NAIROBI, Kenya (AP) — Many of the hospitals in Ethiopia’s conflict-hit Tigray region, outside its capital, have been struck by artillery during the two months of fighting, according to the first humanitarian assessment of the devastation as aid begins to arrive with desperately needed supplies.

The scale of the damage has been largely unknown while Ethiopian forces pursue and clash with those of the now-fugitive Tigray regional leaders, with the involvement of troops from neighboring Eritrea. Transportation and communications links were severed. More than 50,000 people have fled to Sudan, some telling The Associated Press of mass abductions, torture and killings along ethnic lines.

The United Nations and rights groups have long emphasized that intentional attacks on hospitals are war crimes. The assessment does not say who fired at hospitals; the U.N. humanitarian agency said it did not have confirmation of such details.

Tigray leaders dominated Ethiopia’s government for nearly three decades before Prime Minister Abiy Ahmed came to power and sidelined them amid sweeping reforms that won him the 2019 Nobel Peace Prize. Abiy has rejected international “interference” in the conflict, which continues outside the Tigray capital, Mekele, and in other areas.

The full humanitarian assessment, seen by the AP, was prepared by a joint mission of Ethiopia’s government, U.N. agencies and aid groups that visited the Mekele and communities in southern Tigray in late December after weeks of pleading by the U.N. and others for access.

Food, medical supplies and other basics have run alarmingly low across the region. The assessment cites regional authorities as saying more than 4.5 million people, more than two-thirds of the population, need humanitarian assistance.

“The little food stock the affected communities had have either been looted, burned, or damaged,” the assessment says, adding that a locust outbreak has worsened the situation. “Living conditions for both recently displaced people and host communities remain very critical."

It adds: “As a result of the conflict, many houses, shops, and private stores were burned or damaged.” Schools, health centers, shops and other buildings were looted.

An even grimmer picture expected from an assessment based on a visit to western Tigray, where some of the fighting first erupted in early November.

The European Union's foreign policy chief, Josep Borrell, said Saturday that he had spoken with Ethiopia's deputy prime minister, Demeke Mekonnen, “and conveyed the EU’s alarm over the situation in Tigray. Full and unrestricted humanitarian access must be granted. This is not an EU demand — this is international law.”