Forty-four critically injured civilians, 33 of them children, reached Mekelle's Aydar Referral Hospital between Saturday and Monday after shelling in Maychew and Alamata. The hospital’s senior health worker described the toll plainly. “Some are blinded, some have their legs and hands amputated from the bombing,” the worker said. At least four people died on the way there.
Fighting between Ethiopian federal forces and Tigrayan fighters has spread across northern Ethiopia. Reports describe civilian deaths, wounded people unable to reach care, damage to public facilities and disrupted communications.
Who Is Bearing the Cost
A 22-year-old woman from Selenwuha told Deutsche Welle that heavy-weapon shelling hit her relatives as they sheltered at home. “I have lost six family members,” she said. Survivors, including the wounded, remain trapped in their homes. “They have no access to medical facilities or vehicles, and the nearest treatment center is far away,” she said.
A 45-year-old Alamata resident said an attack came during the opening hours of a market, “when large numbers of people would be gathered there.” He said 11 people were killed and 15 wounded at the Saturday market. A 40-year-old resident said militia members told him government forces had fired artillery at civilians in retaliation. DW said it couldn't independently verify the claims, and an Ethiopian National Defense Force spokesperson hadn't responded to its request for comment.
Prices are climbing fast as supply routes break down, even in communities spared direct fighting. Tigray, home to roughly 7 million people, faces federal restrictions on fuel and medical supplies, as well as blocked public-sector salaries. Residents fear further electricity and communications cuts. Reports also describe an attack on a Catholic Relief Services convoy carrying food aid. Tigrayan organizations and human rights groups say strikes in August and September hit schools, residential areas, a farmer training center and a food-aid truck.
Amdegebreal Admassu, an Ethiopian lawyer focused on political and legal affairs, said hospitals, schools and other public facilities, which also serve as shelters, are “either accidentally hit or deliberately targeted.” He added: “Under both international law and our country's penal code, such actions are classified as war crimes.” Mebrihi Birhane of Human Rights First Ethiopia said civilian facilities also came under attack in the 2020-22 war. “The population must have access to essential services even in times of war. Ensuring this is an obligation for all armed forces involved in the conflict,” he said.
A Peace Deal That Never Fully Took Hold
The Pretoria Agreement, signed on November 2, 2022, under African Union mediation, ended the 2020-2022 war. Depending on the source, that war killed between 162,000 and 600,000 people and displaced more than 2 million. Key provisions never took effect. Disputes continued over contested territories, the return of displaced people and the full demobilization of Tigrayan forces. Hundreds of thousands of displaced people still haven't returned to western and southern Tigray, claimed by both Tigray and Amhara.
Alemayehu Fentaw Weldemariam of Indiana University's Center for Constitutional Democracy said the deal wasn't a comprehensive peace settlement and wasn't followed by broader talks about the war's root causes.
The current escalation began on September 23, when Tigrayan forces took control of Mekelle's main airport. Both sides blame each other and describe their actions as defensive. Federal forces answered with drone strikes and ground operations. Pro-government forces say they took Alamata on September 27, a claim ACLED also recorded. On September 25, seven armed groups, including the TPLF, formally named the Ethiopian Peoples' Forces Alliance for Survival. The groups say they aim to remove Abiy's government, establish an inclusive transitional administration and pursue constitutional reform. The TPLF says the federal government withheld funds for civil servants and restricted access to banks and fuel.
The Global Response
Pope Leo XIV appealed Wednesday for peace in Tigray, Afar and Amhara. He urged all parties “to choose the path of dialogue” and asked the international community for “generous” and “timely” humanitarian aid. “Armed conflict never solves problems but only worsens them leaving in its wake a trail of death, destruction and resentment,” he said. On September 22, African Union Commission Chairperson Mahmoud Ali Youssouf called for “the utmost restraint” and a return to direct talks. The International Committee of the Red Cross said it evacuated around 160 people from Tigray.
Weldemariam said preventing a wider war would require an immediate halt to airstrikes and offensive ground operations, restored communications and humanitarian access, independent investigations into attacks on civilians, and negotiations toward a comprehensive political agreement. Those talks, he said, would need to include the wider alliance, contested territories, regional representation and the future of Ethiopia's federal system.
Why This Matters: The people absorbing the shock aren't commanders or political leaders. They're children in a Mekelle hospital ward, families who can't reach a clinic, and communities watching prices climb. Legal experts and rights groups say attacks on hospitals, schools and shelters can amount to war crimes, and protecting essential services is an obligation for every armed force. The unfinished Pretoria Agreement shows how a ceasefire without disarmament, the return of displaced people or a broader political settlement can leave civilians exposed. The stakes extend beyond Ethiopia. Analysts warn that the main trade corridor to Djibouti could be threatened, while Weldemariam warns the conflict could intersect with Sudan's civil war. Independent investigations and humanitarian access, two of his conditions, are measures international institutions can press for.