“There Will Be No Mercy”

When Ethiopia’s government launched a brutal two-year war in Tigray, the region’s largest hospital was overrun with victims. The medical staff risked everything to treat the wounded—and believe the world ignored a genocide.

By Drew Philp

Warning: The following story contains graphic depictions of sexual violence and other atrocities.

Day One

Saba would have preferred to be an architect. A young woman who exuded effortless cool and liked aviator glasses and Pink Floyd T-shirts, she had instead been thrust into studying medicine by her upwardly mobile family. Saba was the eldest daughter, and the first in her family to go to college. In Ethiopia, that meant that she was expected to become a doctor or engineer. Her family chose medicine.

Born and raised in Addis Ababa, Saba Tewoldebrihan Goitom attended medical school in Mekelle, the capital of Ethiopia’s Tigray region. Her family is part of the Tigrayan ethnic group, but she never felt particularly Tigrayan. Saba considered herself a citizen of her nation, one of the pluralistically minded youth who would inherit the empire of dozens of ethnic groups that the world called Ethiopia.

Saba moved to Mekelle because she had extended family in the city, and because Tigray—which is about the size of Denmark and is Ethiopia’s northernmost region—was more stable than most of the country. A two-decade conflict over Ethiopia’s border with Eritrea, which borders Tigray, had ended with a much lauded peace agreement in 2018. The accord earned Ethiopian Prime Minister Abiy Ahmed the Nobel Peace Prize.

Saba liked Mekelle. When she wasn’t studying, she enjoyed the city’s coffeehouses and kaleidoscopic nightlife. She had a diverse group of friends—many of her fellow students weren’t Tigrayan. She even grew to like medicine, particularly when it meant playing disease detective by trying to determine the illness afflicting a patient. Then, only a few months before Saba was set to begin her internship, the outbreak of COVID put her education on hold. Like many young people, she moved back home. She helped her mother around the house, looked after her sisters, and watched countless movies. In the fall of 2020, she was summoned back to school. The 24-year-old expected that the pandemic would be the only disruption on her path to becoming a doctor.

But on November 3, as her father drove her to the airport for the return flight to Mekelle, his phone rang. The caller bore distressing news: Her father’s best friend had been arrested. Law enforcement detained him without explanation when he went to a government office to pay his taxes.

Saba’s father was as confused as he was frightened. Both he and his friend, who was also Tigrayan, were law-abiding men who made no trouble. When Saba said goodbye to her father at the airport, she hoped that he would soon have answers. The call left her feeling uneasy.

Saba had kept her apartment in Mekelle, a five-minute walk from Ayder Comprehensive Specialized Hospital, where her medical school was located. But the government required a COVID test upon arrival to the city; she spent the night in a hotel downtown while awaiting the results. She checked in late and spoke on the phone with her mother. There was no news about her father’s friend. She looked at social media for a few moments. Nothing seemed out of the ordinary. She fell asleep around 11 p.m.

By the time she awoke the next morning, both internet and cell service were gone. Power in the neighborhood appeared to be out too, but the hotel had a generator, so Saba turned on the television. Tigray’s regional president was on screen saying that a war had begun. Tigray Special Forces* had launched several attacks on federal troops in Tigray, including one at their headquarters in Mekelle. The federal government claimed that the assault was unprovoked. Tension had simmered between the federal and Tigrayan governments in recent months, but Saba couldn’t fathom that anyone in power would be “stupid enough to start a war.”

* Ethiopia’s constitution authorizes each regional government to maintain its own armed forces.

Saba ran downstairs. The hotel receptionist told her that banking in the city had been suspended. Saba had only 1,500 birr in cash (about $40), and more than half of that would be covering the hotel room. She was on the verge of tears, but the receptionist assured her that she’d be able to withdraw money soon. Whatever was going on, it wouldn’t last long.

Saba wanted to believe the receptionist. She had never felt afraid in Mekelle before. After covering the cab to her apartment and buying a few necessities, Saba had 300 birr ($8) left. She didn’t know it then, but the money would have to last her a month.

Ayder Comprehensive Specialized Hospital in Mekelle. (Photo by Yasuyoshi Chiba/AFP via Getty Images)

Tesfaye* woke up on the morning of November 4 to the sound of gunfire. An ob-gyn at Ayder, he was a physically imposing man who was accustomed to deference from others in light of his professional skills and stature. His father had been a farmer, like his father before him, but Tesfaye’s drive and intelligence helped him escape a life of manual labor. His star rose so fast that he never had to apply for a job—he was always offered them. He was a man completely in control of his domain, a master of his trade. Nearly every day, people lived or died at his hands. Mostly they lived.

*The Atavist is using a pseudonym to protect his safety.

Tesfaye wan’t sure where the gunfire was coming from, and with service outages across Mekelle, he couldn’t look online for answers. He was certain something was very wrong. But what could he do? He got dressed and did what he did most mornings. He went to work.

Ayder  was the second-largest hospital in Ethiopia, a public institution serving seven million people. It was the jewel of the Tigrayan health system, a network of hospitals and clinics painstakingly built over decades into one of the most comprehensive in sub-Saharan Africa. Ayder’s campus consisted of a complex of white buildings encircled by low trees, and that November the skeletons of two new structures—a multistory oncology unit and an emergency complex—were visible on the property.

When Tesfaye arrived, the hospital was busy with patients—women in white headscarves and flower-print dresses, men in Western-style collared shirts buttoned to the neck, some wearing head wraps or cotton shawls. But there was also something surprising: soldiers. They lined the halls of Ayder’s ER bearing gunshot wounds.

Tesfaye moved quickly through the hospital to attend his daily staff meeting. The morning assembly typically involved a case review of the previous 24 hours, discussions about the work of interns and residents, and updates on general goings-on throughout the hospital. At this meeting, however, there was talk only of conflict.

Employees in white coats and scrubs wondered aloud: Is it really war or just a skirmish? How long will it last? There were already soldiers arriving at Ayder for medical assistance; would there be civilians, too? Tesfaye was due to travel to Addis Ababa soon for further training. Rumors circulated that the federal government was rounding up prominent Tigrayans in the capital. Would it be safe for him to go?

Tesfaye was no stranger to conflict. He had seen the Ethiopian civil war, which had lasted from 1974 to 1991, and ended with the Tigray People’s Liberation Front (TPLF) leading a coalition that overthrew the Derg, the country’s military junta. At the time, Eritrea was also fighting a war of independence against Ethiopia. Eritrea became a sovereign nation in 1993, but peace was fleeting. Five years later it invaded Ethiopia, triggering what became known as the Badme War, which lasted two years.

Tesfaye knew that war had a way of leaving no one untouched. He had a wife and child at home. He looked at his colleagues and wondered how many of them would be injured, sustain scars, possibly die. Would he be among them? Would his family?

For now there were only questions.

What most Tigrayans didn’t know—what few people in the world knew—was that behind the scenes, Abiy had been plotting all-out war.

Abraha Gebreegziabher, the head of Ayder’s pediatrics unit, was also at the hospital that morning. The kind of man who was never late, and polite to a fault, Abraha was a natural at his job, able to calm sick children and anxious parents alike. With communications down, he’d brought along a handheld radio on his way to work. As his loafers crunched over Mekelle’s sandy streets, he listened to news of the conflict and wondered how long the fighting would last.

Like Saba and Tesfaye, Abraha was astonished by the announcement of war. Recent disagreements between the TPLF in Tigray and federal authorities in Addis Ababa had seemed like political skirmishes, not the run-up to war. Though Tigrayans made up only 6 percent of the population, the TPLF led Ethiopia’s governing coalition from 1991 to 2018 and oversaw rapid national development. Under its rule, Ethiopia became the seat of the African Union, was home to a powerful military, and boasted one of the fastest-growing economies in the world. But the TPLF was also a brutal and repressive force that jailed journalists and political opponents. Prime Minister Abiy, who was not Tigrayan, came to power amid a wave of protests and had promised democratic reforms. It didn’t take him long to marginalize the group.

Abiy’s administration pushed the TPLF out of the country’s governing coalition and purged high-level Tigrayans from its military. The administration then postponed elections, thereby extending the prime minister’s first term of office. The government attributed the delay to COVID. The TPLF, which still held political sway in Tigray, saw the move as illegitimate and a possible step toward dictatorship. It decided to hold regional elections in September 2020 anyway, defying the national government. Abiy’s government declared the election in Tigray illegal and barred journalists from covering the vote.

What most Tigrayans didn’t know—what few people in the world knew—was that behind the scenes, Abiy was plotting all-out war. While the international community was busy feting the 2018 peace accord he negotiated with Eritrea’s authoritarian leader, Isais Afwerki, Abiy was quietly moving federal troops toward Tigray and into Eritrea. He met with Isais more than a dozen times, sometimes clandestinely, including at military installations. Apparently they discussed plans for war, including the use of Eritrean troops to bolster Ethiopia’s military efforts.

Tigray Special Forces didn’t deny attacking the military bases in the early hours of November 4, but they insisted that it was a matter of preemptive self-defense. While the incident may have been the spark that started the conflict, Abiy had been laying tinder at Tigray’s doorstep for at least two years. Within hours of the attack, the extent of his planning became evident: Abiy declared a state of emergency in Tigray and plunged the region into a banking and communications blackout. Transportation to and from the region was cut off. Civilians could no longer leave.

On November 5, the Ethiopian National Defense Force began dropping bombs in Tigray, advancing toward Mekelle from the south. Within a week, Eritrean soldiers entered the region from the north. The two military forces acted like a hammer and an anvil, crushing civilians trapped between them. Soon regional troops from Ethiopia’s Amhara state and soldiers from Somalia joined the war on the side of Abiy’s government.

If Abiy and his allies hoped that the conflict would be short-lived, ending in decisive victory, they were wrong. The war dragged on for two years, becoming one of the deadliest conflicts of the 21st century. The fact that many readers are likely unfamiliar with it is no accident; Abiy’s information blockade was one of the most effective in modern history. His government also used propaganda and exploited weaknesses in the international order to hide the truth about what was happening in Tigray, which included intentional starvation, mass detention, widespread rape, targeting of civilians, and ethnic cleansing.

It remains an open question whether Abiy’s government perpetrated a genocide against the Tigrayan people. Each person featured in this story, and others who helped make the reporting possible, risk imprisonment or assassination by providing evidence that could move the world closer to an answer.

Unlike most health facilities in the region, Ayder remained largely operational throughout the war.* Patients came from across northern Ethiopia seeking help. The stories collected by the hospital’s staff, as well as their personal experiences, lay bare the scope of the war.

