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Azerbaijan told hospitals to be ready for war and started what it called “intense” military exercises, raising the risk of an escalation in its conflict with Russian ally Armenia over the breakaway region of Nagorno-Karabakh.

All medical institutions and personnel received “specific instructions” from the Azeri Defense Ministry to “take the necessary measures to prepare for possible military action that can take place at any moment,” the ministry in the capital, Baku, said on its website on Thursday. The Defense Ministry said earlier in the day that its armed forces began drills involving tanks, armored infantry carriers and aircraft.

The conflict over Nagorno-Karabakh, frozen since a cease-fire 21 years ago, periodically threatens to spark a war on Russia’s southern periphery. Armenians took over the region and surrounding territory from Azerbaijan, which has repeatedly warned it will use force to regain it. Dozens of deaths have been reported this year in clashes on the front line.

An escalation would pose risks to the energy infrastructure around Azerbaijan. The Caspian Sea nation is the third-biggest oil producer in the former Soviet Union, and also provides the only westward route for central Asian crude that bypasses Russia.

The State Department is aware of the Azeri military measures and is watching the situation closely, spokesman John Kirby said in Washington on Thursday.

(Updates with State Department comment in last paragraph.)