The humanitarian situation in Ethiopia's troubled northern Tigray region is getting worse. 

Over the past two months, most hospitals in Tigray have been looted or destroyed in fighting between troops loyal to the government of Prime Minister Abiy Ahmed and forces led by the regional Tigray People's Liberation Front (TPLF) party.

Health services have collapsed and food and medicines are in short supply. 

Around 2.3 million people, more than half of Tigray's population, are in urgent need of humanitarian assistance, according to the United Nations. 

International organizations are sounding the alarm and are demanding unhindered access to the entire Tigray region.

COVID-19 threatens refugee camps

The UN fears a jump in coronavirus infections could exacerbate what is an already difficult situation. 

COVID-19 surveillance and control work was interrupted for more than a month in Tigray, and that, along with the displacement of hundreds of thousands of people, "is feared to have facilitated massive community transmission of the pandemic," a recent UN report warns. 

This would be catastrophic in a region where the UN recently reported that only "five out of 40 hospitals are physically accessible." 

Fighting is still ongoing 

To make matters worse, sporadic fighting and insecurity continue in several areas in Tigray even though Abiy's government declared victory over the TPLF in November. 

In the latest bloodshed, the government claimed its forces had killed four TPLF leaders, including former Ethiopian foreign minister Seyoum Mesfin, after they failed to surrender. 

The information could not be independently verified however. 

"The killings aren't an immense blow because they aren't high-ranking leaders but they are important leaders," said William Davison, a senior analyst on Ethiopia at the International Crisis Group. 

The deaths highlight "the great pressure that the TPLF is under," Davison added. 

The killing of the Tigrayan leaders will have "a big impact on the reconciliation process," said Annette Weber, East Africa expert at the German Institute for International and Security Affairs.

"Although [reconciliation] isn't something Prime Minister Abiy is thinking of. He declared the TPLF a terrorist organization."

She believes the latest events will further weaken the TPLF: "We must abandon the ideas of two months ago when many still believed the TPLF would win the guerrilla war." 

Aid workers face enormous challenges

The French medical charity Doctors Without Borders (MSF) has said the instability is making it difficult to access people and the camps many are fleeing to.

"There are massive obstacles to our work," said Mari Carmen Vinoles, spokeswoman for MSF's emergency unit.

"People are afraid because of the fighting, and most Tigray areas are unsafe. On top of that, there is a lack of medicine, oxygen, food, water, shelter. Thousands have been displaced. The challenges are extreme," Vinoles told DW.The few functioning hospitals lack staff — they have fled for fear of violence. 

"We are at a stage where millions of people are not receiving health care," Vinoles said, adding that this meant attempts to curb the transmission of the coronavirus were also minimal.

Banks are also closed, and people are unable to withdraw cash to pay for basic necessities. 

Glimmer of hope in Mekelle

There seems to be some hope in Tigray's regional capital Mekelle, where some basic services are returning.

"There is water, electricity, and even the internet is working again," Vinoles said. "Slowly, some stores are reopening and life seems to be returning to normal. 

"But Mekelle is just one city in the region where, right now, millions of people don't have the option of health care. The situation is appalling."

Conflict entered its third month

The Tigray conflict began when Prime Minister Abiy ordered air and ground strikes against the TPLF after Tigray forces attacked a federal army base in the region at the beginning of November. 

Abiy's government subsequently sacked the the TPLF administration, and Ethiopia's army, supported by militias from the neighboring Amhara region (and potentially troops from neighboring Eritrea), invaded Tigray. 

Abiy declared victory over the TPLF six weeks ago.

The crisis threatens to destabilize one of Africa's most populous countries and drag in neighbors like Sudan. 

East Africa expert Annette Weber criticizes the general lack of access to the conflict zone. 

"Now it would be urgent to signal to the people in Tigray that they are part of Ethiopia but that's not happening."

This article was adapted from German.