* In March 2021, Doctors Without Borders reported that one in five Tigrayan health facilities visited by the organization in early 2021 were occupied by armed soldiers. Nearly 70 percent had been looted. “Health facilities in most areas appear to have been deliberately vandalized to render them non-functional,” the organization wrote.

Less than 24 hours passed before Abraha began to glimpse the war’s toll on children. Young patients with blast and shrapnel wounds began arriving in the pediatrics ward the from areas outside Mekelle. In time, so many children would pour into Ayder that Abraha wondered: Were soldiers targeting them?

Fifteen-year-old Desalegn Gebreselassie’s leg was badly injured in eastern Tigray in February 2021. He was one of the lucky few able to obtain treatment at Ayder. (Photo by Eduardo Soteras/AFP via Getty Images)

When he learned about the outbreak of the war, Mebrahtu Haftu came to the hospital to see if he could help. An energetic knot of a man and a perpetual volunteer, Mebrahtu worked as a nursing instructor at Mekelle University. That morning, his classes were put on hold because of the start of the war, and Mebrahtu spent the day pitching in where he could, checking patients’ vitals and cleaning wounds in the ER. His skills as a scrub nurse and his wide, welcoming smile helped people trust him.

When he learned that the hospital desperately needed blood, he signed up right away. Mebrahtu lay down in a bed in one of the emergency bays and extended his arm, flanked by a number of colleagues who also volunteered. On a bed across from him lay an injured federal soldier.

While Mebrahtu’s blood flowed from his arm, he had time to think. He regretted spending all his available cash the previous day on a cell phone, a gift for his wife. They were adding apps to the phone and playing with its features when suddenly service was cut. Now, without access to banking, Mebrahtu wondered how he’d pay for food and other necessities.

When he was finished with his donation, Mebrahtu held a cotton ball to his arm as a plump nurse tested the half-liter of blood. She determined that it was free of disease, then turned to the soldier. She hung the bag on an IV stand, then pierced the soldier’s arm with a syringe. Mebrahtu watched as the blood he’d just given, still warm, flowed down a plastic tube and into the wounded man.

Mebrahtu was grateful to be able to help. On the first day of the conflict, Ethiopian soldiers were not yet his enemy. 

Sounds

For weeks, violence blazed across the countryside. But outside Ayder, the inhabitants of Mekelle rarely saw it firsthand. They could only hear it. The war was in the hum of drones, possibly operated by the United Arab Emirates at the behest of the Ethiopian government, headed to pound the wider region with airstrikes. It was in the word-of-mouth reports that in the town of Humera, federal soldiers and Amhara militia had murdered civilians and dumped their bodies in the Tekeze River, and that in Zalambessa, corpses left in the streets were eaten by hyenas and dogs. Tigrayan fighters committed violence too, including a massacre of ethnic Amharans in the town of Mai Kadra. A massacre of Tigrayans in the city swiftly followed.

Yet in Mekelle, ghastly stories were just that—stories. The lack of reliable communication with the outside world meant that little could be confirmed. Residents went on with their lives as best they could. Neighbors congregated to drink coffee and smoke. The feeling on the street was that the war wouldn’t last.

Saba’s cash dwindled quickly. She found some silver jewelry her sister had given her and was able to sell it on the street for 400 birr (just under $12), which she spent on food. She passed the time reading George R.R. Martin’s fantasy novels, the Harry Potter saga, and books by Sebhat Gebre-Egziabher, a renowned Tigrayan author who wrote in Amharic. Most days she also studied at the hospital, which had a generator.

One day she ran into an acquaintance who told her that Tigrayans in Addis Ababa were being thrown in jail. Saba hadn’t been able to speak with her family since the day she left home. Could her father have been imprisoned like his best friend? Could something worse have happened? She burst into tears.

Saba wanted to go home, but leaving Tigray was nearly impossible. Those who attempted to flee the region were most often interrogated, arrested, and sent to prison. She, and most everyone else, was trapped.

A cousin of Saba’s who lived in Mekelle told her that he’d been able to watch a bit of news, and that he’d seen Saba’s father in the background during a government event in which several Tigrayans pledged loyalty to Abiy. Saba was sure that her father had no choice but to appear. She was told that he’d been forced to give money to the government—to “fund the genocide of his own family,” as she put it.

The safety of other family members remained uncertain, including that of her grandfather, who lived near the border with Eritrea. Knowing what often happened to women in war, his second wife and their daughters went to hide in nearby caves. His sons became Tigrayan soldiers. But Saba’s grandfather refused to leave his home, even as Eritrean soldiers advanced toward it.

“We are the sons of Eritrea,” the letter read. “We are brave. And we will continue, even now. We will make the Tigrayan womb bear no fruits.”

Abraha couldn’t ignore what he was seeing. So many kids were appearing at the hospital with gunshot wounds that it couldn’t be accidental. He began a comprehensive study he believed might show that soldiers were deliberately attacking children. He documented more than 200 cases of kids hit by bullets, shells, and bombs. Others had touched live ordnance that seemed purposefully placed to attract curiosity. Some of his patients had been mutilated, others rendered blind or deaf. Perversely, the children Abraha saw were the lucky ones; at Ayder they at least had a chance at survival.

With his classes still suspended, Mebrahtu worked as a scrub nurse, preparing materials for the OR and handing across the instruments when the doctor called out “scalpel.” One man he tended to had been shot in the face twice. The first bullet grazed his cheekbone and tore through his skin. Strangely, the same thing happened on the other side of his face. Perhaps the luckiest survivor of the war, the man received symmetrical scars instead of a casket.

Others injuries were more horrific. The case of one child caused Mebrahtu to vomit at work for the first time in his career. The boy weighed only a few pounds and arrived at the hospital with a piece of shrapnel lodged in his chest. He bled to death in Mebrahtu’s arms.

Tesfaye’s patients had also changed. Women who traveled long distances to get help at Ayder reported shocking sexual assaults. Survivors of gang rape by soldiers staggered into the facility nearly catatonic. One of the resident physicians in Tesfaye’s department pulled a letter from a woman’s vagina, where it had been forced by her attackers. “We are the sons of Eritrea,” it read. “We are brave. And we will continue, even now. We will make the Tigrayan womb bear no fruits.”

Tesfaye documented some of the most harrowing cases he saw, including that of a woman who arrived in the maternity ward wearing clothes stained in blood. She told Tesfaye that she’d gone into labor a week before. Because soldiers arrived in the village where she lived, she decided that a home birth might be safer. She labored for four days, but the baby wouldn’t come. Finally, her family took her to a local clinic but found it empty, the staff having fled for their lives. The woman then went to a small hospital, but Ethiopian and Eritrean soldiers had requisitioned it as barracks, in defiance of international law. They chased the woman and her family away.

The woman’s family took her to another clinic, but it was ill-equipped for difficult births. The baby was breech, and when the staff attempted to deliver it with forceps, they decapitated it. The head remained inside the mother’s body. As she bled profusely, the staff told her that she would have to go to Ayder.

Her family began the long journey on foot, carrying her on a stretcher made of cloth and sticks. Outside Mekelle, they ran into a checkpoint manned by federal soldiers. The troops broke the stretcher into pieces, beat the family, and turned everyone away except the woman. Alone and bleeding, she crawled on her hands and knees toward the city, until a stranger in a car picked her up and transported her to Ayder.

When Tesfaye examined her, the woman barely had a pulse. Her blood pressure was so low that nurses couldn’t get a reading. Tesfaye performed surgery and managed to save the woman but not her uterus, which had ruptured. She would never again bear a child. “Many women have sustained similar atrocities,” Tesfaye said.

Tesfaye had long believed that people were inherently good and that the world tended toward progress. But as more and more civilians assailed by war arrived at Ayder, he lost faith in his fellow man. In more optimistic moments, Tesfaye clung to a sliver of hope. If individuals couldn’t stop this, surely institutions would. Once word about what was happening in Tigray reached the wider world, the international community would respond. Powerful countries would step in and demand that the atrocities stop. Abiy’s government would be forced to yield.

Nine-year-old Arsema Berha lost her hand when her village in southern Tigray was shelled. (Photo by Eduardo Soteras/AFP via Getty Images)

Day by day, the war inched closer to Mekelle. On November 22, a colonel in the Ethiopian military urged residents to surrender—soon the city would be surrounded, blitzed, and then captured. “There will be no mercy,” he said on state-run television, to those able to access it. Civilians were told to shelter in place. Abraha soon moved his family outside the city, into the home of a friend. He hoped it would be safer than the heart of Mekelle. But the war would find him anyway.

Abraha had grown up in the town of Idaga Hamus. His father was a teff and sorghum farmer, and part of their land had been allotted by the government for a new health center when Abraha was still a boy. The facility was called St. Hannah’s, and watching its staff treat children made Abraha realize that he wanted to be a pediatrician.

His parents’ home stood near a main road. Two weeks into the war, the family began to hear shelling and gunfire. One morning, Abraha’s father saw movement outside and went to investigate. Almost immediately, Eritrean soldiers began shooting, forcing Abraha’s father to shelter in another building. His wife quickly took her daughters and grandchildren to hide with a nearby relative. When she returned later that day, she found Eritrean soldiers holding captive two of her sons who had stayed behind. The soldiers beat the sons and threatened to kill them. They confined the family to a single room.

Soon the family’s hay storage, intended to keep their farm animals alive during the dry season, was in flames. Abraha’s father saw the blaze from his hiding place. Was the family’s home burning? It was risky to go outside, but he went anyway.

On the fifth day, the soldiers finally allowed residents out of their homes. It was then that Abraha’s brothers found their father shot dead 20 yards from their home. His was one of dozens of bodies that lay scattered around the city. The soldiers warned that anyone found crying or mourning would be killed, so the family asked a more distant relative to collect the body and bury it at a church. There would be no funeral.

Many of the family’s neighbors fled to a nearby town called Dengelat, where they hoped they’d be safe. But nine days later, on one of the holiest days in the Ethiopian Orthodox calendar, the Feast of St. Mary of Zion, Eritrean soldiers arrived. They went house to house, bound the hands of men, women, and children, and shot them. Among the dead were more than 20 teenagers who sang in church.

Only days later, a number of Abraha’s cousins, as well as one of his mother’s cousins and her son, were executed near the Goda Bottle and Glass Factory. Then his grandfather died of an illness—the war had prevented him from traveling to a clinic or hospital for treatment.

In the span of five weeks, Abraha lost at least seven family members, and many neighbors and acquaintances. When he learned of their deaths at his sister’s house in Mekelle, his thoughts turned hazy. The only clarity that pierced his shock and grief was that he needed to keep working. He had to try to save as many people as he could.

Mebrahtu spent the night huddled with his wife and daughter, praying. “Please save my family. Please. Not today. It shouldn’t be today.”

