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LONDON: In Sudan’s North Darfur region, by all accounts, a humanitarian catastrophe is unfolding as hospitals overflow, food supplies dwindle and families flee violence that has engulfed El-Fasher.

Since the paramilitary Rapid Support Forces stormed the city in late October, aid workers have been overwhelmed as civilians arrive on foot in nearby towns while many others remain missing.

“Right now, many people are arriving to locations like Tawila, Al-Malha, Melit and Kosti with no possessions and in desperate need of humanitarian support,” Kashif Shafique, country director at Relief International Sudan, told Arab News by email.

“Terrifyingly, hundreds of thousands are still missing and unaccounted for. It will take some families weeks to reach safe havens; a lot of people who were already severely malnourished are in open deserts without enough to eat or drink.”

Sudan plunged into conflict in April 2023 after a violent struggle for power broke out between the RSF and the Sudanese Armed Forces.

More than 150,000 people were killed across the country, and about 12 million have fled their homes in what the UN has called the world's largest humanitarian crisis.

For many, not knowing the fate of loved ones since Oct. 26, when the RSF seized El-Fasher, has been agonizing, according to Sudan-based journalist Yosra Sabir.

“Everyone I speak to fears that their families are dead,” she wrote in a LinkedIn post on Oct. 30. “They are desperately reaching out to contacts in Tawila to see if anyone has made it there, or scanning through hundreds of graphic videos, trying to recognize their relatives among the victims being humiliated and killed on camera.”

In Tawila, about 60 km from El-Fasher, people have been trickling in — exhausted, starved, traumatized and injured — many missing family members.

“Among all the people arriving in Tawila, we are seeing very few adult men,” Javid Abdelmoneim, president of Medecins Sans Frontieres, said in a statement on Oct. 28.

“Given the history of ethnically targeted violence in El-Fasher, we are deeply concerned about the risk of a potential bloodbath.”

He also highlighted that his teams have been observing “extremely alarming levels of malnutrition among women and children … indicative of a famine-like situation.

Sabir noted that “the testimonies of survivors from the genocide in El-Fasher are beyond horrific.”

“Starved and skeletal, they describe witnessing their loved ones executed before their eyes, being beaten, raped, injured, and then forced to flee for their lives — running past countless bodies that lined the road.”

According to the International Organization for Migration, 33,485 people were displaced from El-Fasher in just three days, from Oct. 26 to 28. Since April, more than half a million have arrived in Tawila from El-Fasher and nearby towns, the Norwegian Refugee Council said.

But the road to Tawila is perilous.

One man who escaped described the suffering during the four-day journey on foot. “We were divided into groups and beaten,” he told the BBC on Oct. 30. “We saw people murdered in front of us. We saw people being beaten.

“I myself was hit on the head, back and legs. They beat me with sticks. They wanted to execute us completely. But when the opportunity arose, we ran, while others in front were detained.”

Sabir noted that even by car, the journey is far from easy. “Fleeing to Tawila may sound like a short escape, but it is not,” she wrote. “The dirt road from El-Fasher to Tawila takes around three hours by car. Though it’s only about 70 km on the map, the road winds and twists, making it even longer.

“People who have been starving under siege for months are now walking this entire distance on foot.”

The walk takes three to four days, according to the UN Human Rights office.

“There’s no safe passage out,” said Shahd Hammou, senior country program manager at the Center for Civilians in Conflict. “There is no access to aid, humanitarian aid is blocked, and staff continue to come under attack.”

Hammou stressed the “urgent need” to guarantee safe routes for fleeing civilians, end attacks on infrastructure and aid workers, and allow unrestricted humanitarian access.

“Without these immediate actions,” she told Arab News from Port Sudan, “civilian protection and humanitarian response will collapse — or rather continue to collapse, leaving millions and millions of people beyond the reach of both safety and support.”

Port Sudan is currently under the SAF’s military control, serving as the de facto seat of its government. SAF consolidated control over Port Sudan and central and eastern Sudan after retaking Khartoum from the RSF in March 2025.

Despite the loss of the capital, the RSF currently holds sway across the vast Darfur region in western Sudan.

In Tawila, the situation is “heartbreaking,” a Relief International staff member, whose name is being withheld for safety reasons, told Arab News.

“Most of the cases we are seeing are related to trauma injuries and malnutrition, as well as complications following long journeys without clean water, medical care or shelter,” the aid worker said.

“One case that stayed with me was a young boy who arrived severely dehydrated and weak, but he slowly recovered after receiving emergency support.”

Relief International runs more than 130 health facilities across Sudan, but humanitarian access to El-Fasher has been severely restricted since April 2024 due to the ongoing siege.

After tightening that siege for 18 months, reportedly depriving residents of food, water and medical supplies, the RSF seized the last major SAF stronghold in Darfur.

As in previous assaults on the city, civilians bore the brunt amid already dire conditions.

UN agencies warn that roughly 250,000 civilians remain trapped in the city, including an estimated 130,000 children facing severe shortages of food, clean water and medicine.

At least 1,500 people were killed in just two days as residents tried to flee, said Tasneem Al-Amin, a spokesperson for the Sudan Doctors Network.

In a post shared by the medical group on X, Al-Amin described the situation as “a true genocide based on ethnicity.”

Echoing those words, Mona Nour Al-Daem, the SAF government’s deputy commissioner of humanitarian aid, denounced the assault as “genocide against unarmed civilians.”

Speaking in Port Sudan, she said RSF forces had “executed patients and the wounded in hospitals” and hunted civilians fleeing the city, with many victims subjected to sexual violence.

Satellite imagery analyzed by the Yale University Humanitarian Research Lab shows pools of blood and human bodies in El-Fasher after the RSF takeover, corroborating reports of mass killings.

