NAIROBI, Kenya (AP) — The United States says it is sending a special envoy to Ethiopia as the fast-moving conflict in the Tigray region has spread into neighboring regions and Ethiopia’s government this week called on all able citizens to stop the resurgent Tigray forces “once and for all.”

The widening war in Africa’s second-most populous country, with 110 million people, is also a growing humanitarian crisis. Millions of people in Tigray remain beyond the reach of food and other aid as the United Nations and U.S. say Ethiopian authorities allow just a small fraction of what’s needed. And hundreds of thousands of people in the Amhara and Afar regions are displaced as Tigray forces move in, vowing to go to the capital, Addis Ababa, if needed to stop the fighting and remove the blockade on their region of 6 million people.

“It’s one of these cases where we’ve run out of words to describe the horror of what civilians are being inflicted,” U.N. spokesman Stephane Dujarric told reporters this week. “More conflict can only lead, sadly, to more civilian pain.”

Here’s a look at the latest in the nine-month war and what pressure the U.S. special envoy might apply.

WHAT IS THE U.S. SEEKING IN ETHIOPIA?

The U.S. announced overnight that special envoy Jeffrey Feltman would travel to Ethiopia, neighboring Djibouti and the United Arab Emirates, a key Ethiopia ally, starting on Sunday. This is a “critical moment,” White House national security adviser Jake Sullivan tweeted. “Months of war have brought immense suffering and division to a great nation, that won’t be healed through more fighting. We call on all parties to urgently come to the negotiating table.”

That seems highly unlikely. Ethiopia’s government this year declared the Tigray People’s Liberation Front, which dominated the government for nearly three decades before Prime Minister Abiy Ahmed took office in 2018, a terrorist group. The Tigray forces have set several preconditions for talks and say Abiy no longer has the legitimacy to govern. They retook much of the Tigray region in June in a dramatic turn in the war as Ethiopia’s military retreated.

What began as a political dispute has now killed thousands of people.

Discussing what pressure the U.S. could apply to encourage negotiations, a congressional aide told The Associated Press that “I understand all options are on the table, from Global Magnitsky (sanctions over human rights violations) to an executive order on sanctions, to removal from (the African Growth and Opportunity Act), to more restrictive measures on assistance,” as well as ways to block Ethiopia’s efforts to get cash from international financial institutions. The aide spoke on condition of anonymity because they were not authorized to speak publicly on policy discussions.

Officials and lawmakers in Washington have signaled impatience as Ethiopian officials deny widespread human rights abuses such as gang-rapes and forced expulsions of ethnic Tigrayans or blame the Tigray forces.

The Ethiopian government’s prickly dismissal of a new Amnesty International report on shocking sexual violence against Tigrayan women during the war “reflects the tone-deafness with which the government is handling the multiple conflicts and humanitarian crises across the country,” Senate Foreign Relations Committee ranking member Sen. Jim Risch tweeted on Thursday.

WHAT DOES ETHIOPIA’S GOVERNMENT SAY?

Ethiopia’s government has repeatedly expressed frustration, alleging without evidence that the U.S., U.N. and others are taking the side of the Tigray forces or supporting the fighters with aid. It has asserted that disproportionate attention is paid to the Tigray people and not enough is done to address alleged abuses by Tigray forces in the Amhara and Afar regions.

The most urgent allegation was raised by the U.N. children’s agency, which cited “credible information from partners” about deadly attacks last week on a camp for newly displaced people in Afar. A U.N. team plans to assess the scene as soon as security allows, the agency said Thursday. Ethiopia’s government has blamed the Tigray forces, whose spokesman Getachew Reda denied it but said they’re willing to cooperate in an independent investigation.

In the Amhara region, humanitarian groups are having trouble reaching their colleagues in Woldiya, one center of the fighting, amid a communications blackout. Now the Tigray forces have formed a military alliance with the Oromo Liberation Army, also designated by Ethiopia as a terrorist group.

On Thursday the prime minister’s spokeswoman, Billene Seyoum, told reporters that the government’s call to arms this week, signaling an end to a unilateral cease-fire, meant that Ethiopians are urged to stop the Tigray forces by “all means necessary.” She said this is not a result of the military’s inability to take on the Tigray forces, and asserted that “in the millions, people are taking this call.”

WHAT ABOUT THE FATE OF EVERYDAY PEOPLE?

Caught in the middle are civilians, and efforts to reach them with aid are increasingly challenging because of the Ethiopian government’s concern that it will end up helping the Tigray forces.

Just 10% of the aid needed for Tigray reached the region in recent weeks, the administrator of the U.S. Agency for International Development, Samantha Power, told reporters after a brief Ethiopia visit last week in which the prime minister did not meet her. USAID has estimated that up to 900,000 people in Tigray face “man-made” famine conditions while phone, internet and banking services remain cut off.

The U.N. World Food Program on Friday said at least 30 trucks a day must enter the region to address the need and what has arrived so far is a “drop in the ocean.”

Meanwhile, Ethiopia’s government has suspended the operations of two major international aid groups, the Dutch section of Doctors Without Borders and the Norwegian Refugee Council, accusing them of spreading “misinformation.” This has further deterred many humanitarian workers from speaking openly, worried about retaliation. It also means efforts to respond to the crises in the Amhara and Afar regions could be affected.

“Some humanitarian organizations may now alter their public messaging campaigns or self-censor to avoid facing suspension. This would further contribute to Ethiopia’s closing civic space,” the Washington-based Center for Strategic and International Studies wrote on Thursday.

That means even less knowledge about conditions on the ground as many journalists face government-imposed restrictions, it said, adding that “civilians will suffer.”