UNITED NATIONS (AP) — The U.N. humanitarian chief warned the Security Council that the humanitarian crisis in Ethiopia’s embattled Tigray region is worsening and “there is a serious risk of famine if assistance is not scaled up in the next two months.”

In a note to the council obtained Wednesday by The Associated Press, Mark Lowcock said: “It is clear that people living in the Tigray region are now facing significantly heightened food insecurity as a result of conflict, and that conflict parties are restricting access to food.”

He said the latest alert on May 19 from the Famine Early Warning System Network indicated that central and eastern Tigray and some areas of the northwest and southeast are currently in Phase 4, which means at least 20% of the population faces “emergency food insecurity.”

Lowcock said the estimated population in those areas is 3.3 million people and the network says they face “very high acute malnutrition and excess mortality.”

No one knows how many thousands of civilians or combatants have been killed since months of political tensions between Ethiopian President Abiy Ahmed’s government and the Tigray leaders who once dominated Ethiopia’s government exploded into war last November. Eritrea, a longtime Tigray enemy, teamed up with neighboring Ethiopia in the conflict.

Lowcock painted a grim picture of Tigray since November, with an estimated 2 million people displaced, civilians killed and injured, rapes and other forms of “abhorrent sexual violence” widespread and systematic and public and private infrastructure essential for civilians destroyed, including hospitals and agricultural land.

“The destruction and violence against civilians continue even now across Tigray,” he said.

Lowcock said the need for food is driven in part by below average rains, desert locust infestations, economic conditions and the COVID-19 pandemic, but added that “the scale of the food crisis Tigray faces today is a clear result of the conflict and the behavior of the parties.”

The conflict broke out at the peak of the last harvest season, and over 90% of the harvest was lost due to looting, burning and other destructive activities and 80% of the livestock in the region were also looted or slaughtered, he said. In addition, 46% of general and primary hospitals aren’t functioning because of looting and destructive actions and 37% are only partially functioning, he said.

“Having missed one harvest, the region now faces a second failed agricultural season, as continued fighting is preventing planting before rains beginning in June,” Lowcock said. “This means that we project the population will be even more dependent on the delivery of humanitarian relief in the coming months.”

He said that since March, humanitarian organizations have been scaling up their presence and response and are targeting 5.2 million people in need of food, including all 3.3 million in the Phase 4 emergency areas.

But despite improvements in March, Lowcock said access for humanitarian workers has recently deteriorated, with organizations told by “armed actors” to stop distributing food in some areas and many humanitarian vehicles turned back at checkpoints and regularly searched. As a result, he said, “not nearly enough support is being provided.”

Lowcock said the three main providers of food assistance reached 2.2 million people in Tigray between March 27 and May 12, but “this falls far short of the 5.2 million in need of support.”

“Concrete measures are urgently needed to break the vicious cycle between armed conflict, violence and food insecurity,” he said. “I urge members of the Security Council and other member states to take any steps possible to prevent a famine from occurring.”