Axum, Ethiopia — Eritrean troops are operating with total impunity in Ethiopia’s war-torn northern Tigray region, killing, raping and blocking humanitarian aid to starving populations more than a month after the country’s Nobel Peace Prize winning leader pledged to the international community that they would leave.

A CNN team traveling through Tigray’s central zone witnessed Eritrean soldiers, some disguising themselves in old Ethiopian military uniforms, manning checkpoints, obstructing and occupying critical aid routes, roaming the halls of one of the region’s few operating hospitals and threatening medical staff.

Despite pressure from the Biden administration, there is no sign that Eritrean forces plan to exit the border region anytime soon.

On April 21, a CNN team reporting in Tigray with the permission of Ethiopian authorities traveled from the regional capital Mekelle to the besieged city of Axum, two weeks after it had been sealed off by Ethiopian and Eritrean soldiers. An aid convoy also made the seven-hour journey.

Ethiopia’s government has severely restricted access to the media until recently, and a state-enforced communications blackout concealed events in the region, making it challenging to gauge the extent of the crisis or verify survivors’ accounts.

But CNN’s interviews with humanitarian workers, doctors, soldiers and displaced people in Axum and across central Tigray – where up to 800,000 displaced people are sheltering – indicate the situation is even worse than was feared. Eritrean troops aren’t just working hand in glove with the Ethiopian government, assisting in a merciless campaign against the Tigrayan people, in some pockets they’re fully in control and waging a reign of terror.

The testimonies, shared at great personal risk, present a horrifying picture of the situation in Tigray, where a clash between Prime Minister Abiy Ahmed and the region’s ruling party, the Tigray People’s Liberation Front (TPLF), in November has deteriorated into a protracted conflict that, by many accounts, bears the hallmarks of genocide and has the potential to destabilize the wider Horn of Africa region.

Ethiopian security officials working with Tigray’s interim administration told CNN that the Ethiopian government has no control over Eritrean soldiers operating in Ethiopia, and that Eritrean forces had blocked roads into central Tigray for over two weeks and in the northwestern part of the region for nearly one month.

As the war and its impact on civilians deepens, world leaders have voiced their concern about the role of Eritrean forces in exacerbating what US Secretary of State Antony Blinken, according to spokesperson Ned Price, has described as a “growing humanitarian disaster.” In a phone call with Abiy on April 26, Blinken pressed Ethiopia and Eritrea to make good on commitments to withdraw Eritrean troops “in full, and in a verifiable manner.”

CNN’s efforts to reach Axum were thwarted by both Ethiopian and Eritrean soldiers multiple times over several days.

On one of the first attempts, the CNN team encountered what it later learned was the aftermath of a grenade attack, where a group of local residents were flagging down cars, warning passersby not to go any further. But before we reached the scene, a large army truck drove up and parked sideways, blocking the road. Our cameraman got out of the car and started filming only to be confronted by Ethiopian soldiers, who threatened the team with detention, demanding that we hand over the camera and delete the footage. But we refused and were able to conceal the footage until we were eventually released.

On another occasion, CNN was turned back by an Ethiopian National Defence Force (ENDF) Command operating out of a former USAID distribution center in the outskirts of the city of Adigrat, where several trucks laden with sacks of desperately needed food sat languishing in the hot sun. The aid, bound for communities in Tigray’s starved central zone, had been stopped from going any further despite daily phone calls from humanitarian workers pleading for access.

Even after being granted entry to Axum by the Ethiopian military, CNN’s path was obstructed by Eritrean troops controlling a checkpoint on a desolate mountain top overlooking Adigrat. The forces were wearing a mixture of their official light-colored Eritrean Defence Forces (EDF) fatigues and a woodland camouflage with a green beret, which military experts verified as tallying with old Ethiopian army uniforms.

It is one of the first visual confirmations of reports – relayed in recent weeks by the UN’s top humanitarian official Mark Lowcock and US ambassador to the UN Linda Thomas-Greenfield – that Eritrean soldiers are disguising their identities by re-uniforming as Ethiopian military, in what Thomas-Greenfield described as a move to “remain in Tigray indefinitely.”

CNN was informed by aid agencies that they had also been turned back by Eritrean soldiers manning the same checkpoint. Ethiopian military sources in the region confirmed to CNN that Eritrean soldiers were in control of key checkpoints along the route to Axum. The military sources said they had requested multiple times for the Eritreans to allow cars and convoys through, but had been refused.

CNN has reached out to the Ethiopian and Eritrean governments for comment.

Eritrean soldiers are captured on a hidden camera at a checkpoint in the hills above Adigrat, as they block access to the road to Axum.

After repeated phone calls to Ethiopian central government and senior military officials, CNN was finally allowed into Axum on its fourth try. On the same day, international medical humanitarian organization Medecins Sans Frontieres demanded that the 12-day blockade of the road into Axum be lifted.

Many aid agencies are still being barred from the besieged city, where one of the few hospitals operating for miles is running out of essential supplies, including oxygen and blood, humanitarian workers working in the region told CNN.

On arrival at the Axum University Teaching and Referral Hospital, patients are greeted by a sign asking for blood.