On November 26, Mebrahtu ate a breakfast of spiced and fried injera, a flatbread, at home with his wife and daughter. They lived in a simple house with a corrugated steel roof. His daughter was too young to really understand the war, and she didn’t ask many questions. Sometimes distant shelling made her laugh. But this morning was different. Explosions were getting closer, more frequent, more threatening. Mebrahtu and his wife tried not to show fear in front of their daughter, lest it become contagious, and they sat to eat as normal. They could hear their dog, Buchi, barking outside. Then all the windows of the house blew in.

Mebrahtu found himself on the kitchen floor covered in glass. He searched for his wife and child and found them also on the ground, unharmed. Outside, in front of his mother-in-law’s home, there was a cloud of ash and a crater the size of a truck. Mebrahtu couldn’t understand why they had been hit. They didn’t live anywhere near government or military structures. The dog had stopped barking, and Mebrahtu feared that the shell had landed on it.

Mebrahtu and his wife quickly pulled her mother from her collapsed home. Thankfully the dog reappeared. Together they took shelter in the basement of a nearby concrete building. Mebrahtu watched as cars raced through the streets, many heading out of town. He suspected that members of the TPLF were escaping, and he was correct. They fled Mekelle hoping that if federal troops knew they were gone, the assault on the city would cease.

At dark, Mebrahtu’s family returned to their windowless house. Mebrahtu spent the night huddled with his wife and daughter, praying. “Please save my family. Please. Not today. It shouldn’t be today.” He also hatched a plan. He had been building a new house for his family in another neighborhood three or four miles away. The house was stronger than their current one. If they could get there, maybe they would be safe.

In the morning, the family heard nearby small-arms fire. They joined thousands of residents in the streets, trying to escape the encroaching violence. Mebrahtu and his family had nearly reached their new house when a bus appeared ahead of them, traveling quickly. It was followed by another, then another, maybe a dozen in all. They were full of armed soldiers.

Mebrahtu held his daughter as the buses sped toward them. He realized that, as a Tigrayan man of fighting age, he might be perceived as a threat and shot on the spot. What if his daughter was hit, too? He couldn’t fathom another child dying in his arms, much less his own. So he abruptly let go of his daughter and dropped her to the pavement. He braced for the bullets as she began to cry. But he couldn’t bear to hear her screams, even if soothing her might mean her death. As the buses rushed past, Mebrahtu fell to his knees and hugged his crying daughter. Dust whipped up around them in the trucks’ wake. Mebrahtu closed his eyes tight. Once again he prayed. The bullets never came.

Medical staff treat a young patient at Ayder. (Photo by Yasuyoshi Chiba/AFP via Getty Images)

Tesfaye refused to leave his home as attacks intensified across Mekelle. His wife and child had departed for a friend’s residence with a basement where they could hide. Not Tesfaye. He’d been able to choose most everything in his life. Now he would choose where it would end. “Let me die here,” he told his wife before she fled.

Tesfaye waited for soldiers to knock on his door. For a long time he sat in his bedroom, drinking beer and feeling surly. He returned again and again to his copy of Left to Tell: Discovering God Amidst the Rwandan Holocaust, by Immaculée Ilibagiza. “There were many voices, many killers,” Ilibagiza writes. “I could see them in my mind: my former friends and neighbors, who had always greeted me with love and kindness, moving through the house carrying spears and machetes and calling my name.”

When Tesfaye read that génocidaires in Rwanda had split open the head of a Tutsi with a master’s degree simply to see what his brain looked like, Tesfaye wondered: Could this be my fate?

In time he ventured to the rest of the house. He prayed for his wife and child, but not for himself. For hours on end he read and prayed, paced and drank, listening to bombs fall outside his home, to the deathly rattle of machine guns, to the diesel-fuel roar of tanks. When would the soldiers knock? He pined for his wife. It was hell not being able to speak to her.

By November 28, after days of shelling, the Ethiopian military gained full control of the city. By evening, Abiy announced the end of the military confrontation in Tigray. “Our focus now will be on rebuilding the region and providing humanitarian assistance while federal police apprehend the TPLF clique,” he wrote on Twitter. From hiding, TPLF chair Debretsion Gebremichel insisted that armed resistance would continue. “As long as they are on our land, we’ll fight to the last,” he told the international press. Gebremichel would soon call the government’s campaign in Tigray “genocidal.”

The mass killings that had taken place elsewhere didn’t come to pass in Mekelle. Instead, the city settled into the new, tense normalcy of occupation. Abiy’s administration hastily installed an interim puppet government to oversee Tigray. It instituted a curfew of 6 p.m., no exceptions, even for medical emergencies. Spotty electricity and cell service soon returned in Mekelle, although it remained suspended elsewhere.

Tesfaye’s wife came back home with their child, and as they reunited, Tesfaye heard a surprising noise. Someone was using the sound system at a nearby mosque, which usually broadcast calls to prayer, to announce that Ayder was being ransacked. The call snapped Tesfaye out of his despair. Although he was loath to part from his wife and child a second time, he left for the hospital.

During his furtive walk along a path he’d once trod daily without a thought, he saw that the citizens of Mekelle had been busy. Overnight, despite relentless shelling, they’d piled stones in the streets to prevent Eritrean soldiers from looting the hospital. When Tesfaye arrived at Ayder, he found a group of colleagues and local residents hastily erecting a barricade in front of the main entrance. With his delicate surgeon’s hands, Tesfaye picked up a stone and began to build.

Occupation

Mebrahtu also responded to the mosque’s call to aid the hospital. When he arrived, he found soldiers beating the civilians who were erecting the barricade. A soldier fired his rifle and the crowd scattered. Mebrahtu saw a man he knew, the owner of a local butcher shop, bleeding on the ground. The man would die three days later in the very hospital he was attempting to protect.

Despite their efforts, Ayder’s staff and their supporters weren’t able to keep the troops at bay. Once soldiers secured the grounds, they laid a Tigrayan flag and military uniforms on the threshold of the main entrance. Anyone who wanted to go inside would have to step on these. Mebrahtu and Tesfaye refused to trample on the symbols of Tigrayan pride. “Before the war, I had no attachment to the flag,” Mebrahtu said. Now he felt that it represented his very being.

A surgeon approached the soldiers and said that they could kill him if they wished, then bent down and carefully collected the flag and uniforms. Onlookers waited for the troops to fire their Kalashnikovs. Instead they relented. Staff were able to enter the hospital without enduring ritual humiliation.

The troops didn’t leave, however. They allowed Ayder to remain functional only under constant surveillance. Soldiers were stationed at the hospital around the clock, operating out of tents set up in the courtyard. Twice they assaulted the hospital’s director. The first time, when he went to a satellite facility run by Ayder to retrieve medical equipment, they beat him, called him a thief, and threatened him with death. The second time they pulled him from his office and assaulted him in a hallway.

Intimidation and beatings were just two of the ugly realities of occupation. Lies were another. On November 30, Abiy declared that federal troops had not killed a single civilian in Tigray. The staff of Ayder knew the truth. Victims of the war died on their operating tables and in their arms. Doctors and nurses lost members of their own families. At least one hospital employee, a midwife, was executed after fleeing the city.

Only two days before Abiy’s announcement, in the holy city of Axum, Eritrean forces shot as many as 800 Tigrayans—including children as young as 13—in the shadow of the Church of St. Mary of Zion. Ethiopian Orthodox Christians believe that the church’s chapel holds the Ark of the Covenant, said to contain the stone tablets, given to Moses by God, bearing the Ten Commandments. Those divine orders include “Thou shalt not kill.”

He hoped that a record of what doctors and nurses witnessed would help write the history of the war—the true version, not the government’s.

Abraha considered leaving his job and joining a volunteer Tigrayan army that was forming under TPLF leadership. Called the Tigray Defense Force (TDF), it was composed of men and women from all areas of society: farmers, professors, students, journalists, even the former president of Mekelle University. The TDF trained in the hills of central Tigray, where for centuries their ancestors had repelled invaders. They were taught to march, ambush, and disappear into the brush. To pull the bolt, shoulder the stock, and aim for body mass.

Abraha wasn’t a fighter by nature. His soft hands were more comfortable cradling babies than gripping deadly steel. But like many Tigrayans, he sensed an existential threat. “They were mercilessly killing people,” Abraha said of the military forces allied under Abiy. “[Pediatrics] was filled with war-injured children.” Perhaps picking up arms was the only answer.

What ultimately compelled Abraha against joining the TDF was the government allowing him and others from the hospital to set up medical services in the vast encampments around Mekelle. In early January 2021, the United Nations reported that there were more than 222,000 internally displaced people (IDP) in Tigray, most living in camps sprouting like mushrooms on the outskirts of cities and towns.*

*An additional 56,000 people fled Ethiopia entirely. Many became refugees in neighboring Sudan.

Between Ayder and the camps, Abraha worked every minute he could manage. He supervised younger staff. He ran clinical seminars. He taught volunteers how to provide basic care. He helped colleagues coordinate documentation of patients’ injuries and testimonies. He hoped that a record of what doctors and nurses witnessed would help write the history of the war—the true version, not the government’s.

Abiy’s administration continued to lie—to its own people and to the world. In violation of an agreement it reached in December with the UN to allow “unimpeded, sustained and secure access” for humanitarian aid, the government limited the flow of essential resources into Tigray. Leaked notes from a January meeting of the state-run Tigray Emergency Coordination Center quoted an interim government official saying that the need for food in the region was so great that “hundreds of thousands might starve to death.” The notes also described people in the town of Adwa, northwest of Mekelle, “dying while they are sleeping” from hunger. Yet on January 19, a government representative declared to the world, “There is no starvation in Ethiopia.”

Soon after, U.S. Secretary of State Anthony Blinken called on Eritrea to immediately withdraw troops from Tigray. Abiy’s government had previously denied the foreign forces’ presence, and would continue to do so for several weeks. It also rejected accusations of ethnic cleansing, referring to its actions in Tigray as a “law enforcement operation” that had now concluded.

For outsiders facts were hard to ascertain. Communications in Tigray were still obstructed, and journalists were harassed, detained, and barred from the territory. It would be more than a year before international human rights groups were able to prove an organized campaign of ethnic cleansing to erase Tigrayans from their own land.* But there were at least two atrocities documented in real time, in the form of videos that wound up online.

*In 2022, Human Rights Watch and Amnesty International reported that, in the earliest weeks of the conflict, newly appointed Amharan officials in western Tigray “openly discussed such plans during public town meetings. Signs were displayed demanding that Tigrayans depart, and pamphlets distributed issuing Tigrayans a 24-hour or 72-hour ultimatum to leave or be killed.”

