The common hippopotamus (Hippopotamus amphibius) is one of the most endangered mega herbivore in Africa. Although the human-hippo conflict (HHC) is currently escalating due to habitat loss, little is known about the scope of the conflict and potential mitigation measures. From 2021 to 2022, the extent of HHC, the perception of local inhabitants towards the animal, and its impacts on the conservation of the hippo were assessed within and in the surrounding areas of Dhidhessa Wildlife Sanctuary, southwestern Ethiopia. A total of 227 households were used as a data sources, participating in the questionnaire survey, focus group discussion and key informant interviews. Direct field observations were also used as key data source. Crop raiding and damage (63%, n = 143), was the most severely reported source of conflict, followed by direct human attack (22.9%, n = 52). Livestock predation and increased hippo mortality were also common types of HHC in the area. According to the study, the majority of respondents (74.4%, n = 169) agreed that the trend of conflict was increasing, while 16.7% (n = 38) argued that there was no change. Food scarcities in the buffer zone, as well as agricultural expansion in the area, have been identified as major drivers of HHC. The majority of respondents had a negative attitude toward hippo conservation; however, there were differences based on gender, age, and educational level. The major traditional hippo conflict mitigation strategies in the area include guarding, fencing, and trenching. Field observation revealed that a large extent of the former grazing and ranging areas of hippo in the area are heavily encroached and taken over by large private and public agricultural investments. Vacating and recovering at least the former buffer areas dedicated to the wildlife in the area and modern, non-lethal mitigation strategies are recommended for better conservation and safeguarding of the currently good-sized hippo population of the sanctuary.