In a paper published Oct. 27, researchers noted that “El-Fasher appears to be in a systematic and intentional process of ethnic cleansing of Fur, Zaghawa and Berti indigenous non-Arab communities through forced displacement and summary execution.”

Videos circulating on social media, reportedly filmed by RSF fighters, show armed men terrorizing unarmed civilians, including women holding small children.

“We’ve seen really horrifying footage being circulated on social media and the news, with witness accounts pointing to house-to-house killings and entire families being executed,” said Hammou.

“It’s one of the darkest chapters of the Darfuri conflict in decades — El-Fasher has become a slaughterhouse.”

The UN Human Rights office warned on Oct. 31 that atrocities in El-Fasher and in Bara, North Kordofan, could amount to “numerous crimes under international law.”

It said that in El-Fasher, communications were cut and the situation “chaotic on the ground,” with reports of sexual violence and attacks on shelters for displaced families.

It quoted witnesses as saying that at least 25 women were gang-raped at gunpoint when RSF forces entered a shelter for displaced people near El-Fasher University, “forcing the remaining displaced persons — around 100 families— to leave the location amid shooting and intimidation of older residents.”

On Oct. 29, RSF leader Mohamed Hamdan Dagalo acknowledged “violations” in El-Fasher and promised an investigation. A day later, a senior UN official said RSF representatives claimed to have arrested suspects.

Hammou warned that “the fall of El-Fasher marks a dangerous new phase in Sudan’s war, with the violence spreading toward Kordofan, an area that had previously sheltered thousands of displaced people from Darfur.

“Further instability there would really trigger new waves of displacement, leave entire communities exposed to renewed violence, and shrink the possibilities and likelihoods of the protection of civilians and access to humanitarian aid and safety,” she said.

On Oct. 30, the Sudan Doctors Network accused the RSF of “summarily executing” 38 civilians in the village of Umm Dam Hajj Ahmed in North Kordofan state “on charges of army affiliation.”

The medical group also wrote on X that more than 4,500 people have been displaced from Baba, with 1,900 of them reaching El-Obeid city by Oct. 31.

As the violence intensifies, humanitarian workers, who are often the first and sometimes the only responders in crisis zones, have also become targets.

Medical facilities have been ransacked and staff killed. On Oct. 28, RSF militants reportedly attacked El-Fasher’s main medical center, the Saudi Hospital, and “cold-bloodedly” killed 460 people, said the Sudan Doctors Network.

The next day, five Sudanese Red Crescent Society volunteers were killed in Bara, in North Kordofan state, the organization said in a statement.

Amid the mayhem, aid teams are struggling to meet the rising needs.

Relief International’s Shafique said aid teams “are doing everything we can to provide life-saving health care, however the locations receiving an influx of displaced people were already severely overwhelmed with nowhere near enough resources.”

Dr. Zahra, who is part of Relief International’s mobile team in Tawila, said the near-collapse of Sudan’s health system has left “the few remaining facilities overwhelmed.

“Even prior to the latest surge of displacement from El-Fasher, the number of health consultations our teams were delivering often surpassed 80 — and at times 100 — patients per day, stretching both staff and resources,” she told Arab News by email through the NGO’s media department.

“People here are starving and dying from preventable diseases,” she said. “Every day, children who arrive at our clinics could survive, if only the right treatment and nutrition was available.”

Likewise, MSF’s Abdelmoneim said Tawila Hospital is “overwhelmed” and its surgical team “working at full capacity.”

Humanitarian groups are calling for an urgent surge in aid and safe, unimpeded access to affected communities.

Hammou, of the Center for Civilians in Conflict, gave warning that “humanitarian access is dwindling further, particularly in Darfur. It’s been brought to a standstill by the violence and then further consolidated by the fall of El-Fasher to the RSF.”

She added: “This brings entire populations further cut off from food, from water and medical relief.”

Separately, the Tawila-based Relief International staffer said: “Our most urgent needs are medical supplies, adequate shelter, clean water and food, as well as more support for our frontline health workers.

“We hope the world will not forget Sudan.”

Before the war erupted in April 2023, 15.8 million people in Sudan needed humanitarian assistance, according to UN figures. Now, that number has doubled to 30.4 million — more than half the population.

The World Food Program says 24.6 million people are acutely food insecure, while 637,000 face catastrophic hunger.

According to Relief International Sudan’s Shafique, the situation “is only getting worse” as conflict, famine and disease claim more lives daily.

For her part, Hammou said: “Repeated displacement is taking a devastating toll on families, who have been forced to flee time and again, constantly searching for new places of refuge.

“Towns that once offered safety are now overwhelmed, leaving people with nowhere stable to go — no food and no shelter.”

Yet even those who manage to flee are the fortunate few. Most remain trapped in horrific conditions, cut off from aid and the outside world.

“We’ve seen only a small minority flee from El-Fasher toward Tawila, Melit and other North Darfur localities along the border with Chad, while the vast majority remain trapped in and around the city, cut off and besieged by the paramilitaries,” Hammou said.

“With both Darfur and Kordofan destabilizing, civilians face an impossible choice; stay under fire or flee into the unknown.”

The RSF has denied involvement in what it calls “tribal conflicts,” and in the Oct. 29 video statement, Dagalo said any “soldier or any officer who committed a crime or crossed the lines against any person … will be immediately arrested and the result (of the investigation) to be announced immediately and in public in front of everyone.”

According to a BBC News report, “it is not clear how much control the RSF leadership has over its foot soldiers, a loose mix of hired militias, allied Arab groups and regional mercenaries, many from Chad and South Sudan.”