The first happened near the Debre Abbay monastery in central Tigray, likely in the initial week of January 2021. Footage captured at the scene shows dozens of bodies strewn on the dusty earth, apparently massacred by Ethiopian soldiers. “You should have finished off the survivors,” the person behind the camera says. Then, on January 15, federal soldiers filmed one another executing civilians in the city of Mahbere Dego and pushing their bodies from a cliff.

For many people concerned about the conflict, and even some caught in the middle of it, the videos provided the first glimpses of what was happening across Tigray. In Mekelle, residents with restored service watched in horror as mass murder unfolded on their screens, perpetrated by men in the same uniforms as the soldiers now patrolling the city’s streets.

A young survivor of a massacre at the Togoga market. (Photo by Yasuyoshi Chiba/AFP via Getty Images)

By early 2021, Mebrahtu had thrown himself into supporting Ayder’s One Stop Center, an innovative clinic that opened a year prior specializing in care for sexual assault survivors. In a small building separate from the main hospital, patients could receive physical exams, mental health counseling, and referrals to legal services without fear of being seen or stigmatized by the general population. Before the conflict erupted, the facility had seen about twenty patients per month. Now it was seeing that many every day.

Still, Mebrahtu knew that the presence of troops in Mekelle stopped many people who were in need from coming to the hospital. They were too scared, especially women who said they’d been raped by soldiers. Mebrahtu began providing physical exams in his own home and at the homes of patients. The first patient he saw in this manner, referred to him by his wife, was a deeply religious woman who would tell no one what had happened to her. When Mebrahtu performed a pelvic exam in her aunt’s house, he observed that her vulva was inflamed and laced with tears. He then pulled four used condoms from inside her vagina. He could tell there was another one too deep to remove with his hands. He went to Ayder to retrieve a speculum. After he pulled the fifth condom from the woman, he wept.

Mebrahtu left the woman with medication to help prevent pregnancy and the contraction of HIV. He wanted to see her again to record her story. What had been done to her seemed as if it went beyond grotesque sexual gratification. It signaled both hatred and a desire to humiliate. Mebrahtu was shaken.

A few days after treating the woman, he returned with a tape recorder, but she had disappeared. She showed up on Mebrahtu’s doorstep a few weeks later. She said that she was experiencing vaginal discharge and was worried that an object was still inside her. Mebrahtu examined her again and found only an infection. Because she wouldn’t go to the One Stop Center, he again brought her medication. He asked if she would tell him what happened. She agreed.

Over the course of three interviews, which Mebrahtu recorded, the woman said that she came from a small town where Ethiopian and Eritrean troops had burned crops and looted factories. To support her family, she decided to go to Mekelle, hoping to get a job as a domestic servant or selling wares on the street. On her way to the city, Ethiopian soldiers stopped her bus at a military checkpoint. The passengers were searched. The soldiers singled out six women and told them to stay. The bus left without them.

That evening, after the checkpoint was closed because of the region-wide curfew, the troops moved the women to a primary school being used as barracks. The commander told the women, seated at students’ desks, that they should cooperate. “If you do this, your life is going to be easy and you’ll be released soon,” he said. Next to him, set prominently on a school desk, was a pack of condoms.

The commander told the women that, if they agreed to have sex with his soldiers, the men would use the condoms. Afterward the women could go free. Five women took the deal, such as it was. But the woman Mebrahtu provided care to refused. She was a devout Christian. She had never had sex before.

The other women were taken away by soldiers. When the men were finished, the commander collected the condoms they’d used and laid them out on a desk in front of the sixth woman. He beat her and raped her without using protection. He then told two soldiers to hold her legs open and forced the used condoms inside her.

The woman was released the next day. Delirious and bleeding, she managed to make her way to Mekelle, where she hid herself away in shame. She ventured out to a church, hoping to be cleansed by a holy water treatment—a folk tradition—but felt no better. How could she ever return home? she asked Mebrahtu. How could she face her family, her boyfriend?

Hers was just one of numerous cases of horrific assault that staff at Ayder saw as the federal troops’ occupation of Mekelle stretched into weeks, then months. One woman arrived at the hospital with her vagina filled with wood splinters—forced there, she said, by a soldier who then put his sock inside her to hinder removal. Another woman reported that she’d been tied to a tree and raped by dozens of soldiers in front of her son, who was then killed in front of her eyes. The soldiers raped her again, she said, while forcing her to look at his corpse. Ayder treated women and girls who told him that they were assaulted in front of their parents, raped by family members whom soldiers threatened with death if they didn’t follow orders, and kept in sexual slavery, moved from location to location to service Ethiopian and Eritrean soldiers.

All this violence felt too similar to be a coincidence. To Mebrahtu, it seemed intended to break the spirit of the Tigrayan people, to destroy their culture, to prevent them from bearing future children. He began to believe that the sexual violence perpetrated in Tigray was systematic, directed from above, and genocidal.* 

*According to Article 2 of the Convention on the Prevention and Punishment of the Crime of Genocide, an international treaty, genocide refers to acts “committed with intent to destroy, in whole or in part, a national, ethnical, racial, or religious group,” including “deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part” and “imposing measures intended to prevent births within the group.” 

He thought of his wife, who he’d only recently learned was pregnant with their second child, a daughter. He feared for her health. She’d needed a C-section to deliver their first, and the next birth was likely to be complicated as well. What if she couldn’t get the care she needed? What if she went into labor after curfew, only to be shot in the street on the way to Ayder? As for his unborn daughter, Mebrahtu feared for her future.

Saba treated a 16-year-old boy whose hands had been blown off by a shell fired from a military tank. He was also blinded in the attack, which killed his siblings.

It was a feeling Saba knew well. After federal troops occupied Mekelle, she was able to depart for Addis Ababa to see her family, but not without incident. When her bus was stopped at a military checkpoint, both the passengers and the driver were taken to a police station. Besides the driver, Saba was the only Tigrayan. Soon the soldiers were calling the driver a terrorist and beat him in front of the group of students, first with their fists, then with the butts of their rifles. One soldier raised his weapon to shoot the man but was stopped by another.

Saba was paralyzed with fear. A friend from medical school also on the bus took Saba by the arm and led her to the back of the group. Quietly, he told her to hide her government ID, which listed her as Tigrayan. If the soldiers asked for identification, she should show them her student card instead, since it made no mention of her ethnicity. Eventually, the bus’s passengers were allowed through the checkpoint. The driver was not. He was sent back to Tigray and the students found another ride to Addis Ababa. Saba made the rest of the trip in silence. It was the first time in her life she’d ever felt Tigrayan.

At home, Saba found her mother sick with worry and visibly aged. Saba was sure it was because she hadn’t been able to speak with her eldest daughter in weeks as she languished in a war zone. Her father, by contrast, seemed angry. “How could you leave Mekelle with what is happening?” he asked Saba, accusing her of abandoning her ancestral home. She thought, How could you not tell your children how much they hated us?

Saba’s father never spoke with her about the loyalty ceremony he’d participated in on TV. He did tell her that he helped get his best friend out of jail. The friend would later sell his assets and immigrate to the United States.

Saba, too, tried to find a way out, and sought placement in a different medical school. Nothing was available, and final exams were only months away. She made the difficult decision to return to Mekelle, hoping to finish out her education if the government allowed classes to continue. In a few months, perhaps, she could leave Tigray for good.

Though she’d only been gone a matter of weeks, Saba found Mekelle changed when she returned. Assisting staff at the hospital—taking vitals, dressing wounds—she treated a 16-year-old boy whose hands had been blown off by a shell fired from a military tank. He was also blinded in the attack, which killed his siblings.

Walking home from Ayder, Saba felt the eyes of leering soldiers on her. She heard that troops stationed at the hospital had raped two female medical students in the same bank of classrooms where she studied. Between that incident and the rape survivors being treated at the hospital, Saba believed it was only a matter of time before she, too, became a victim of sexual violence.*

*One study in the region found that nearly 30 percent of women under 50 experienced physical violence and 8 percent were raped. An NGO called Hiwyet (“healing” in the Tigrinya language) collected nearly 5,000 testimonies from rape survivors and estimated that 15 percent of them had contracted HIV as a result of their assault.

“There’s just nothing you can do about it,” she said. “If it’s going to happen, I guess it’s going to happen.”

A scene from Ayder in June 2021. (Photo by Yasuyoshi Chiba/AFP via Getty Images)

In March 2021, five months into the conflict, the Office of the United Nations High Commissioner for Human Rights announced an investigation into possible humanitarian violations in Tigray. The inquiry was discredited from the beginning in the eyes of Tigrayans and some international advocates, because the OHCHR had partnered with the Ethiopian Human Rights Commission (EHRC), a federal body. It felt like allowing the fox to help investigate the chicken coop. More formally, the partnership was an example of what experts in international affairs refer to as quasi-compliance: token actions taken by governments to placate human rights concerns while circumventing serious scrutiny.

Hoping to further burnish its international image, the Ethiopian government hired Holland and Knight and the lobbying firm Venable, both based in the U.S., at a cost of more than $80,000 per month. It also leaned on international agencies to do its bidding. It compelled the World Health Organization (WHO) to redact a report, published in April 2021, about the lack of functional health facilities in Tigray.

“This episode does not stand on its own,” the Geneva-based Humanitarian Exchange and Research Center later stated in an audit of the international response to the war. “When the authorities did not agree with the data collected, humanitarian actors were instructed to use different figures and/or to use beneficiary lists that they could not verify.” As it happened, the WHO’s director general, Tedros Adhanom Ghebreyesus, was Tigrayan. He had formerly served as Ethiopia’s national health minister. 

One voice of urgency on the international stage was Mark Lowcock, chief humanitarian officer with the United Nations. As the joint OHCHR-EHRC investigation commenced, Lowcock told the UN Security Council that time was of the essence. “To be very clear: The conflict is not over and things are not improving,” he declared in a closed-door meeting, according to Reuters. “Sexual violence is being used as a weapon of war,” he said. “Girls as young as eight are being targeted.”

In a memo for the Security Council obtained by Agence France-Presse, Lowcock described reports of mass killings and the continued presence of Eritrean troops in Tigray. He spoke of widespread hunger caused by crop destruction, looting and killing of livestock, and insufficient humanitarian aid being allowed into the region. It seemed as if the Ethiopian government were trying to starve out the Tigrayan resistance while also devastating the civilian population. Ethiopia’s ambassador to the UN responded to Lowcock’s comments by calling him “a nemesis” and insisting that there was “no gap in humanitarian access.”

By June 2021, the UN estimated that more than 90 percent of people in Tigray needed emergency food aid, yet it stopped short of calling what was happening a famine. Lowcock, who left his role that month, later claimed, “It was clear to me that there was famine in Tigray, and the only reason it wasn’t declared was because the Ethiopian authorities were quite effective in slowing down the whole declaration system.”*

*Famine declarations are typically made jointly by various United Nations agencies in coordination with the affected country’s government, and only when certain conditions are met. The process can be highly politicized—for instance, when a government is keen to avoid responsibility for the starvation of its own people.

