In parts of Ethiopia’s Tigray region, people now eat only green leaves for days. At a health center last week, a mother and her newborn weighing just 1.7 pounds died from hunger. In every district of the more than 20 where one aid group works, residents have starved to death. For months, the United Nations has warned of famine. 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 were stripped bare, a new death has set in. The U.N. calls it the world’s worst hunger crisis in a decade. “You are killing people,” Hayelom Kebede, the former director of Tigray’s flagship Ayder Referral Hospital, recalled telling Ethiopia’s health ministry in a phone call this month. “They said, ‘Yeah, OK, we’ll forward it to the prime minister.’ What can I do? I just cry.” Hayelom shared with The Associated Press photos of a few of the 50 children receiving “very intensive care” because of malnutrition, some of the first images to emerge from Tigray in months. In one, a small child stares straight into the camera, a feeding tube in his nose, a protective amulet lying in the pronounced hollow of his throat. The blockade marks a new phase in the 10-month war between Tigray forces and the Ethiopian government, along with its allies. Now the United States has issued an ultimatum: Take steps to stop the fighting and let aid flow freely, or new sanctions could come within weeks. Read: Ethiopia calls “all capable” citizens to fight in Tigray war 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. In June, the Tigray forces fighters retook the region of 6 million people, and Ethiopia’s government declared a ceasefire, citing humanitarian grounds. Instead, it has sealed off the region tighter than ever. More than 350,000 metric tons of food aid are positioned in Ethiopia, but almost none of it can get into Tigray. The government is so wary of supplies reaching the Tigray forces 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, even personal ones. The list, obtained by the AP, also banned means of documenting the crisis such as hard drives and flash drives. Tigray has returned to darkness, with no telecommunications, no internet, no banking services and very little aid. Ethiopia’s prime minister and other senior officials have denied there is hunger in Tigray. The government blames the Tigray forces and insecurity for troubles with aid delivery and says it has reduced the number of checkpoints that slowed convoys. It also has accused humanitarian groups of supporting the Tigray fighters. The prime minister’s spokeswoman, Billene Seyoum, did not say when the government would allow basic services to the region. 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," she said in a statement. However, medical supplies on the first European Union air bridge flight were removed during government inspection. In the most extensive account yet of the blockade's toll, a humanitarian worker told the AP that deaths from starvation are reported in “every single” district of the more than 20 in Tigray where one aid group operates. The group had run out of food aid and fuel. The worker, like others, spoke on condition of anonymity for fear of retaliation. “Currently, there are devastating reports coming from every corner,” the aid group wrote to a donor in August, according to documents shared with the AP. In April, the group wrote that 22 people in one sub-district had starved to death. In August, another staffer visited a community in central Tigray and wrote that some people "are eating only green leaves for days.” One aid worker who recently visited Tigray described the effects of the deprivation: Some toilets in crowded camps for the displaced are overflowing without the cash to pay for their cleaning, leaving thousands of people vulnerable to outbreaks of disease. 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. “It’s worse than subsistence," the aid worker said. At least 150 people starved to death in August, including in camps for displaced people, the Tigray External Affairs Office has alleged. The International Organization for Migration, the U.N. agency which supports the camps, said: “We unfortunately are not able to speak on this topic.” Food security experts months ago estimated that 400,000 people in Tigray face famine conditions, more than the rest of the world combined. But the blockade means experts cannot collect needed data to make a formal declaration of famine. Read: At river where Tigrayan bodies floated, fears of ‘many more’ 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 some 1 million people died. Now malnutrition rates are near 30% for children under 5, the U.N. World Food Program said Wednesday, and near 80% for pregnant and breastfeeding women. As the war spreads, so might the hunger. Tigray forces have entered the neighboring regions of Amhara and Afar in recent weeks, and some residents accuse them of carrying out acts of retaliation, including closing off supply routes. The Tigray forces deny it, saying they aim to pressure Ethiopia’s government to lift the blockade. There is little help coming. The U.N. says at least 100 trucks of aid must reach Tigray every day. But as of Sept. 8, less than 500 had arrived since July. No medical supplies or fuel have been delivered to Tigray in more than a month, the U.S. says, blaming “government harassment,” not the fighting. On Tuesday, the U.N. issued the first report of its kind showing the number of days remaining before cash or fuel ran out for critical work like treating Tigray’s most severely malnourished. Often, that number was zero.

