Ten-year-old Iyerusalem lies in a hospital bed in northern Ethiopia, her amputated legs propped up by rolled blankets as she struggles with pain and the loss of her older brother, who was killed alongside their horse when fighting struck their home.
“I was in our compound with my older brother and our horse when we were hit. My brother and the horse died,” she told Agence France-Presse (AFP) from Ayder Comprehensive Specialised Hospital in Mekelle, the capital of the northern Tigray region.
Iyerusalem is among dozens of civilians wounded since fighting erupted between the Tigray People's Liberation Front (TPLF) and Ethiopian federal forces on Sept. 23, reviving a conflict in a region still scarred by the devastating 2020-22 war.
Federal forces repelled the TPLF offensive and took control of Mekelle without resistance on Oct. 3 after rebel leaders and fighters abandoned the city.
The fighting has nevertheless left civilians, including children, with severe injuries and families mourning relatives killed in bombardments.
Many wounded people come from remote villages in southern Tigray, hours from medical care along difficult roads affected by fighting and shelling.
Iyerusalem, from Qarsole village in Alamata district, said her amputated legs were causing severe pain.
“If I get medical treatment and can walk again, I want to go back to school,” she said, as her father, Hiluf, watched anxiously.
Nearby, 12-year-old Hana was recovering from severe facial injuries and a broken leg. The explosion that wounded her killed her mother and brother.
“First I heard a loud explosion, and the whole house shook. I was scared and did not even know what had happened. I could not open my eyes or my mouth,” she said.
“The sound of the explosion keeps coming back in my head.”
In another room, Betelhem, 10, was being treated for a broken leg, while her 6-year-old sister, Melet, had suffered a neck injury. Their pregnant mother was killed when heavy artillery struck their home.
“The bomb hit our house directly, all these people have died, but no one is being held responsible. There is no government,” said their father, Haftom, a 39-year-old shopkeeper.
Birhanu Hailemariam, the emergency coordinator at Ayder hospital, said 34 people wounded by heavy artillery, drones, gunfire and explosives had arrived in recent days. Twenty-three were children, and one patient had died.
Medical staff lacked basic equipment and medicines, including anesthesia, he said.
“But we are doing our best to treat everyone,” he said.
Although the latest fighting had not reached the scale of the previous Tigray war, which the African Union (AU) estimates killed about 600,000 people, fear remained pervasive among patients and medical workers.
“Both are hurting people,” another doctor said of the TPLF and federal forces, asking not to be identified.
Families were reluctant to assign blame for attacks. Hiluf said he did not know who had bombarded his village and feared reprisals if he accused either side.
“I do not want to fight with anyone,” he said. “Let there be peace for us.”
Farther north, residents of the border town of Zalambessa say they are caught between Ethiopian and Eritrean troops as the risk of a broader conflict grows.
Eritrea has deployed thousands of troops to northern Tigray to support forces opposing Ethiopia's central government, according to a security source.
“Ethiopian troops are on one side, and Eritrean troops are on the other,” said Selam, 33, whose first name was changed for security reasons.
Eritrean soldiers initially advanced south before drone strikes forced them to retreat into the surrounding mountains, she said. Although the area was no longer seeing active fighting, her home and small shop had been without electricity or water for a week.
“We are caught in the middle and living in deep anxiety,” she said.
Conflict monitor ACLED reported that Ethiopian federal forces had moved heavy weapons toward Zalambessa in recent days. Eyewitnesses reported seeing a substantial convoy of tanks and other heavy weaponry advancing from the south, though AFP could not independently verify the reports.
Residents described deserted streets, closed businesses and growing shortages as blocked roads disrupted supplies.
“Most people only go out to attend church and pray,” said Hadush, 45, who also requested anonymity.
“Now there is no bread,” he said, describing the worsening hardship.
Selam said federal soldiers were preventing residents from traveling to Adigrat, about 30 kilometers (18 miles) south, making it difficult to visit relatives or obtain essential supplies.
Eritrean Information Minister Yemane Gebremeskel did not respond to AFP questions about the reported presence of Eritrean troops.
The military buildup has raised international concern that the fighting in Tigray could draw the neighboring countries into another war.
On Wednesday, the United States urged Ethiopia and Eritrea to pursue “de-escalation,” calling on all countries to respect their neighbors' sovereignty and territorial integrity and avoid cross-border incursions.
Eritrea gained independence from Ethiopia in 1993. The countries fought a deadly border war from 1998 to 2000 before relations improved in 2018, when Ethiopian Prime Minister Abiy Ahmed took office and pursued closer ties with Asmara.
Relations have since deteriorated, with the two countries severing ties this month amid the renewed Tigray conflict.
Ethiopia accuses Eritrea of backing the TPLF, which launched its offensive on Sept. 23. Eritrea alleges that Ethiopia intends to exploit the fighting to invade its territory and seize Assab port on the Red Sea.
The TPLF initially made gains in the Afar region but has since retreated ahead of advancing federal forces, abandoning towns for the surrounding hills.
Federal troops took Mekelle without resistance on Oct. 3 and subsequently seized several other towns without encountering opposition. The latest reported advance brought government forces to Rama, about 7 kilometers (4 miles) from the Eritrean border, according to two residents.
