called a concerted effort to destroy the region’s health care system. In his meeting with Mr. Abiy in March, Senator Coons said they discussed “directly and forcefully” the reports of widespread human rights violations including rape.

Whether Mr. Abiy delivers on his promise of bringing the perpetrators to justice, he added, “is going to be critical to any successful resolution of this conflict.”

marched into Mekelle on Nov. 28. Some said they had been raped by soldiers in the camps for displaced people on the edge of the city; others were abducted from their homes in rural areas and held for days as soldiers repeatedly raped them.

The doctor, who like several other medics spoke on the condition of anonymity for fear of reprisals from the authorities, produced a list of 18 registered sexual violence patients at the hospital. The youngest was 14. Most said their attackers were soldiers, he said.

In one bed, a 29-year old woman who asked to be identified only by her first name, Helen, trembled as she recounted how Eritrean and Ethiopian troops tied her to a tree near her home in Agula, 15 miles north of Mekelle, and assaulted her repeatedly over a 10-day period in late November.

“I lost count,” she said. “They took photos of me, poured alcohol on me and laughed.” Some of her assailants also shot dead her 12-year-old son, she added.

Selam Assefe, a police investigator working on rape cases at the Ayder Referral Hospital, corroborated Ms. Helen’s account.

Most sexual assault cases in Tigray, however, may not be recorded anywhere. Health workers said that officials are reluctant to register such violence, fearing the military could target them for documenting the crime. Patients often remain anonymous for the same reason.

Filsan Abdullahi Ahmed, Ethiopia’s minister of women, children and youth, insisted that the federal government was taking seriously the reports of sexual violence in Tigray, and had sent a task force including social workers, police and prosecutors to investigate.

While her own mandate was limited to providing victims with psychological support, Ms. Filsan said she had pressured Ethiopia’s attorney general to deliver justice. But it is a difficult process, she insisted.

“I cannot 100 percent confirm whom this is being committed by,” Ms. Filsan said, referring to the perpetrators.

The sexual attacks are so common that even some Ethiopian soldiers have spoken out. At a public meeting in Mekelle in January, a man in military uniform made an outburst that was broadcast on state TV.

“I was angry yesterday,” he said. “Why does a woman get raped in Mekelle city?” The soldier, who was not identified, questioned why the police weren’t stopping them. “It wouldn’t be shocking if it happened during fighting,” he said. “But women were raped yesterday and today when the local police and federal police are around.”

Haben, a waitress in Mekelle, was raped with two other women at the cafe where they work in December, she said. Her body is still covered in bruises from the assault.

“They told us not to resist,” she recalled. “‘Lie down. Don’t shout.’”

But even if they had shouted, she added, “there was nobody to listen.”

An employee of The New York Times contributed reporting from Mekelle, Ethiopia.

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