Alongside children injured by guns and bombs, Abraha saw evidence of famine every day in Ayder’s pediatrics ward. When EHRC investigators came to the hospital, he took one member of the team to meet the recovering children. Abraha estimated that more than 80 percent of his patients had been injured by gunshots, land mines, and shelling. He introduced the investigator to children so malnourished they had bone fractures that wouldn’t heal and infections their immune systems couldn’t fight. The patients who were old enough to describe their experiences told their stories.

Abraha didn’t trust the investigators to tell the truth about what they’d seen. He found it hard to have confidence in any outside actor purporting to do the right thing in Tigray. Too many international agencies and NGOs were relying on the Ethiopian government for access and information. To Abraha, many of these bodies seemed to be in league with Abiy’s administration. He felt betrayed by the very organizations that were supposed to help people like his patients.

In a closed-door meeting, Ethiopian leaders told a European envoy “they are going to wipe out the Tigrayans for a hundred years.”

If there was cause for optimism among Tigrayans, it was that the TDF had been growing in strength and sophistication in recent months. It attacked supply lines, then vanished into the hills its soldiers knew so well. It accumulated resources and soldiers. Sensing that its position was weakening, the Ethiopian military dug trenches around Mekelle and launched fresh offensives.

Tesfaye spent hours searching social media for news about the war. He was stunned at how little attention it was getting on the international stage. Unlike the war in Ukraine, it seemed to have barely made a dent in the public consciousness. Abiy’s information blockade was working, it seemed. But to Tesfaye, it also felt like people around the world didn’t really care about Africans fighting Africans—not even when a European envoy announced that, in a closed-door meeting, Ethiopian leaders had told him “they are going to wipe out the Tigrayans for a hundred years.” (Abiy’s government called this claim “ludicrous,” a “hallucination of sorts.”) Tesfaye also heard members of the government openly refer to the TPLF—and by extension all Tigrayans, according to some experts—using dehumanizing language like “weeds,” “cancer,” “rats,” and “worse than the devil.”

Amid warning signs of serious breaches of international law, the U.S. authorized limited sanctions and visa restrictions on Ethiopian government officials and members of the TPLF—but only actually issued sanctions against six Eritrean entities. The U.S. also removed Ethiopia from a trade-preference program and imposed a national ban on arms sales. Broader international sanctions—like the arms embargo imposed by the UN Security Council on Ethiopia and Eritrea in 2000—never materialized. Weapons flowed to the Ethiopian government from the UAE, Iran, Turkey, and China. Controversially, the EU would announce no sanctions at all during the course of the war, only delaying a 90 million euro direct governmental aid package.

One rare event that did catch the attention of western journalists was a massacre in Togoga, a town 16 miles from Mekelle. On June 21, 2021, Abiy’s Prosperity Party won a landslide victory in national elections that the U.S. State Department described as “not free or fair.” (Polls were not opened in Tigray at all.) The next day, a Tuesday, was market day in Togoga. Once a week people from the surrounding areas came to sell vegetables and clothes, shine shoes, and trade animals.

The Ethiopian air force bombed the market around 11 a.m., its busiest hour, killing at least 64 people and wounding 180. Many of them were women and children. The youngest casualty was only a year old. The federal government insisted that only TDF targets had been hit.

Staff from Ayder who rushed to Togoga to offer medical aid reported being blocked from the city by federal soldiers. Two ambulances that made it to the market via a back road were later barred from returning to Mekelle with a number of the most critically injured. It took more than 24 hours for a handful of wounded, including three children, to be transported to Ayder for treatment.

Saba watched in horror as footage from Togoga appeared on social media. She saw photo after photo of bloody bodies that had been crumpled and twisted only a short drive from her apartment. She figured that if Abiy’s government would bomb a market, it would bomb anything—maybe even Ayder.

Less than a week after the Togoga attack, the TDF launched a surprise offensive to retake Mekelle. Despite fielding fewer troops, the TDF forced its opponents to retreat in a matter of hours, astonishing government officials and the international community. In a response that seemed intended to save face, Abiy’s administration declared a unilateral ceasefire.

Saba was studying at home when a friend visited to tell her the news. Scared of reprisal bombings by the government, she hid inside her apartment for two days. When she finally emerged into the streets, she witnessed jubilation. The city’s residents welcomed the TDF soldiers as heroes. There were fireworks, cheering, music and dancing. Bystanders jeered as captured federal soldiers were paraded through the city, bound for detention centers.

During the respite from fighting, Mebrahtu’s wife gave birth to a healthy daughter at Ayder. The couple named her Alina. The name sounded cosmopolitan, and they hoped it would come to represent the freedom she’d eventually have to go wherever she wanted, to be whoever she wanted. The name also had a secondary meaning. It sounds like Tigrinya for “we remove them.”

If the TDF victory was celebrated in Mekelle, many in Addis Ababa knew that it heralded retribution. In a matter of days, the Ethiopian government launched a campaign of mass arrests of Tigrayans in the capital and elsewhere in Ethiopia. People were apprehended based solely on their ethnicity. One detainee told Amnesty International that officers entered the snooker hall he owned. “They began to harass and beat customers and employees and demanded to see their identity documents, before taking five people, all ethnic Tigrayans, to the nearby … police station,” the organization reported. The man later learned that his brother had been arrested and taken to a detention facility 150 miles away.

Despite expulsion of the military, residents of Mekelle soon felt the federal government’s grip tighten around them, too. Abiy again cut off electricity, cellular and internet service, banking, and transportation to and from Tigray. Saba’s call with her family after the TDF’s victory was the last time she spoke with them for more than six months.

Salaries for public workers were also discontinued. Whatever was required of Ayder’s staff, they wouldn’t receive a cent.

Siege

The arrests in Addis Ababa continued, soon numbering in the thousands. The government made vague claims of detainees’ “support for terrorism” to justify its actions. Speaking Tigrinya was reason enough for law enforcement to arrest a person. Businesses were shut down for playing Tigrayan music. Sometimes the police went house to house looking for Tigrayans. Some people were hidden by friends. Others escaped abroad. Journalists were harassed and arrested. After Lucy Kassa reported on a gang rape in Tigray for the Los Angeles Times, unidentified men came to her house, knocked her to the floor, and ransacked her belongings.

The TDF’s triumph in Mekelle also translated into increased suffering across Tigray as the federal government escalated its obstruction of humanitarian assistance into an outright blockade. In early July, the acting UN aid chief said that “more than 400,000 people are estimated to have crossed the threshold into famine, and another 1.8 million people are on the brink of famine.” Later that month, the UN’s World Food Program (WFP) announced that it was on the verge of running out of food for its operations in the region. Still, the UN stopped short of declaring famine in Tigray. It never would.

The WFP estimated that it would need 100 trucks of aid delivered each day to “meet the vast humanitarian needs in the region.” But few trucks were getting in. At one point, some 170 were “stuck” at Tigray’s border with Afar, one of Ethiopia’s regional states. Another truck was attacked, likely by federal troops or their allies, while trying to enter Tigray. In September, the WFP reported that more than 400 trucks sent to Tigray never returned—although the cause was unclear. A government Twitter account blamed the missing trucks on the TPLF. The group denied responsibility and blamed fuel shortages and federal military harassment.

Ayder was seeing more patients than at any time in its history, so many that the hospital was overrun. Each day brought a terrible procession of pain and misery, and those seeking care sat or lay down wherever they could—in hallways, in the courtyard, outside the hospital’s doors. Without aid deliveries, and with medicine dwindling, the crisis had become catastrophic.

In a first for the hospital, doctors were forced to administer expired medications. The only other option in many cases was death. Medical tubing intended for single use was washed and utilized again. Staff had to make difficult decisions about which patients needed antibiotics, insulin, and oxygen. The hospital’s CT and MRI machines needed repairs, but the blockade made it impossible to obtain parts. Tesfaye and the other surgeons were forced to operate on patients based solely on clinical examinations.

Tesfaye was limited in what he could do in the face of so much suffering. He found that approximately three-quarters of the pregnant women he treated were malnourished. Some had gained no weight during pregnancy. Others had lost weight, leaving their faces sunken and their limbs skeletal. What nutrition these women were able to obtain was being siphoned off by the babies growing in their bellies, babies nonetheless born with congenital defects associated with their mothers’ starvation.

Ayder’s staff was hungry, too. “We were trained to treat patients,” Tesfaye said. “But malnutrition came to our homes.” For the first two months of the government’s siege of Tigray, Ayder occasionally provided employees with 22 pounds of wheat and about two pints of cooking oil. Tesfaye set aside his pride and accepted the charity. He did the same when his father brought him a sack of teff from his farm.

Once certain that the international community would step in to help Tigray, Tesfaye’s confidence in the international order slipped away. Where were the powerful nations that spoke soaringly of human rights, that pledged “never again,” that boasted of their dedication to aiding the world? Why had no one forced Abiy to stop killing his own people?

“Having seen what I have seen happening to innocent mothers who have no agency in this war, who paid the steepest price, including losing their fertility potential, losing their kids, losing their dignity, being raped in front of their husbands,” Tesfaye said, “the only hope we have is that God is up there.”

So many children were treated at Ayder that the head of pediatrics wondered if they were being targeted by government forces. (Photo by Yasuyoshi Chiba/AFP via Getty Images)

The TDF didn’t stop its military efforts after retaking Mekelle. Troops loyal to Abiy’s government were still occupying parts of the wider Tigray region, and soon the TDF pushed most of these forces beyond the state’s borders. Still, Tigray was surrounded and its people were starving. The TDF needed to break the siege. It plotted an offensive that would drive south toward Addis Ababa.

In mid-July, the TDF entered the Afar region. Soon it was in Amhara too, where it took Lalibela, a historic city famous for subterranean rock-hewn churches. The TDF fought toward the capital, capturing city after city along the way. Civilians suffered: Sixteen women in the Amharan town of Nifas Mewcha told Amnesty International that they were raped by TDF fighters. In the municipalities of Chenna and Kobo, the TDF killed dozens of residents. There were also reports of Tigrayan fighters looting limited food stores in some towns.

Abiy responded to the offensive by pummeling Tigray with air strikes. The bombings seemed to have little objective other than inflicting terror. Even Mekelle University was attacked. Still, at night Saba studied by flashlight as bombs fell on the city. Amid the ceaseless carnage and starvation, Ayder was desperate for more certified doctors. With the TDF firmly in control of Mekelle, Saba was able to take her final exams. Normally, grades were posted online, but with the internet gone the results were tacked up on a board in a hallway. She passed with a B average.