The medical staff we spoke to asked not to be named for fear of reprisals, but requested that CNN identify their hospital – they say that they want people to know that they are still here.

Inside one of the under-resourced examination rooms, a malnourished 7-year-old was lying on a gurney, wrapped in a blanket to cushion her fragile skin. Latebrahan’s emaciated legs could no longer hold her weight and she lay wide-eyed, staring up at the crowd of doctors gathered around her bed.

Seven-year-old Latebrahan lies on a gurney at Axum University Teaching and Referral Hospital, where she's being treated for malnourishment.

The medical team were doing their best to keep her alive, but they had run out of a therapeutic feeding agent due to the blockade, the only way to help her gain weight without disturbing her delicate system.

Latebrahan’s father, Girmay, who asked to be identified only by his first name, told CNN the journey from their home in Chila, around 60 miles north of Axum, near the border with Eritrea, had been dangerous and costly.

“There is no help, no food, nothing. I didn’t have a choice though – look at her,” Girmay said.

Like many other rural border towns, Chila has been blocked off from receiving aid since the conflict began six months ago. Humanitarian workers say famine could have already arrived there and they would have no way of knowing.

“Based on guesswork there is a sense that in these areas that we are not able to access, out in the countryside for instance, places are falling into pockets of famine. But we’re not able to verify that and that’s part of the problem,” Thomas Thompson, the UN World Food Programme’s emergency coordinator, told CNN.

The fighting erupted during the autumn harvest season following the worst invasion of desert locusts in Ethiopia in decades. The conflict has plunged Tigray even further into severe food insecurity, and the deliberate blockade of food risks mass starvation, a recent report by the World Peace Foundation warned. The Ethiopian government itself estimates that at least 5.2 million people out of 5.7 million in the region are in need of emergency food assistance.

USAID distributes supplies in Hawzen, central Tigray, where residents hadn't received aid for two months.

Eritrean soldiers have been blocking and looting food relief in multiple parts of Tigray, including in Samre and Gijet, southwest of Mekele, according to a leaked document from the Emergency Coordination Centre of Tigray’s Abiy-appointed interim government obtained by CNN. In a PowerPoint presentation dated April 23, the center states that Eritrean soldiers have also started showing up at food distribution points in Tigray, looting supplies after “our beneficiaries became frightened and [ran] away.”

That report was corroborated by humanitarian workers in Tigray, who said they had “protection” issues around distributing aid in some areas as civilians were later robbed of the aid by Eritrean soldiers. Emily Dakin, who leads the USAID Disaster Assistance Response Team in Tigray, also told CNN that she had received reports of health centers being looted, which was “contributing to some of the dysfunctionality of the hospitals.”

Eritrea’s Minister of Information Yemane Meskel has rejected these claims.

Hannibal, 7, is treated at Axum Teaching and Referral Hospital for a gunshot wound to the leg, which he received from soldiers' gunfire as he was sitting on his mother's lap.

Eritrea’s power in the region feels absolute even in the Axum Teaching Hospital, where Eritrean soldiers are among the gun-toting troops roaming the corridors, dropping off wounded soldiers and threatening medical staff. It is a terrifying scene for patients, many of whom say they were injured either directly or indirectly by soldiers.

One doctor, who asked not to be named, told CNN that the siege had prompted a surge in patients. In addition to cases of malnutrition like Latebrahan, doctors and nurses are treating a grim array of trauma from shrapnel, bullets, stabbings and rapes. In a desperate attempt to keep pace with demand, medical workers have also begun donating blood.

A sign at Axum University Teaching and Referral Hospital reads: "Blood Campaign, for mothers, for children, for all those that need it."

But despite this, there wasn’t enough blood on hand to save one young woman, who had been attacked by soldiers who tried to rape her.

The doctor treating the woman told CNN that the hospital had seen a spike in sexual assault cases over recent weeks, but that the rise was just “the tip of the iceberg,” as many were too scared to seek medical services.

An alarming number of women are being gang-raped, drugged and held hostage in the conflict, in which sexual violence is being used as a weapon of war and its use linked to genocide. According to one agency’s estimate, almost one-third of all attacks on civilians involve sexual violence, the majority committed by men in uniform.

An autopsy photo of the young woman seen by CNN showed her internal organs spilling out from a wound in her lower abdomen.

“She came to our emergency department and she had a sign of life initially. [But] if you find blood for a patient, it’s only one or two units and one or two units could not save this woman. She bled [out] and she died,” the doctor said haltingly, overcome with emotion.

He took a deep breath, then added, “I see this woman in my dreams.”

This reporting would not have been possible without the support of dozens of Tigrayans, who shared their stories at great personal risk. CNN is not naming them to protect their safety. It also builds on a series of investigations into massacres and sexual violence in Tigray by CNN’s Bethlehem Feleke, Gianluca Mezzofiore and Katie Polglase. Read CNN’s full Tigray coverage here

Nima Elbagir and Barbara Arvanitidis reported from Axum. Eliza Mackintosh wrote and reported from London. CNN’s Richard Roth in New York and Jennifer Hansler in Washington, DC, also contributed to this report.

Design and visual editing by Natalie Croker, Sarah Tilotta and Muhammad Darwish.