According to a UN World Food Program assessment issued on Friday, over 40% of residents in Ethiopia’s Tigray area do not have enough food after 15 months of fighting (WFP).

The organization examined 980 families in the region and discovered that three-quarters of individuals are employing severe coping tactics such as reducing the amount of meals they consume each day.

The conflict began in November 2020, between the Ethiopian government and its supporters against Tigrayan troops loyal to the Tigray People’s Liberation Front (TPLF), the political group that administers the Tigray region.

Thousands of people have been murdered and millions have been displaced throughout three areas of Ethiopia and into neighboring Sudan as a result of the fighting.

Legesse Tulu, the government’s spokesperson, did not immediately reply to a request for comment on the UN assessment, but he did tell Reuters on Monday that the TPLF is using “hunger as a political instrument.”

The study comes as international worries over humanitarian access to the Tigray area rise once more.

Although the capacity of aid workers to access Tigray improved throughout the summer months and “kept famine at bay” for people there, no assistance convoy has arrived since mid-December, according to WFP.

The Ethiopian government said last week that 43 trucks would carry food and other help to Tigray, but no trucks have come as violence continues along the border between Afar and Tigray. The administration claimed in a statement on Friday that a convoy delivering food and medication was forced to return due to violence blamed on the TPLF.

A doctor at the Ayder Referral Hospital in Mekelle, Tigray’s regional capital, told Reuters that hospital employees had not been paid in eight months. According to the doctor, some physicians and nurses have had their own children brought to the hospital for malnutrition, and some employees have resorted to begging for food.

According to the UN Office for the Coordination of Humanitarian Affairs, all foreign relief organisations operating in Tigray have ran out of fuel. A request for comment on that story was not immediately responded to by a government spokeswoman.