The devastating war in the Tigray region of Ethiopia which started on October 3, 2020 has ended with cessation of hostilities agreement on Nov 3, 2022. However, the dire health impacts of the conflict especially those caused by the triple whammy, shelling and air bombing by unmanned aerial vehicles (UAV), weaponized siege and famine, are continuing to cause deaths and morbidity. While a systematic assessment of the evidence was not possible due to blackouts, accumulating reports show that the impacts on civilian’s health are devastating. The objective of this study is to assess the impact of these factors on civilian casualties and their geographic distribution.

We gathered data on all aerial strikes in non-war zones using a consecutive sampling technique from mid-June 2021 to mid-January 2022. Data were collected using a structured reporting format prepared for the purpose of morbidity and mortality records. Initially, we identified the locations where the strikes occurred and subsequently mapped them using geo-mapping techniques, utilizing coordinates for precise documentation. We then documented all victims from each site, presenting their frequency and percentage by geography, type of episode and demography.

During the study period 60 episodes (each having three or more shelling) occurred. Around 60 residential houses, four schools, and three hospitals were targets of the attacks. A total of 1097 civilian casualties were recorded, of which 32.0% were killed. Sadly, 89.0% of the victims were targeted while they were at their residential areas. Almost all the casualties of the indiscriminate bombings were civilians including an 8-month infant, 87-year elderly, and pregnant mothers. Pregnant and lactating constitute 45.4% of the total affected while children under 18 years constitute 28.2%.

The findings highlight the devastating impact of aerial bombings on civilian populations in the Tigray. The deliberate targeting of residential areas and essential health facilities underscores the indiscriminate nature of the attacks and violation of international law resulting in significant loss of life and injuries, particularly among vulnerable population groups such as women and children. We call for a collective action for the enforcement of existing international laws against weaponization of healthcare, food, and unlawful UAV attacks.