There would be no celebratory dinner, no handshake, no one to tell her they were proud of her. With phone service discontinued, Saba couldn’t even share the good news with her parents. To celebrate she bought herself a bag of potato chips. She considered it a luxury.

Soon after, she was offered a rare chance to leave Tigray when the government agreed to allow students to exit the region by bus. Staying would mean embarking on her medical internship without pay or even reliable access to food. It would mean psychological torment and intimate physical danger. Leaving would mean finding out what had become of her family. Assuming they were safe, she might be able to live in comparative luxury, with access to the internet, hot showers, home-cooked meals. She hadn’t even wanted to come back to Tigray in the first place.

For Saba the decision was easy. When the buses arrived at Ayder to take students away, she was there. Out of 200 or so interns, approximately 130 chose to stay. Most who left were of other ethnicities, but a few non-Tigrayans remained, knowing what lay ahead. Saba said goodbye to her friends and wished them well. When the buses departed, she was not on any of them.

Saba’s identity was changing. She was still torn between feeling Ethiopian and Tigrayan, but the balance had begun to tip toward the latter. Young Tigrayans had joined the TDF to fight on her behalf. Now she wanted to return the favor by working at Ayder, no matter the cost.

Her first rotation would be three months in internal medicine, then another three in surgery. She spent much of her time in the emergency room. The smell of festering wounds was pervasive, but Saba soon stopped noticing. Sick or injured bodies lay in every bed and chair, covered every inch of floor. Saba was forced to step over patients as she tended to others. She found people who had died waiting for treatment, their last words unheard. Some went unnoticed for so long that rigor mortis had set in. Orderlies had to break their bones to fit the corpses into body bags.

Orphaned and abandoned children became a concern. Saba treated women who reported being raped by soldiers early in the war and now needed late-term abortions. There was nothing she could do. “You cannot abort a baby at eight or nine months,” she said. “You just can’t.” When these women gave birth, some of them told Saba, “I don’t want to see this child.”

Nearly 80 percent of dialysis patients died for lack of seven-dollar parts.

Supply shortages plagued the hospital, and it became part of Abraha’s job to try and address them. He made contact with international NGOs and begged for aid. Little was forthcoming, due to the government’s blockade and poor coordination from humanitarian agencies. Financial donations from the Tigrayan diaspora were transferred to the hospital via black-market money changers. The funds were spent at private pharmacies that still had medicines in stock and on the limited amount of food being produced in the region. Prices were astronomical.

According to Abraha, some medical supplies were smuggled into Tigray by donkey. When saline became scarce, Ayder’s staff made their own using salt and boiled tap water. When bandages dwindled, the hospital asked the community for help. Many people donated traditional white shawls, which were cut into strips, sterilized, and wrapped around wounds. The hospital also asked the community for soap, detergent, and linens.

In the hospital’s dialysis unit, single-use blood filters with patients’ names written on them were used until they shattered. When no replacements could be found, longtime patients, people who’d been coming to Ayder for care for years, faced certain death. Nearly 80 percent of dialysis patients died for lack of seven-dollar parts.

Abraha tried to be strong for his mother, who came to stay with him in Mekelle. Addled by trauma, she repeated the same stories over and over, including how her husband had gone out the door one day and never come back. Only after the TDF had made its advances was Abraha able to travel to his home village for a single day to pay his respects.

Abraha kept himself going with the same encouragement he gave his staff. As a pediatrician, he told them, he observed children suffering from crushing disabilities. But he also saw those children learn to read braille, communicate with sign language, walk on prosthetic limbs. If they could survive and thrive, so could the Tigrayan people, even in the face of what increasingly felt like genocide.

In September, Daniel Kibret, a close adviser to Abiy, called for Tigrayans to “be erased and disappeared from historical records. A person who wants to study them should find nothing about them. Maybe he can find out about them by digging in the ground.” When the U.S. State Department and international human rights advocates condemned Kibret’s comments, he claimed that he was referring to the TPLF, not all Tigrayans. The following month, a journalist with Ethiopian Satellite Television declared, “It is necessary to intern everyone of Tigrayan descent, even if they have no connection with TPLF.” 

Other Ethiopians took to social media to encourage violence against Tigrayans.

“Do it even if it grieves you!!!!! You will not be any crueler than they are!!!!”

“Time to clean up trash!”

“No mercy!”

“Senior officials obfuscated and lied, and tried to omit any mention of rape by the government and Eritrean forces from the official investigation,” Fislan wrote in The Guardian.

Like his colleagues, Mebrahtu suffered under the blockade. Without a paycheck, he fell from a middle-class lifestyle into abject poverty. He lost 30 pounds. His sister-in-law, who worked for a humanitarian agency in Tigray, sent him what money she could. It went straight to necessities. Mebrahtu’s wife begged him to get another job, one where he would be paid, but he couldn’t abandon people in need. “I would be a person who is in a cage,” he said.

Mebrahtu continued to focus on caring for victims of sexual violence. Now that Ethiopian and Eritrean troops had been pushed back, even more women were seeking care. The One Stop Center saw between 50 and 60 patients per day, a 9,000 percent increase from before the war. Under the direction of the Tigray Region Health Bureau, Mebrahtu reviewed the techniques used by the center to ensure that they conformed to international standards. Then he led a team that traveled around Tigray setting up service centers to offer medical and psychological care to survivors not able to make it to Ayder. He trained dozens of clinicians and volunteers.

The impact of sexual violence wasn’t going unnoticed, even at the highest levels of the government. In response to international concern, Abiy’s government claimed that more than 50 soldiers had been tried for extrajudicial killings, rape, and other atrocities in Tigray. But the world had to take his word for it. The trials were held in a military court, and records of the proceedings were never made public. There are conflicting reports about whether the soldiers were convicted or sentenced.

On the public front, the government charged Filsan Abdi, the country’s minister for women, children, and youth, with investigating sexual violence and the use of child soldiers in the conflict. According to Filsan, when she submitted her report, it was censored. She was instructed to state that only TPLF-aligned fighters had committed crimes. In September 2021, Filsan resigned from her post and fled the country. “Senior officials obfuscated and lied, and tried to omit any mention of rape by the government and Eritrean forces from the official investigation,” Filsan wrote in The Guardian. “The government focused on propaganda at the expense of genuinely pursuing justice.”

Around the time of Filsan’s resignation, Abiy deported seven UN staffers for allegedly “meddling in the internal affairs of the country.” According to the Humanitarian Exchange and Research Center, many of them “were known for their advocacy for a principled approach” to their work. At least one had been involved in the joint OHCHR-EHRC report, which was finally released on November 3.

The report’s authors noted limitations—for instance, they hadn’t been able to visit every area of Tigray affected by the conflict—and said that further investigation was necessary. They described atrocities committed by armed forces of all allegiances, but said that they “could not confirm deliberate or willful denial of humanitarian assistance to the civilian population or the use of starvation as a weapon of war” by Abiy’s government. Nor did they come to any conclusion about ethnic cleansing.

To anyone paying attention, both the blockade and ethnic cleansing were as obvious as the sun in the sky. The TPLF outright rejected the report. Human Rights Watch criticized it for failing to “give well-documented trends the attention they deserve,” such as “the scale of abuses, including sexual slavery, by Ethiopian, Eritrean, and Amhara forces targeting Tigrayan women and girls.” The organization also claimed that the report “glosses over the deliberate and extensive destruction and pillaging of health infrastructure, and the intimidation and killing of humanitarian workers.”

Soon after the report’s release, the United Nations mandated another inquiry into the war: the International Commission of Human Rights Experts on Ethiopia, or ICHREE, made up of experts under the supervision of the UN’s Human Rights Council. There would be no partnership with the Ethiopian government this time, and the new investigation was designed to give a truly independent account of the conflict. In response, Abiy’s administration refused to cooperate, attempted to block the inquiry’s funding, and barred investigators from entering Tigray. Notwithstanding its own call for additional research into the conflict, the EHRC issued a statement opposing the committee.

Meanwhile, the TDF fought to within a couple hundred miles of Addis Ababa, sending panic through the city. The government declared a nationwide state of emergency. Citizens were told to march “with any weapon and resources they have to defend, repulse, and bury the terrorist TPLF.” State media reported that Abiy himself would visit the front lines. The U.S. ordered all its nationals to leave on November 5. Other nations soon followed.

In the end, the TDF was unable to reach the capital. On the plains outside Addis Ababa, Tigrayan forces were devastated by drones supplied from abroad. With no answer to the Ethiopian military’s air power, they were forced to retreat. By late December, Ethiopian forces and their allies had driven the TDF back within the borders of Tigray. The TDF would attempt another offensive again in January 2022 but was unable to advance beyond the region.

The offensive was over, and the war was at a stalemate. Though the TDF still controlled much of Tigray, including Mekelle, Amharan forces held areas to the west, and Eritrean troops occupied points along the northern border. Abiy’s administration continued to pound and starve Tigrayans into submission—or as Kibret, the government adviser, put it in another speech, to “wipe … out” the “disease” of rebellion.

By the end of 2021, Ethiopia had set a world record for the most people internally displaced in a country in a single year: 5.1 million.* Hundreds of people were dying from hunger in Tigray every day.

*According to a report by the Internal Displacement Monitoring Center, “The conflict in the North accounted for the vast majority of the internal displacements recorded in Ethiopia in 2021.… Across the country as a whole, around 3.6 million people were living in displacement as a result of conflict and violence at the end of the year, including 1.7 million children without access to education.”

International agencies that previously seemed to acquiesce to the Ethiopian government’s narratives about the war began to speak more frankly about its horrors. “Even in the toughest periods of conflict in Syria, South Sudan, Yemen, and others, WHO and partners have had access to save lives,” World Health Organization director general Tedros Adhanom Ghebreyesus said at a press conference in January 2022. “However, in Tigray, the de facto blockade is preventing access to humanitarian supplies, which is killing people.” In response, the Ethiopian government accused Tedros of having ties to Tigrayan rebels and tried to thwart his reelection to a second term as head of the WHO.

It was risky to move around the region—in January, a government air strike on a Tigrayan IDP camp killed more than 50 people. Yet Mebrahtu continued to do so, hoping to help as many sexual assault survivors as possible. One day, as he was riding in an SUV about 18 miles from Mekelle, he heard the unmistakable scream of a missile overhead. He was on a trip to establish a women’s health center, traveling in a clearly marked humanitarian vehicle—an image of Kalashnikovs overlaid by a red circle and a slash adorned the sides and roof, large enough to be seen from the sky. As he and his colleagues approached a checkpoint, the missile slammed into a truck transporting grain ahead of them.