From time to time, a body floating down the river separating Ethiopia’s troubled Tigray region from Sudan was a silent reminder of a war conducted in the shadows. But in recent days, the corpses became a flow. Bloated, drained of color from their journey, the bodies were often mutilated: genitals severed, eyes gouged, a missing limb. The Sudanese fishermen who spotted them, and the refugees from Tigray who helped pull them to shore, found many corpses’ hands bound. Some of them had been shot. The Associated Press reported dozens of bodies floating down the Tekeze River earlier this week and saw six of the graves on Wednesday, marking the first time any reporters could reach the scene. Doctors who saw the bodies said one was tattooed with a common name in the Tigrinya language and others had the facial markings common among Tigrayans, raising fresh alarm about atrocities in the least-known area of the Tigray war. Read:Tunisia on edge as president suspends parliament, fires PM “They are from Tigray,” said Garey Youhanis, a Tigrayan who helped bury several bodies found on Sunday. With a piece of red cord, he demonstrated how their hands were tied behind their backs. He squatted on the rock-strewn shore, crossed himself and prayed. The deaths are the latest massacre in a nine-month war that has killed thousands of civilians and is now spilling into other regions of Ethiopia, Africa’s second most populous country and the anchor of the often-volatile Horn of Africa. Though Tigray forces in June reclaimed much of the region as Ethiopian and allied forces retreated, western Tigray is still controlled by authorities from Ethiopia’s neighboring Amhara region, who have cleared out many ethnic Tigrayans while saying the land is historically theirs. Witnesses have told the AP of watching mass expulsions. More than 60,000 Tigrayans fled to Sudan, where thousands remain in makeshift camps a short walk from the river in the hope of hearing news from those who still arrive. Some scrutinized the bodies in the river for clues, and they have asked Sudanese police and the United Nations to exhume them for autopsies. “In the last one week, 43 bodies were buried around this river,” the surgeon from the nearby Tigray town of Humera, Tewodros Tefera, told the AP. He and other refugees believe the bodies were dumped into the river at Humera, which has seen some of the worst violence since the war began in November. “Some had amputated limbs and legs,” Tewodros said. “There was a man which we buried yesterday, his genital area was completely severed. ... So this is the kind of trauma that we’re seeing of western Tigray.” He told the AP they hadn’t heard of any new bodies since Tuesday, when at least seven were found. But he believes an active search along the river could reveal “many, many more,” perhaps hundreds. Ethiopia’s government has accused the rival Tigray forces of dumping the bodies themselves for propaganda purposes. A “fake massacre,” the spokeswoman for Prime Minister Abiy Ahmed, Billene Seyoum, told reporters on Thursday. But the discovery has increased international pressure on the prime minister, a Nobel Peace Prize winner, at a time when his government is already accused by the U.N., the United States and the European Union of besieging Tigray and blocking food and other aid to millions of people. Hundreds of thousands face famine conditions in the world’s worst hunger crisis in a decade. Ethiopia’s prime minister in recent days referred to the Tigray forces as “weeds” and a “cancer,” bringing a warning from the U.N. special envoy on genocide prevention that such dehumanizing language “is of utmost concern.” Ethiopia’s