"You must specify a region" is a not an ECS specific error, it can happen with any AWS API/CLI/SDK command.
For the CLI, either set the AWS_DEFAULT_REGION
environment variable. e.g.
export AWS_DEFAULT_REGION=us-east-1
or add it into the command (you will need this every time you use a region-specific command)
AWS_DEFAULT_REGION=us-east-1 aws ecs list-container-instances --cluster default
or set it in the CLI configuration file: ~/.aws/config
[default]
region=us-east-1
or pass/override it with the CLI call:
aws ecs list-container-instances --cluster default --region us-east-1