She was the second daughter of Ludvig of Hesse-Darmstadt and Alice, daughter of Queen Victoria, and sister to the last Tsarina. Her family name was Ella. She refused a proposal from her cousin later Kaiser Wilhelm II of Germany, and married another cousin Grand Duke Sergei Alexandrovich. Elisabeth converted to Orthodoxy and became extremely devout, to her husband's exasperation. She seems to have been happy with him, although neither showed much feeling or spent much time together. There were no children. Family diaries and letters reveal a great deal about Elisabeth. She was extremely beautiful, tall and blonde with blue-grey eyes. She designed her own dresses, and was extremely stylish; each outfit had its own lavish jewellery given by her husband. Everyone at the Russian court thought her wonderful.

Sergei was governor of Moscow and extremely cruel. In 1905 he was blown up by a bomb. Elisabeth witnessed it, and looked for his head which she couldn't find. She then went to see his assassin in prison, forgave him, gave him an icon and said she would pray for him.

She gave away her jewels, sold her belongings, and with her millions of roubles built the convent of Martha and Mary, becoming Mother Superior of the Order of the Sisters of Love and Mercy. The habit was a grey wool robe, a wimple and a white woollen veil. Within a few years her convents were in every big city. They had hospitals, workshops and school, and were for the poor and outcast. Elisabeth lived in Spartan conditions, and spent her time nursing and praying. When war came in 1914 she continued her work, and refused to leave Russia at the Revolution. She was much loved by the people, but that did not save her.

In June 1918 she was arrested and taken to Alapaevsk. She, a nun, Varvara, and some of her family were thrown down a mineshaft, blasted by two grenades, and then burnt to death. The murderers heard hymn singing for some time.

In 1992 the Russian Orthodox Church declared her a saint, Elisabeth Romanova. Her statue is one of those above the west door of Westminster Abbey