Federal forces in Ethiopia have seized control of Mekelle and other major cities in the northern Tigray region following renewed fighting that erupted in late September, testing a fragile peace four years after the 2020-2022 civil war.
Armed conflict reignited across the northern Tigray region on September 23, according to NPR reporting, as fighting broke out between federal forces and the rebel Liberation Front (TPLF). The renewed violence tests the Pretoria Agreement signed in November 2022, which had ended two years of devastating conflict that left an estimated 500,000 people dead from violence, famine, and the collapse of healthcare, according to Al Jazeera.
Military Advance and TPLF Tactical Retreat
Ethiopian federal forces have taken control of Mekelle and other major urban centers in Tigray following a brief armed confrontation with the TPLF, UA.News reported, citing BBC News. Residents across central, northern, and northwestern Tigray reported continued fighting involving heavy artillery and drones.
Fighting escalated on September 22, 2026, and TPLF forces launched an offensive the following day, seizing Mekelle’s airport. Both sides disputed responsibility for the escalation, which marks the most serious outbreak since the 2020–2022 war. Federal forces and allied fighters counterattacked, retaking Mekelle on October 4 as Tigrayan fighters withdrew.
Between November 5 and 7, both federal troops and the TPLF’s military wing, the Tigray Defense Forces (TDF), massed units in the vicinity of Rama—situated approximately 20 miles north of Adwa close to the Ethiopia-Eritrea border—as documented by ACLED and mapping analyst The Ethiopian Conflict Map. The two sides subsequently clashed around Rama on November 7.
Ethiopian government officials and their supporters maintain that the war has effectively concluded and that their remaining objective is to expel TPLF forces from the region.
TPLF spokesperson Mikael Asgedom rejected claims that the group has suffered defeat, characterizing the withdrawal from Mekelle and other cities as strategic and tactical.
According to Asgedom, TPLF forces are preparing a large-scale counteroffensive and have already initiated attacks against Ethiopian troops in several sectors.
Abraha Hailezgi, a scholar at Mekelle University, said that the army lacks a clear political vision and has become associated with coercion, abuses, forced recruitment, and arbitrary actions, leading many people to view the TPLF army as an adversary rather than a protector.
Meanwhile, Prime Minister Abiy Ahmed faces an opposition coalition of seven rebel groups, and the military has asserted that Sudan, Egypt, and Eritrea are providing support to these Tigrayan militants.
Humanitarian Strain on Regional Healthcare
The renewed hostilities have placed severe strain on medical facilities already weakened by years of conflict and an ongoing aid blockade. At Ayder Referral Hospital in Mekelle, emergency rooms filled with war trauma patients following artillery shelling in Alamata.
Ten-year-old Betelhem lay on a bed next to her father at the hospital on October 6, 2026, after sustaining injuries during heavy artillery shelling in Alamata.
“The whole emergency (room) was flooded with war trauma patients,” a doctor at Ayder Referral Hospital told Al Jazeera on condition of anonymity.
“The floors were all filled up, there was no place to step,” the doctor added.
Federal authorities cut funding to Tigray and its regional administration hospitals, leaving doctors unpaid for months. Lindsey Green, a researcher focused on Ethiopia for the U.S. nonprofit Physicians for Human Rights, said that continual attacks against healthcare erode the accepted norm of medical facilities remaining protected during conflicts.
In August, Physicians for Human Rights and the Organization for Justice and Accountability in the Horn of Africa published a joint report detailing these attacks.
The situation has grown even more complex due to reductions in international health spending, which included the winding down of USAID shortly after Donald Trump assumed the presidency in 2025. Ayoda Werede, a California-based physician with the nonprofit Health Professionals for Tigray, said that the military has not targeted health centers during this latest outbreak of violence.
However, a health worker reported that people were told they must be punished for supporting the TPLF.
“They told us, the people should be punished, because we are supporters of the TPLF,” the health worker said, adding that the situation represents a repeat of past events.
“It’s an open wound, which was never closed, you know. Left for healing and never healed,” a doctor at Ayder Referral Hospital said, adding, “I guess now it’s infected.”
Displaced Families Face Permanent Exile
Years of unresolved territorial disputes, particularly concerning Western Tigray under Amhara control, have left millions displaced with little prospect of returning home. Families who fled their homes at the start of the 2020 conflict continue to live in makeshift shelters and former school buildings in towns like Abi Adi.
“Our children are growing up in this school, and we still don’t know when we will be able to go back,” said Tewolde, who was displaced from Setit Humera in Western Tigray, as reported by Face2Face Africa.
Human Rights Watch and other organizations warned the United Nations Human Rights Council in an October letter that renewed fighting involving drone strikes, mortar fire, and artillery attacks near residential areas and displaced persons camps threatens to undermine the Pretoria agreement entirely.
Gebretsadkan, working with a team examining potential crimes, believes enough women have spoken up to present evidence of genocide that could lead to criminal proceedings against various state and military leaders, though she expressed doubt that the Ethiopian state will acknowledge crimes without external intervention.
“Everything has been destroyed in the educational institutions, the health institutions—which are basic,” Gebretsadkan said. “There is no humanitarian assistance. So you see, we are dying, so what is the Pretoria peace agreement for us?”
Earlier coverage: Neither War nor Peace in Tigray – Is Ethiopia's Latest Conflict Really