government has said such talk is not meant to describe ordinary Tigrayans. But the bodies in the river brought new fears of ethnic cleansing, or the forcing of a population from a region through expulsions and other violence. Read: Jihadis expand control to new Burkina Faso fronts “We are deeply concerned by the latest developments,” the U.N. refugee agency in Sudan said on Thursday. It confirmed seeing one of the bodies pulled from the river along with “what appear to be several fresh graves.” It said it was unable to confirm the identifies of the dead or how they died. Like other international aid organizations, the U.N. agency said it has no access on the Ethiopian side of the border region. Underlining that absence, the U.N. humanitarian agency on Wednesday tweeted a map showing no foreign aid group active in western Tigray. One that had worked there, the Dutch section of Doctors Without Borders, had its operations suspended by Ethiopia on July 30, accused by the government of spreading “misinformation” and illegally using satellite radio equipment. Ethiopia’s government has alleged that aid groups are arming and supporting the Tigray forces, without evidence. “Those who want corridors for weapons and non-humanitarian goods to be brought into them continue to try to manipulate the realities on the ground in an attempt to convince the world that unfettered access is not happening” in Tigray, the prime minister’s spokeswoman said. She called the Tigray forces, who dominated Ethiopia’s repressive government for years but were sidelined when Abiy took office, a “terrorist organization that has hijacked the well-being of the people of Tigray.” Phone, internet and banking services remain down across the Tigray region of some 6 million people, and the U.N. says more than 5 million need help now. The Tigray forces, who have pushed into the neighboring Afar and Amhara regions and displaced more than 200,000 people, have said restoring basic services is a precondition to negotiations to end the war. Tigray forces on Thursday entered the Amhara town of Lalibela, a UNESCO World Heritage site for its rock-hewn churches, a resident told the AP. While they entered peacefully, “yeah, we’re scared,” he said, worried about damage to what residents call the “new Jerusalem.” He estimated thousands of fighters were there and “many people are running away.” He spoke on condition of anonymity for his safety. With the Tigray forces pushing south after threatening to go as far as the capital if needed, the U.N. humanitarian chief and the USAID administrator in visits to Ethiopia this week urged a cease-fire and talks. Sudan has offered to play a role in mediation. Sudan also could be a direct aid corridor to Tigray. But the prime minister’s spokeswoman called Ethiopia’s relationship with Sudan “a bit tricky,” pointing to a border dispute. “That element needs to be thoroughly addressed before Sudan can be entertained as a credible party in negotiations,” she said. For the refugees in Sudan, each body found in the river is a reminder of loved ones trapped in the fighting. Read:25,000 troops deployed to quell South Africa riots, 117 dead Horrified, refugees in the Sudanese border community of Hamdayet spotted one body that looked familiar. Like most of the Tigrayans killed in the war, it was a young man. “How can I not feel the death of my brother and friend?” said one of the Tigrayans who buried him, Awet, who gave only his first name. “I’m very sorry.” The dead man’s name was Robel, the surgeon Tewodros said. By the water’s edge, his fingers tapping his graying temple in anxiety, he checked his phone for news of other bodies found.

