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Background The COVID-19 pandemic exposed critical care disparities in low-resource settings. In Ethiopia, intensive care unit (ICU) expansion had begun prior to COVID-19 but accelerated during the pandemic with substantial new investment. This study provides the first nationwide assessment of ICU capacity, service readiness and patient characteristics across both public and private hospitals.Methods A cross-sectional survey was conducted in 2024 across all Ethiopian hospitals with operational ICUs, using site visits and standardised tools to assess facility capacity, staffing, equipment and preparedness. Patient-level data were collected for admissions on the survey day. Results were compared with pre-COVID-19 data to evaluate progress.Findings A total of 159 hospitals (117 public, 42 private) were surveyed, encompassing 1028 ICU beds. Public ICU facilities increased from 51 to 117 since COVID-19, with beds rising from 324 to 762. Private facilities added 266 beds (25.9% of the total). Improvements included 24/7 ICU-trained physician availability (52.1% vs 29.0% pre-COVID-19) and disaster preparedness plans (21.4% vs 6.0%). Persistent gaps were evident in advanced haemodynamic monitoring (available in <10 facilities) and organ support (9/117 public ICUs). Among 279 admissions (mean age 39.1 years; 55.2% male), neurological (32.1%) and respiratory (25.8%) conditions predominated, with sepsis observed in 29.4% of patients. Hypertension (25.1%) and diabetes (17.2%) were common comorbidities.Interpretation Ethiopia’s ICU capacity has tripled since 2019, with a more balanced regional distribution and improved workforce coverage; however, deficits in advanced monitoring, organ support and referral coordination limit the system’s readiness. The high burden of sepsis among ICU patients highlights systemic gaps in early recognition and supportive care; this supports scaling Essential Emergency and Critical Care as a foundational platform, alongside targeted improvements in infection management and antimicrobial stewardship. Strengthening public-private integration, standardised referral systems and cost-effective, high-impact interventions will be key to improving equity and outcomes in Ethiopia and comparable settings across sub-Saharan Africa and other low-resource contexts.