By James Landale
Diplomatic correspondent, in Mekelle, Ethiopia
Monday February 5, 2024
Tsega Tsigabu's baby is one of the many suffering from malnutrition in Ethiopia's Tigray region
In Ayder hospital in Mekelle, the capital of Ethiopia's Tigray region, the corridors are filled with the hubbub of any busy medical facility. But in the paediatric wing, there is a stillness to the wards.
For here lie children numbly bearing witness to the latest food crisis to ravage northern Ethiopia. Mostly babies, they are suffering from severe acute malnutrition.
Their mothers sit silently at their beds, staring into the middle distance, clutching their infants to their breast, hoping what milk they have can deliver the salvation for which they yearn.
For they and Ethiopia are suffering once again from a devastating legacy of conflict and drought, twin evils that in recent years have destroyed farms and crops and forced millions from their homes.
The government says 16 million people across the country are facing food shortages, with almost half of those suffering emergency or severe levels of food insecurity. That means many are not just hungry, they are starving.
This is why Tsega Tsigabu, 23, and her four-month-old son, Kidisty, are languishing in Ayder hospital.
Her family were farmers. But their crops failed and they moved to Mekelle to try to survive. Like so many others, they ended up in a camp for people forced from their homes.
Tsega's husband was in the army but he injured his hand and cannot work. She took her baby for a vaccination and the nurses saw instantly it was malnourished.
"Even when I was pregnant, I was not eating a balanced diet," Tsega tells us. "I was not producing enough breast milk, that's why the baby has developed malnutrition. I just didn't have enough to eat at home."
Doctors at the hospital tell us the numbers of severely malnourished children being admitted have doubled since 2020 when the war between Tigrayan forces and Ethiopian and Eritrean armies began.
A ceasefire was agreed in 2022 but the impact of the conflict still lingers with at least one million people still unable to return home remaining in the region.
We travelled with the British Africa minister, Andrew Mitchell, to Agulae, an hours' drive north into the hills, where a clinic was assessing children from outlying villages.
He watched as anxious mothers lined up to have the circumference of their children's arms measured; the less flesh on the bone, the more likely the malnutrition. The nurses showed him their charts and they all told a similar story of the numbers getting worse.
"There is clearly a risk of famine if we don't now take action," Mr Mitchell told the BBC.
"There are serious indicators of the danger of famine. If you ask me, 'Is there a famine taking place now in Ethiopia?' I say no, and we have the power to stop it. But if we don't take the necessary action now, then there is every danger that a famine will engulf this war-torn country which has suffered so much already."
He promised Britain would commit a further £100m to help up to three million mothers and babies in Ethiopia get access to health care; a new fund to provide medicines and vaccines designed to end preventable deaths.
But is famine in Ethiopia really likely?
International aid agencies are cautious about using what some call "the F- word".
It has a precise technical definition - 20% of households facing extreme food shortages, 30% of children under five with acute malnutrition, and two people out of every 10,000 dying every day. Few suggest those criteria have been formally met in Ethiopia.
But for Getachew Reda, president of the Tigray interim regional administration, those definitions are otiose.
He told the BBC there was an "unfolding famine" in Tigray. The numbers of those "staring death in the eye" were rising all the time, he told us, criticising the international community for its "lacklustre" response.
"One thing I know is that thousands of people who would otherwise have been able to feed themselves are not in a position to feed themselves and are succumbing to death because of starvation," Mr Getachew said.
"Whether you call it famine or a risk of famine or a potential famine, for me it's purely academic… What transpired in 1985, for example, would pale into comparison, if we fail to address the kind of unfolding famine that's staring us in the eye."
What he was referring to were the devastating crises of the mid-1980s when many hundreds of thousands died in a famine in Tigray and elsewhere.
The BBC's powerful reporting of the humanitarian disaster prompted a wave of publicity and campaigning, including the Live Aid concert led by the musician Bob Geldof.
These comparisons infuriate the federal government in Addis Ababa which denies there is famine.
Shiferaw Teklemariam, commissioner of the Ethiopian disaster risk management commission, said Ethiopia was a victim of climate change. He warned regional governments against politicising the issue and urged them and the international community to do more.
"There is a drought, no famine," Mr Shiferaw told the BBC.
"The government is responding very seriously, but at the same time we call on all stakeholders to do their share."
There are politics here.
Past famines in Ethiopia have sometimes been linked to the downfall of governments. Analysts say the word makes the current administration - led by Prime Minister Abiy Ahmed - nervous.
The government is working with the UN to tackle the food crisis but the economy here is weak and budgets are being cut.
The truth is that no-one really knows how bad this crisis is because hard data is difficult to obtain.
Media access is limited. Many areas in the north are impossible for humanitarian agencies to visit because of continuing fighting, especially in Amhara.
There, and in neighbouring Afar region, there are fears the food crisis could be even worse than in Tigray. Successive anecdotal evidence - reports from villages and towns across northern Ethiopia - suggest the situation is deteriorating.
What most sides agree is the international community should be doing more.
Last year USAID, America's development agency, and the United Nation's World Food Programme suspended humanitarian support for five months after it emerged that huge amounts were being stolen, much of it to feed various armed forces.
This has aggravated the situation. The world is also distracted by conflicts in the Middle East and Ukraine and less attention and funding is being targeted at Ethiopia.
The head of the UN here, Ramiz Alakbarov, said this was a forgotten crisis. "The world is not paying attention," he said.
"We grieve for all the troubles and difficulties elsewhere, yet people in this part of the world cannot be forgotten. We need to get organised and donors need to step up contributions."
At a food distribution centre in Mekelle, we saw the World Food Programme doing what it could, handing out scoops of wheat and lentils along with cups of oil.
The hungry queue up bearing QR codes which identify them, their households and their needs. But the food they get is a bare minimum and budgets are running thin.
Claire Nevill, who speaks for the WFP in Ethiopia, said what was needed was not just food assistance but help to get people back to their farms so they can feed themselves.
The problem is that parts of the country are still occupied by militias and Eritrean forces.
"In Ethiopia you have several overlapping crises at a time," she said.
"We have drought, people recovering from a two-year conflict, rising inflation, an upsurge in cases of disease and all of this together just pushes people further into hunger and malnutrition. So if we don't get food assistance to people right now, the situation will worsen."
Back in Ayder hospital we met Tsige Degef, 28, whose 15-month old daughter, Bereket, was malnourished.
And her story was typical. Tsige's extended family were forced to sell their oxen during the war to pay for expensive cereals. When peace came, the crops failed and there was nothing to fall back on.
Tsige was already struggling when Bereket fell ill. "Her feet and legs were swollen," she said. "I was so worried. She was vomiting every day. The fear of a mother with a sick child is the fear of death."
But Bereket is getting better and Tsige is hopeful of leaving hospital. "I wish she will heal soon," she said.
"I want to open a tea shop and sell things so I can better protect my child. I promise to do the best I can so that she doesn't suffer in the future."