NAIROBI, Kenya (AP) — The United Nations says food distribution in Ethiopia’s blockaded Tigray region has reached its “all-time lowest” while more than 50,000 children are thought to be severely malnourished, the latest sign of growing crisis amid efforts to end the country’s 14-month war.

Thursday’s update by the U.N. humanitarian agency says food aid stocks and fuel are “almost entirely exhausted” in the region of some 6 million people, where a government blockade was imposed in late June 2021 to keep supplies from reaching Tigray forces battling Ethiopian and allied troops.

Conditions under the blockade have become so dire that the International Committee of the Red Cross in a statement this week said some doctors in Tigray are now using salt to clean wounds, handing out expired medications and reusing single-use items such as chest drains and gloves.

The war also has affected Ethiopia’s neighboring regions of Amhara and Afar, where rebuilding has begun after Tigray forces retreated back into their region in late December under a drone-supported military offensive. The U.N. update says more than a half-million people in Amhara received food assistance during the week ending Jan. 12.

During that time, food aid reached only about 10,000 people in Tigray, the U.N. said.

The recent shift in the war, and talk of national dialogue, was seen as an opening for further mediation efforts and new U.S. special envoy David Satterfield was in Ethiopia on Thursday to meet with senior officials.

On Wednesday, United Nations Secretary-General Antonio Guterres after a call with the African Union envoy leading mediation efforts said he was delighted to hear “there is now a demonstrable effort to make peace” in Ethiopia, but neither he nor envoy Olusegun Obasanjo’s spokesman gave details.

Fighting continues. Several drone strikes have killed scores of civilians in Tigray in recent weeks.

When asked why Ethiopia’s military didn’t pursue the Tigray forces into their region when they retreated, an army general on Thursday told the state-affiliated Fana Broadcasting Corporate that Ethiopia has concluded part one in the war “and that, by definition, means there will be part two.” Gen. Abebaw Tadesse added that “we will go there and discard the enemy. … It’s just a matter of time.”

The war’s combatants also include soldiers from neighboring Eritrea, who are allied with Ethiopian forces and blamed by witnesses for some of the worst atrocities in the war, as well as fighters from Amhara who now occupy western Tigray.

In light of Eritrea’s involvement, “any possibility of ending the war through a negotiated settlement goes directly through Asmara,” Eritrea’s capital, the leader of the Tigray forces, Debretsion Gebremichael, wrote Thursday in The Africa Report.