An airstrike hit a busy market in Ethiopia’s northern Tigray village of Togoga on Tuesday and killed at least 51 people, according to health workers who said soldiers blocked medical teams from traveling to the scene. An official with Tigray’s health bureau told The Associated Press that more than 100 other people were wounded, more than 50 seriously, and at least 33 people were still missing. The official spoke on condition of anonymity because of concerns about retaliation. The alleged airstrike comes amid some of the fiercest fighting in the Tigray region since the conflict began in November as Ethiopian forces supported by those from neighboring Eritrea pursue Tigray’s former leaders. A military spokesman and the spokeswoman for Ethiopia’s prime minister, Billene Seyoum, did not immediately respond to a request for comment. Wounded patients being treated at Ayder hospital in the regional capital, Mekele, told doctors and a nurse that a plane dropped a bomb on Togoga’s marketplace. The patients included a 2-year-old child with “abdominal trauma” and a 6-year-old, the nurse said. An ambulance carrying a wounded baby to Mekele, almost 60 kilometers (37 miles) away by road, was blocked for two hours and the baby died on the way, the nurse added, speaking on condition of anonymity because of concerns about retaliation. READ: Israel swears in new coalition, ending Netanyahu’s long rule Hailu Kebede, foreign affairs head for the Salsay Woyane Tigray opposition party and who comes from Togoga, told the AP that one fleeing witness to the attack had counted more than 30 bodies in the remote village that’s linked to Mekele in part by challenging stretches of dirt roads. “It was horrific,” said a staffer with an international aid group who told the AP he had spoken with a colleague and others at the scene. “We don’t know if the jets were coming from Ethiopia or Eritrea. They are still looking for bodies by hand.” On Tuesday afternoon, a convoy of ambulances attempting to reach Togoga, about 25 kilometers (15 miles) west of Mekele, was turned back by soldiers near Tukul, the health workers said. Several more ambulances were turned back later in the day and on Wednesday morning, but one group of medical workers reached the site on Tuesday evening via a different route. “We have been asking, but until now we didn’t get permission to go, so we don’t know how many people are dead,” said one of the doctors in Mekele. Another doctor said the Red Cross ambulance he was traveling in on Tuesday while trying to reach the scene was shot at twice by Ethiopian soldiers, who held his team for 45 minutes before ordering them back to Mekele. READ: Israel arrests Jerusalem activists in contested neighborhood “We are not allowed to go,” he said. “They told us whoever goes, they are helping the troops of the TPLF.” The TPLF refers to the Tigray People’s Liberation Front, which governed Tigray until it was ousted by a federal government offensive in November. The subsequent fighting has killed thousands and forced more than 2 million people from their homes. More than 25 of the wounded finally reached Ayder hospital later on Wednesday, a day after the airstrike, the regional health official said. While the United Nations has said all sides have been accused of abuses in the Tigray conflict, Ethiopian and Eritrean soldiers have been repeatedly accused by witnesses of looting and destroying health centers across the Tigray region and denying civilians access to care. The European Union “strongly condemns the deliberate targeting of civilians” in Togoga, EU foreign policy chief Josep Borrell said Wednesday, calling it the latest in a “horrific series” of abuses committed in Tigray. He again called for an immediate cease-fire and urged the international community “to wake up and take action.” READ: Israel suspends ultranationalists' march in east Jerusalem This month, humanitarian agencies warned that 350,00 people in Tigray are facing famine. Aid workers have said they have been repeatedly denied access to several parts of the region by soldiers. The government of Prime Minister Abiy Ahmed says it has nearly defeated the rebels. But forces loyal to the TPLF recently announced an offensive in parts of Tigray and have claimed a string of victories. On Wednesday one of the former Tigray leaders, Getachew Reda, asserted that Tigray forces had shot down a C-130 transport plane carrying explosives, military officers and “Eritrean camouflage uniforms.” The claim could not immediately be verified. A resident in Adigrat, about 100 kilometers (62 miles) north of Mekele, said a group of Tigrayan fighters briefly entered the town on Tuesday, although he said it had since been retaken by Ethiopian and Eritrean forces. He said federal police had since been seen beating people in the center of the town. “Everybody is staying at home, there is no movement in the town,” he said. Renewed fighting was also reported in Edaga Hamus and Wukro, two towns that sit on the main road to Mekele. The reports came as Ethiopia held federal and regional elections on Monday. The vote was peaceful in most parts of the country, although there was no voting in Tigray. The vote was delayed last year due to the COVID-19 pandemic, heightening tensions between the federal government and the TPLF, which went ahead with its own regional election in September.

Skinny, hungry, fleeing threats of violence, thousands of people who have been hiding in rural areas of Ethiopia’s Tigray region have begun arriving in a community that can barely support them — and more are said to be on the way.

Ethiopia’s prime minister on Tuesday declared “the final and crucial” military operation will launch in the coming days against the government of the country’s rebellious northern Tigray region.