritrea or in western Tigray, now controlled by authorities from the Amhara region who bar the way to neighboring Sudan, a potential route for delivering aid.
As food and the means to find it run out, the humanitarian worker said, “I am sure the people that are dying out of this man-made hunger are way more than this.”