In the agreement, signed on Wednesday in South Africa, the federal government pledged to end the blockade on Tigray imposed at the beginning of the war two years ago, while the Tigray People’s Liberation Front (TPLF), the political movement in power in the region, agreed to disarm its forces. The agreement came as a surprise to many observers, who had expected a more limited truce. Aid agencies, which have been unable to get any aid to Tigray since the last ceasefire collapsed in late August, greeted the news cautiously. Alyona Synenko, regional representative of the International Committee of the Red Cross (ICRC), said she hoped the organization would be able to resume aid delivery “as soon as possible”. Earlier this year, when a previous ceasefire allowed a small amount of aid to reach Tigray, the ICRC transported supplies such as insulin, dialysis equipment and surgical gloves. Aid workers hope the latest deal can lead to the resumption of land convoys, which can carry aid in much larger quantities. “What happens on the ground, we probably have to wait and see,” he said. “But we need more roads open, we need safe access for humanitarian organizations and we just need people [in Tigray] to take a break from it and resume normal life.” The blockade in Tigray imposed by the federal authorities since the start of the war has cut off almost all communications and halted banking and other commercial services. Health care for Tigray’s 6 million residents has dwindled to a bare minimum as facilities have closed and medication has dwindled. Food, fuel and electricity were scarce. Antonio Guterres, the UN secretary-general, has described the conflict’s “devastating impact on civilians in an already dire humanitarian situation”. Within hours of the news of the deal, United Nations staff had begun talks with Ethiopian officials about opening the roads that had been closed for months. “We are in contact with the Ethiopian government and others to resume the movement of aid convoys and personnel… Our humanitarian colleagues tell us that critical supplies, including food, foodstuffs and medicine, are running low in Tigray,” the Office of UN. for the Coordination of Humanitarian Affairs is stated in an announcement. The World Food Program said it was ready to immediately scale up humanitarian aid to affected populations in northern Ethiopia, where more than 13 million people are facing starvation. A senior doctor at one of the few functioning medical facilities in Tigray said he wanted the agreement to be translated into action “on the ground as soon as possible” to save patients’ lives. The hospital, the largest health facility in the area, had to stop providing dialysis to seriously ill kidney patients due to a lack of supplies. “We hope that even with a first humanitarian flight we will get such life-saving drugs, to save the few survivors of kidney failure, who are struggling and struggling with this lack of drugs,” the doctor told the Guardian by phone. . “So we are desperately waiting for these supplies to arrive. Now the peace talks have materialized on paper, we want to see it happen on the ground as soon as possible.” The doctor, who requested anonymity because of retaliation, said that due to a lack of supplies since fighting resumed in August, the hospital had to stop dialysis treatment for 25 patients who were previously stable but were now “on the brink of death.” “We have completely stopped providing dialysis services for this group of patients. We are helpless now … and all this is due to the prolonged war and the siege and the absence of humanitarian access or any supplies of medicine since August,” he said. More than 100 patients had died from normally treatable kidney problems since the de facto blockade began in July 2021, he said, and the death rate for kidney patients had doubled from 25% before the war to 53%. The conflict between the TPLF and Ethiopian central government forces began in November 2020 when Ethiopian Prime Minister Abiy Ahmed sent troops to Tigray after accusing local forces of attacking government military bases. A truce agreed earlier this year collapsed in August, leading to bloody fighting in which thousands were killed and many others displaced. The truce signed on Wednesday after just a week of formal peace talks in Pretoria reflected heavy pressure from both sides. Both made concessions to achieve a ceasefire, although the final agreement appears to fulfill most of the hopes of the Federal Government of Ethiopia and offer little to the TPLF. Tigray forces agreed to a disarmament plan they had previously rejected and backed away from their claim to be the legitimately elected regional government – one of their main justifications for the conflict, as the federal government did not recognize the last regional elections held in Tigray as a jurist. “The terms clearly reflect the very great pressure the Tigrayans were under… [and] they offered themselves on the back of a very violent but successful military offensive. It was an absurd war from the start with massive strategic miscalculations on both sides,” said Alan Boswell, director of the International Crisis Group’s Horn of Africa. A serious potential obstacle to a lasting peace is neighboring Eritrea, which has sent troops to Tigray to fight alongside Ethiopian federal forces, and the presence of pro-government militias from neighboring regions such as Amhara. Eritrea’s authoritarian government was not involved in the talks and has not said anything about whether it will withdraw its troops and abide by the ceasefire agreement. “There is no reason to delay unhindered access to aid deliveries… If this does not happen or the Eritreans do not withdraw, the Tigrayans could use them as excuses to delay their own commitments. On the other hand, Addis may also hesitate if Tigray refuses to disarm quickly as agreed,” Boswell said. There are also concerns about impunity for human rights abusers. Atrocities on all sides, including extrajudicial killings, rape, looting and ethnic cleansing, have been widely documented by UN bodies, Ethiopia’s state-appointed human rights commission, independent aid organizations and the media, including the Guardian. All sides have denied the accusations. The agreement calls for a “transitional political justice framework to ensure accountability, truth, reconciliation and healing,” but gives little indication of how this might work in practice. “The cessation of hostilities in northern Ethiopia after nearly two years of bloodshed is a critical moment to end atrocities and the immense suffering of millions of civilians,” said Carine Kaneza Nantulya, deputy Africa director at Human Rights Watch. “International scrutiny will be key to ensure that the warring parties, who have committed widespread abuses, do not prolong the harm to the civilian population.” Muleya Mwananyanda, Amnesty International’s director for eastern and southern Africa, said the agreement “does not offer a clear road map on how to ensure accountability for war crimes and crimes against humanity and overlooks the rampant impunity in the country, which could lead to repeated infringements”. The actual death toll in the conflict is unknown, but may be approaching levels that make the conflict one of the deadliest anywhere in the world. With no access for independent journalists and a limited presence of international humanitarian organizations, reliable data is scarce. Researchers at Ghent University have estimated that several hundred thousand people in Tigray may have died since the outbreak of the conflict, including those who died from lack of health care and after being weakened by widespread malnutrition. More have been killed in neighboring areas, and the total would make the war in northern Ethiopia among the deadliest in decades. Ethiopia’s government accuses the TPLF, which played a leading role in the country’s ruling coalition until Abiy took power in 2018, of trying to restore Tigrayan rule across the country. Tigrayan leaders accuse Abiy of leading a repressive government and of discrimination. Both deny the other’s accusations. The war has further destabilized the volatile Horn of Africa region and complicated Ethiopia’s diplomatic relations with Western allies, who are calling for a ceasefire. On Friday, the British government called on all parties in Ethiopia to move to implement the agreement. “Most critically, humanitarian aid must be delivered urgently to all those in conflict-affected areas,” a statement said.