Her paternal grandparents were Ludwig IV, Grand Duke of Hesse and by Rhine and Princess Alice of the United Kingdom. Her maternal grandparents were Alfred, Duke of Saxe-Coburg and Gotha and Maria Alexandrovna of Russia. Alice and Alfred were siblings.  Prince Alfred of the United Kingdom, Duke of Saxe-Coburg and Gotha and Duke of Edinburgh (born 6 August 1844 and died 30 July 1900), was the second son and fourth child of Queen Victoria and her husband, Prince Albert of Saxe-Coburg-Gotha. ... Grand Duchess Maria Alexandrovna of Russia (17 October 1853–24 October 1920) was the daughter of Alexander II of Russia and his first Empress consort Marie of Hesse. ...

Her parents 'Ernie' and 'Ducky' did not have a happy marriage. The cousins had married against their wishes by the unanswerable will of their common grandmother, Victoria.

Princess Victoria Melita was 18 at the time of Elisabeth's birth. She was fond of Elisabeth but in an absentminded way. Her father, on the other hand, was enchanted by his daughter from her earliest days. With enthusiasm, he took over her care, convinced - even before she could speak-that he alone could understand her.

At the age of six months, she was scheduled to move to a new nursery and her father 'consulted' her on her color preferences. He claimed that she made 'happy little squeals' when he showed her a particular shade of lilac material. Ernie then decorated her nursery in shades of lilac.

Around October 1901 her parents divorced, her mother having previously embarked on an affair with another cousin, her future husband, Grand Duke Kyril Vladimirovitch of Russia. Her parents divorce meant that Elisabeth divided her year between Darmstadt and her mother's new home in Coburg. Elisabeth was mistrustful of her mother, however Ducky enjoyed turning her daughter into an outstanding horsewoman. But otherwise, Elisabeth did not always fit into her mother's adult world. 

In 1903, Elisabeth and her father went to stay with Ernie's younger sister, Empress Alexandra Feodorovna of Russia and her family. At the imperial family's hunting lodge in Skierniewice, Poland, Elisabeth awoke with a sore throat, which the Russian Court doctor put down to too much excitement with her cousins the previous day. The imperial party went ahead as planned, however, by the evening Elisabeth grew worse. The doctor was certain she had a virulent form of typhoid, although rumours flew that she had eaten poison intended for uncle-by-marriage Nicholas II of Russia. Doctors told Alexandra that the child's mother should be notified, but the telegram did not arrive until the following morning, when Elisabeth had already died.

Elisabeth was placed in a silver casket, a gift from Nicholas II, for the long journey home to Darmstadt. Her father arranged a white funeral, with white instead of black for the funeral trappings, white flowers, and white horses for the procession. In his memoirs, written 30 years later, the still heartbroken father declared that the devastating journey on the funeral train would remain seared into his memory until his own death. 'My dearest Elisabeth,' he wrote, 'was my only sunshine'.

Elisabeth was laid to rest in the Rosenhohe. In a final gesture to Elisabeth and Ernie, Victoria Melita placed her badge of the Order of Hesse, granted to her upon her marriage, into Elisabeth's coffin.