Mebrahtu and his colleagues bolted from the SUV, the doors left open in their haste to flee. Looking up as he ran, Mebrahtu tried to spot the drone that fired the missile but saw nothing. He ran until his lungs burned. When he could run no farther, he sat atop a nearby hill and waited for more bombs to hit the road below. With its wide-open doors, the SUV looked like a dead bird, wings outstretched.

Additional strikes never came. After half an hour, Mebrahtu made his way back to the vehicle, where his colleagues were waiting. As they sped away from the scene, they got a good look at the truck ahead of them. It had been split in half from front to back, as if it were no stronger than a sheet of paper.

Medical staff attend to a patient at Ayder in June 2021. (Photo by Yasuyoshi Chiba/AFP via Getty Images)

As the siege ground on, Ayder teetered on the brink of collapse. “Signing death certificates has become our primary job,” hospital representatives told a group of NGOs in January 2022. Starvation was endemic.

By then Saba was nearing the end of her second rotation, in surgery. After a breakfast of injera and lentils fortified with cabbage or potatoes, she worked 36-hour shifts without eating again. She lost so much weight it affected her menstruation, and she decided to take birth-control pills to halt her monthly cycle, since it was cheaper than buying pads and tampons. She fainted more than once while working—a common occurrence among Ayder’s staff.

When Saba helped triage new patients, who often arrived by the truckload, the first task was separating the living from the dead. She took photos of wounds to show more-senior medical staff. Sometimes the injuries were filled with maggots. Doctors often left the larvae to clean wounds the hospital didn’t have supplies to treat.

One day a colleague asked Saba to help place a urinary catheter. The patient was a teenage girl in a yellow dress caked with dried blood and stool. The hospital didn’t know her name, as she’d arrived unconscious and carried no identification. She had a head injury, the result of being hit in the eye with a bullet or shrapnel. Saba couldn’t see an exit wound. The only stimulus the young woman responded to was pain.

Saba inserted the catheter. “But it was all pointless,” she said. Saba knew the girl in the yellow dress would die. Saba never saw her again, except when she appeared in Saba’s nightmares.

Those nightmares grew worse during her next rotation, pediatrics. Saba felt more helpless than ever watching children suffer and die for lack of supplies. One afternoon a father came in with an 11-month-old boy so malnourished he weighed no more than an infant. His mother had died in childbirth, and the boy suffered from hydrocephalus, a condition where spinal fluid accumulates in the ventricles of the brain, causing the head to swell. Contributing factors can include malnutrition and vitamin deficiency during pregnancy. The little boy’s stare was fixed downward, a condition called “sunset eyes,” which often occurs in cases of hydrocephalus. Saba knew that the child could have serious neurological damage.

The father had traveled a long distance for help, and arriving at Ayder gave him a boost of hope. Treating hydrocephalus requires the insertion of a shunt into the cranial cavity, allowing the fluid to drain. These shunts, small pieces of plastic, cost only a few dollars. They are mass-produced and readily available around the world. The surgery to place them is routine. But there were no shunts left at Ayder. There were none left in all of Tigray. Saba wished that the father hadn’t been so hopeful.

Along with a resident doctor, Saba told the father that there was nothing they could do. He had two options. He could stay at Ayder, where the staff would make his son as comfortable as possible, but he would have to find his own food. Or he could go home. The child would die either way. The father chose to stay.

The last time Saba saw the little boy was that evening. It was February, and so cold that she wore a jacket under her white coat while making rounds. The father wasn’t with the boy—he’d gone looking for milk. The baby was covered in a single bedsheet soaked in urine. When Saba touched him, he felt like ice. She looked for something clean to wrap him in, eventually finding a bedsheet another patient used for a pillow. She picked up the baby, cleaned him, and swaddled him in the sheet. When his father returned, he wept with gratitude. The boy died soon after.

The father and his young son began appearing in Saba’s dreams alongside the girl in the yellow dress. They visited her almost every night.

As the peace talks dragged on, Ayder’s ability to provide care diminished even further. At the end of May, it was forced to close its doors to everything but trauma cases.

Around the time Saba began her pediatrics rotation, Tesfaye and other colleagues began to document the toll the siege had taken on medical professionals for a study they planned to submit to international medical journals. The team surveyed a cross-section of Ayder’s staff—senior physicians, residents, interns, nurses, and midwives—and made sure to include both men and women, married and single. They knew that personal factors could, as they wrote, “influence how individuals experience and cope with the stressors of war and siege.”

The findings were stark. One-third of the hospital’s interns had departed. Eight nurses left the emergency department, which “resulted in significant compromise on the service delivery,” according to one staff member. Providers described insomnia and sensitivity to loud sounds—their nervous systems reacting instinctively to possible explosions—and feelings of inadequacy, grief, and anguish. A nurse said that those able to bring food to work shared it with their colleagues. One day a staff member refused to eat what was offered. According to the nurse, “She said, ‘My kids were asking me to buy them bread in the morning. I did not buy them because I had no money to do so. I left my kids with nothing to eat at home. I left them for God to take care of them. I came here to work. How do you think I can eat?’ ”

In March 2022, as the team compiled their findings into a formal report, the TPLF and the government agreed to a humanitarian truce and the commencement of peace talks. Both sides, it seemed, were becoming war-weary. Nevertheless, the federal blockade of Tigray remained devastating. For its part, the TPLF desperately tried to shore up civilian reserves in case fighting began again. It resorted to widespread conscription, in some cases drafting Tigrayans as young as 17. It also jailed individuals for leaving the TDF.

On April 1, Abiy’s administration allowed a handful of aid trucks to enter Tigray, but it was a drop in an ocean of need, another gesture of quasi-compliance aimed at placating international observers.* As the peace talks dragged on, Ayder’s ability to provide care diminished even further. At the end of May, it was forced to close its doors to everything but trauma cases. Mebrahtu kept doing what he could to support the women of Tigray. Tesfaye performed emergency surgeries while continuing to study the costs of war.

*A few weeks later, reports surfaced that Abiy planned to build himself a new palace complex at a cost of $1 billion, a signal of his government’s priorities. The budget would eventually grow tenfold. 

Saba completed her internship that summer. She was then instructed to volunteer at whatever health centers were still operating in the region. Transportation was nearly impossible. Her only choice was to catch a ride in an ambulance when she could, which wasn’t often—only 11.5 percent of ambulances in Tigray remained functional just six months into the war. Most days Saba was stuck at home.

Saba finally got news of her grandfather who lived near the border in the north. When Eritrean soldiers arrived at his home, he told them that he, too, would have joined the TDF if he weren’t an old man. The soldiers responded by beating him. One of them told him to turn and fall to his knees so they could execute him. Saba’s grandfather told the soldier that if he was going to shoot him, he’d have to look him in the eye. Instead, the soldiers took his valuables and left. Saba wasn’t sure how badly he’d been hurt.

Her PTSD was getting worse. Even when she had access to food, she found that she wasn’t hungry. She grew bitter that she had ever believed—that her parents let her believe—in the promise of Ethiopia. For a while, she told herself that the siege wouldn’t last more than another month, that it couldn’t. But it always did. At some point, she accepted that she would likely never see her family again.

Abraha was promoted in June. As associate clinical director, Abraha helped lead the hospital at large and responded to patient concerns. People pleaded with Abraha for antibiotics, chemotherapy, a meal. For those he couldn’t help, he tried at least to bear witness to their pain. One woman who came to him had lost 19 members of her family in the war. Abraha always prided himself on keeping his composure at work, but sometimes it felt like his tears were all he had to give. He cried at home in the evenings too, his face in his hands.

At the end of the summer, peace talks broke down. Deadly violence resumed across Tigray. Tens of thousands of people, perhaps more, were killed or starved to death. Both sides fought less for tactical position than for advantage at the bargaining table. In October, when a peace agreement again seemed within reach, Eritrean forces slaughtered hundreds of civilians in at least ten villages.

On November 2, 2022, some 16 months after the siege began, the TPLF and the Ethiopian government finally signed a cessation-of-hostilities agreement. The agreement went into effect the next day, exactly two years after the war began. The mood in Tigray was more skeptical than celebratory. People were too tired, too sick, too traumatized for jubilation.

Eleven days later, Ayder welcomed the first aid truck to reach the hospital in more than a year.

Aftermath

Saba and a friend walked to what’s known locally as a “film house,” a shop that bought pirated content from NGO staffers who had internet connections. Saba paid for a PDF of the peace agreement. The pair returned to Saba’s apartment and read the document again and again. The text pledged an end to air strikes and the laying of land mines, and for a cessation of “hostile propaganda, rhetoric, and hate speech.” It condemned sexual violence and stipulated that humanitarian aid should reach those in need.

But Saba and her friend were furious. According to the agreement, the federal government would control Tigray, and both the TPLF and the TDF had to disarm. To Saba this felt like her people’s only real defenses were being stripped away. What if violence continued? Who would protect her and other Tigrayans? Neither Eritrea nor any regional or ethnic militia aligned with Abiy’s administration was party to the agreement. Both sides agreed not to use “proxies” or “any external force” to destabilize Tigray, but Saba didn’t trust the government to adhere to this. She didn’t trust the government at all.

At Ayder, where staff began the painstaking process of restoring services, there was much talk of the peace agreement. The committee of experts appointed by the UN Human Rights Council in 2021 had recently released its first report on Tigray, confirming what so many civilians already knew—the extent of the killing, raping, and pillaging perpetrated by Ethiopian forces and their allies. It found “reasonable grounds to believe that, in several instances, these violations amounted to war crimes and crimes against humanity.”

Would the government, which had lied to the world so persistently throughout the war, really be so quick to turn off the tap of its own brutality, much less bow to accountability for its actions? That Abiy’s administration initially attempted to block the Human Rights Council’s inquiry, and later refused access to any part of the country outside Addis Ababa, wasn’t encouraging.

Abraha was promoted again, to chief clinical director of the hospital. Aid arrived, but only a trickle. The hospital was short on everything essential, including bandages, medications, oxygen, and surgical gloves. Federal funding resumed, allowing Ayder to pay staff,* but the hospital’s budget was less than 50 percent of what it had been before the war. Ayder’s situation matched regional trends. In mid-2023, a WHO study found that of 853 health facilities researchers were able to assess, close to 90 percent had suffered damage during the war—from attacks, looting, or both. Even those partially functioning reported a lack of supplies and finances.

*As of January 2025, health care professionals at Ayder and other federal employees in Tigray are still petitioning the government for the 18 months of back pay they were denied during the siege.

Health facilities weren’t the war’s only structural casualties. Tigray’s economy was in shambles, many of its principal industries looted or destroyed. The school system was particularly devastated. A study from the Tigray Education Bureau found that almost 90 percent of schools were damaged just two months into the war. Many buildings had been repurposed for displaced people, nearly a million of whom had yet to return home, either because they lacked the resources or because Eritrean soldiers and ethnic militias still posed a threat. Unexploded ordnance remained an urgent risk to children. At Ayder, Abraha continued to care for some of the war’s youngest victims. “All wars are fought against children,” he said.

Mebrahtu felt the same about women and girls. After the siege ended, he was able to resume his nursing instruction, including classes on reproductive health and obstetrics. He became an official adviser to the Tigray Regional Health Bureau on gender-based prevention and response. (He continues to help coordinate One Stop Centers across the region.) He also suffered from nightmares, flashbacks, and intrusive thoughts. He sometimes had anxiety attacks and heart palpitations. For a while he was able to see a therapist, but that only helped so much.* 

*Refugees International estimated that there are only eight psychologists in Tigray, or about one for every million people. 

 Tesfaye kept working at the hospital, but like many other physicians, he also opened a private practice. He knew that he could never again rely solely on income from the government. The team he’d worked with to document the war’s impact on Ayder and its staff struggled to find a home for their studies. Only when they attached Western coauthors to them did medical journals pay attention.

Tesfaye was sure that there would be another conflict, and he stopped planning for the future as he once did. “You cannot even build something thinking that tomorrow war will happen,” he said. “It’s the same for your dreams as well. You cannot dream, feeling that war will come and destroy it.”

“Abiy’s strategy with the Europeans was essentially bribery,” De Waal said.

War did come, if not for Tigray. By the spring of 2023, an ongoing separatist movement in Ethiopia’s Oromia region to the south had intensified. In Amhara, regional forces and ethnic militias turned on the federal government and launched into open rebellion when Abiy’s administration instructed them to disarm. The conflict widened and would be marked by atrocities similar to those in the Tigray war.

For the time being, guns remained silent in most of Tigray, yet peace was incomplete. According to a report coauthored by Physicians for Human Rights and the Organization for Justice and Accountability in the Horn of Africa, in the six months after the peace agreement was signed, “reports of human rights violations [continued] … including campaigns of ethnic cleansing in western Tigray and continuing cases of sexual violence committed by Eritrean forces.” The TPLF never gave up its arms. Food aid remained limited, not least because federal officials were stealing it for the military or to sell for profit. The problem became so bad that in May 2023, USAID halted all food deliveries to Ethiopia. The WFP followed suit in June.

Still, the international community signaled a desire to normalize relations with Ethiopia. In June, with food aid suspended, President Biden’s administration told Congress that Abiy’s government was no longer exhibiting a “pattern of gross violations of human rights.” The African Union never completed a promised investigation of the war in Tigray. The commission established to conduct the inquiry was quietly disbanded over the summer of 2023.

Most startling, though, was what transpired at the UN. In September and October, the committee of experts appointed by the Human Rights Council to investigate the war in Tigray released two more reports. “The conflict … still not resolved in any comprehensive peace, continues to produce misery,” the first report stated. Responsibility for this, it went on, lay with Abiy’s administration. “The Government of Ethiopia has failed to effectively investigate violations,” the committee found, “and has initiated a flawed transitional justice consultation process. Ethiopia has sought to evade international scrutiny through the creation of domestic mechanisms ostensibly to fight impunity.” The committee noted “past and current abuses … demand further investigation.” This has yet to happen.

Two weeks after the second report’s release, the committee’s mandate expired after no member of the Human Rights Council sponsored its renewal. This was not a bureaucratic oversight. Earlier in 2023, Ethiopia had signaled that it intended to introduce a resolution to terminate the committee’s work. At the time, 63 human rights organizations, including Amnesty International and HRW, wrote an open letter to the UN stating that the government’s actions risked setting “a dangerous precedent regarding international scrutiny and impunity for rights abuses elsewhere.”

Ethiopia never introduced its resolution, but according to sources with knowledge of the matter, this was only because European Union member states agreed to let Ethiopia propose its own investigative mechanism as a replacement for the committee of experts. Once again the UN had placed Ethiopia in charge of prosecuting its own crimes,* effectively killing international scrutiny. Philippe Dam, Human Rights Watch’s EU director, noted that this was likely the first time Europe had led an effort to “bury [a] key UN inquiry.”

*In April of 2024, the Ethiopian Council of Ministers approved a special prosecutor to investigate serious crimes within the country since 1995, including the Tigray war. The process has been described as a “farce” and widely criticized by human rights groups. 

How to explain EU member states’ decision? Alex De Waal, executive director of the World Peace Foundation at Tufts University and one of the world’s foremost experts on the Horn of Africa, said that part of it was due to weak UN leadership, but also that Abiy had dangled carrots in front of European leaders in the form of investment opportunities. Ethiopia planned to privatize portions of its economy, paving the way for foreign players to benefit from future growth.

“Abiy’s strategy with the Europeans was essentially bribery,” De Waal said. “He basically said, ‘We have these big privatizations coming up, especially telecom, and you’ll get a slice of it.’ The French and Italians in particular were salivating at that prospect.”*

*In the fall of 2024, Abiy’s government began the process of privatizing roughly half of Ethio Telecom, which holds a near monopoly on the country’s internet and telecommunications services. 

Just prior to the UN committee’s mandate expiring, the EU and Ethiopia inked a deal to renew the development package frozen during the war, now worth 650 million euros. “This strategic partnership is now back on track,” Abiy said. A few months later, in January 2024, Abiy was given the UN Food and Agriculture Organization’s highest award for contributions to rural and economic development.

Around the same time, Abraha led an effort to gather data on persistent hunger in Tigray. The preliminary findings were clear. “In every corner of Tigray,” Abraha said in the summer of 2024, “there are pockets of starvation.”

A doctor attends to Alem, 29, and her two-month-old son, Leul, who suffered from severe malnutrition, in February 2024. (Photo by Ed Ram/Getty Images)

As with many conflicts, the precise number of deaths from the war in Tigray may never be known. But experts estimate that it claimed the lives of some 600,000 civilians, possibly many more. That figure isn’t far off from the death toll of the Rwanda genocide, in which 800,000 people were slaughtered. “I used to think the world learned a lot of things from Rwanda,” Mebrahtu said. “But they failed in Tigray.”

While all factions in the conflict have committed war crimes, the scale of these atrocities differs considerably. Only one side of the war can be credibly accused of genocide. In Abraha’s mind, there’s no question about what happened in his homeland. “This is a genocide by intention and commission,” he said. Helping to heal survivors will never be enough for him. To process the tragedies he witnessed, as well as his family’s own losses, he wants an impartial investigation, due process, justice.

A growing number of international observers are also calling for accountability for what they see as a probable genocide. That would likely require judicial proceedings at the global level. Ethiopia is not party to the Rome Statute, which governs the International Criminal Court. For the ICC to open a case against Abiy or members of his government, the UN Security Council would have to authorize it. Ethiopia is subject to the jurisdiction of the International Court of Justice (ICJ) for various crimes, including genocide, but another sovereign nation must bring the suit. There is no indication that anyone with the authority to do so is keen to take Ethiopia or its leadership to either court.* Despite overseeing one of this century’s bloodiest conflicts—and a number of well-documented atrocities that may amount to genocide—Abiy managed to keep the international order largely on his side.

*The ICC prosecutes individuals, hence the recent arrest warrant issued for Israeli Prime Minister Benjamin Netanyahu for, among other charges, using starvation as a weapon of war. The ICJ, by contrast, allows UN member states to sue one another. In December of 2023, for example, South Africa alleged before the court that Israel’s conduct in the Gaza Strip amounted to genocide. The case is pending.

This has left many Tigrayans feeling abandoned. “Unless you have power,” Mebrahtu said, “being human or truthful is nothing in this world.” Several sources interviewed for this story said they were “jealous” of the attention the Palestinian cause received since Israel began its assault on Gaza in October 2023.

Tesfaye, once a believer in the promise of global governance, fears that the legacy of the war in Tigray will be one of inaction and impunity. “Dictators have taken a lesson from Ethiopia—that you can kill your own people, you can exterminate,” he said. “You can do ethnic cleansing, and then you can escape.”

“You Tigrayans are all disgusting,” the driver seethed. Saba turned and walked away as the man spat insults. She was no longer surprised by this kind of abuse.

The month after the peace agreement was signed, Saba was able to return to Addis Ababa and see her family. They had returned to the capital from Dubai, where they fled during the mass arrests in 2021. Her sister purchased her a ticket home, and Saba was on the second plane out of Mekelle following the end of the siege.

When she arrived at the Addis Ababa airport, a taxi driver asked Saba if she wanted a ride. Her father was picking her up, so she said no. “You Tigrayans are all disgusting,” the driver seethed. Saba turned and walked away as the man spat insults. She was no longer surprised by this kind of abuse.

At home her mother cooked a feast, including doro wat, Saba’s favorite dish. After more than a year of starvation, she was shocked to see so much food on the table. She found that she could eat very little of it. Her body wasn’t used to so much nourishment, and she felt disgusted to have so much while others had so little. Her father asked why she was so thin—she had lost almost 35 pounds from a five-foot-three-inch frame—and she realized that her own family had little idea what she’d been through.

Saba was finally able to speak with her grandfather in northern Tigray. He now walked with a limp because of the beating he’d sustained from the soldiers. When Saba asked him if he felt resentment, he told her that he was “too old for hatred.”

Saba still sees the girl in the yellow dress and the little boy and his father in her dreams. She briefly went to a therapist but stopped when she could no longer afford it. Asking her parents for help wasn’t an option. “They don’t believe in mental health care,” she said. Saba no longer enjoys her hobbies from before the war. She doesn’t read much or listen to music. When she’s not working, she watches trashy TV, not caring about what happens on screen. Her menstrual cycle still hasn’t returned to normal.

Saba is no longer a practicing doctor. She says that she doesn’t have the “mental capacity” for it after laboring in conditions so heinous that she was forced to leave patients to die. She’s now studying public health at a university in the U.S. and hopes to find “office work.” She wants to return to Tigray one day, to help rebuild the medical system. But not now, not yet. She feels too broken.

After dinner on her first night home, Saba went upstairs to her childhood bedroom. On a shelf were books by J. K. Rowling and Sally Rooney, exactly where she’d left them. Her bed looked the same as she remembered, and when she lay down, sleep came fast. The next morning she decided to go through some of her childhood things. As she looked at old clothes that now swallowed her withered frame, her composure shattered. On the floor of her room, she wept for the life she no longer had. For the child she used to be. For the woman she’d become.

Saba felt that the person who’d once worn the clothes piled around her had been lost in Tigray, had died alongside so many others. She missed that person. She was a good person.

Additional research by David Moulton and Tewelde G.

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