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CAIRO: When Ahlam Saeed awoke last month to the sound of gunfire and roaring vehicle motors, the 43-year-old widow rushed outside her home in war-torn Sudan to find a line of at least two dozen vehicles, many of them motorcycles carrying armed fighters.
“They were firing at everything and in every direction,” the mother of four said. “In an instant, all of us in the village were fleeing for safety.” Many people were gunned down in their houses or while trying to flee. At least 200 people were killed, including many women and children, in the community of straw homes, according to a rights group tracking Sudan’s civil war.
Saeed and her children — ages 9 to 15 — were among those who survived after rebel fighters rampaged through Shag Al-Num, the small farming village of several thousand people in Sudan’s Kordofan region. In interviews with The Associated Press, Saeed and four other villagers described the July 12 attack, one of the deadliest assaults since the war began more than two years ago over a power struggle between commanders of the military and the rival paramilitary group known as the Rapid Support Forces, or RSF.
The villagers’ accounts add to the devastating toll of the conflict, which started in April 2023 and has wrecked the country in northeastern African. The fighting has killed more than 40,000 people, displaced as many as 14 million, caused disease outbreaks and pushed many places to the brink of famine.
Atrocities, including mass killings of civilians and mass rape, have also been reported, particularly in Darfur, triggering an investigation by the International Criminal Court into potential war crimes and crimes against humanity.
‘Hell’s door was opened’
The villagers from Shag Al-Num said RSF fighters and their allied Janjaweed militias stormed into the community, looting houses and robbing residents, especially of women’s gold. Some victims were held at gunpoint.
Some young villagers attempted to fight back by taking up rifles to defend their homes. The RSF fighters knocked them down and continued their rampage, witnesses said.
“It was as if the hell’s door was opened,” Saeed said, sobbing. Her straw house and neighboring homes were burned down, and one RSF fighter seized her necklace. “We were dying of fear,” she said.
The villagers said the fighters also sexually abused or raped many women. One of the women said she saw three fighters wearing RSF uniforms dragging a young woman into an abandoned house. She said she later met the woman, who said she was raped.
Satellite imagery from July 13 and 14 showed “intentional arson attacks” and “a large smoke point” over the village as well as “razed and smoldering” buildings, the Humanitarian Research Lab at the Yale School of Public Health reported.
In the two-day RSF attack in Shaq Al-Noum and surrounding areas, more than 450 civilians, including 35 children and two pregnant women, were killed, according to UNICEF.
After the assault, many of the survivors fled, leaving behind a mostly deserted village.
The RSF did not respond to questions about the attack from the AP.
Both sides seek control of oil-rich Kordofan region

Beyond the village, the oil-rich Kordofan region has emerged as a major front line following the military’s recapture of Khartoum earlier this year. The warring parties have raced for control of the three-province region stretching across southern and central Sudan because it controls vital supply lines.
“Kordofan has become the most strategic area of the country,” said Cameron Hudson, an Africa expert with the Center for Strategic and International Studies.
The fighting has exacerbated the already dire conditions in the region.
In Kadugli, the provincial capital city of South Kordofan province, “roads have been cut off, supply lines have collapsed and residents are walking miles just to search for salt or matches,” said Kadry Furany, country director for Sudan at Mercy Corps aid group.
A mental health therapist in Obeid, the provincial capital of North Kordofan province, said the city received waves of displaced people in recent weeks, all from areas recently ambushed by the RSF.
The therapist, who spoke on the condition of anonymity because of concerns about her safety, said she supported 10 women and girls who endured sexual abuse, including rape, in RSF-seized areas in July alone. Among the victims were two women from Shag Al-Num village, she said.
“The conditions are tragic,” she said.
Another epicenter of starvation and disease
To the west of the Kordofan region is el-Fasher, the military’s last stronghold in the five-province Darfur region. The city — which has been under constant RSF bombardment for over a year — is one of the hardest hit by hunger and disease outbreaks, according to the UN
The World Food Program has been unable to deliver aid by land. It warned this month that 300,000 people, who are “trapped, hungry and running out of time,” are at risk of starvation.
“Everyone in el-Fasher is facing a daily struggle to survive,” said Eric Perdison, the food program’s director for eastern and southern Africa. “Without immediate and sustained access, lives will be lost.”
The paramilitaries and their Janjaweed allies imposed a total blockade of el-Fasher, leaving no route out of the city that the RSF does not control, according to satellite imagery recently analyzed by the humanitarian lab at Yale.
The blockade caused food prices to spike up to 460 percent higher than in the rest of Sudan, according to the African Center for Justice and Peace Studies. Most staples are scarce or no longer available.
Civilians who want to leave the city are required to pass through a single RSF-controlled point, where they have been robbed, forced to pay bribes or killed, according to the Yale lab, aid workers and residents.
On Aug. 2, a group of people, including women and children, attempted to flee the city. When they reached Garni, a village on a crucial supply route just northwest of the city, RSF fighters ambushed the area, residents said.
“They tell you to leave, then they kill you,” said Al-Amin Ammar, a 63-year-old who said he escaped because he is old. “It’s a death trap.”
At least 14 people were killed, and dozens of others were wounded in the village, said the Emergency Lawyers rights group said.
Aside from fighting, the region has been ravaged by lack of food and a cholera outbreak, said Adam Regal, a spokesman for a local aid group known as General Coordination. Many people have nothing to eat and resorted to cattle fodder to survive, he said. Some have not found even fodder, he said.
He shared images of emaciated children with their exhausted, malnourished mothers on the outskirts of el-Fasher or the nearby town of Tawila.
“People don’t await food or medicine,” he said, “rather they await death.”
The 12-year-old son of Sabah Hego, a widow, was admitted with cholera to a makeshift hospital in Tweila, joining dozens of other patients there.
“He is sick, and dying,” Hego said of her youngest child. “He is not alone. There are many like him.”

LONDON: In Gaza’s overwhelmed hospitals, doctors, nurses and other medical staff are battling against what many fear could be their most insurmountable challenge in nearly two years of Israel’s war on the territory’s people — hunger.

“We go to work sometimes without eating and we treat patients while actually feeling dizzy, lightheaded and weak,” said Dr. Mohammed Abu Mughaisib, a physician working in the territory. “The starvation is not just hitting families in Gaza it’s hitting the health workers too.”

Gaza’s health sector has been decimated by Israel’s devastating military assault. Hospitals have been bombed, doctors killed and detained, and medical supplies cut off.

Beleaguered and bloodied, health care workers are now locked in a daily struggle against hunger and malnutrition affecting people across the entire territory.

If the medical staff cannot eat and are not strong enough to perform the painstaking work needed to treat a battered and malnourished population, the situation can only deteriorate.

In accounts provided to Arab News from medical charities, hospital workers have described their daily struggles to find enough food to sustain them through their long shifts and feed their families.

They describe colleagues fainting at work, struggling to continue their lifesaving care for those bombed, starved and shot at as they try to reach the meagre food supplies making it into the territory.

Abu Mughaisib, who is the deputy medical coordinator for Medecins Sans Frontieres in Gaza, said that despite the decades of conflict affecting the territory, he never imagined such a situation.

He said most days he and his colleagues eat only one basic meal of bread with canned food or lentils.

Some days the market is completely empty, and there are never any vegetables, fruit, or meat.

“Honestly, we don’t have options,” he said, almost anticipating that those outside of Gaza would not believe him.

“In the hospitals there is no food for the medical staff. Some health workers faint during their shift. They clean the wounds, they deliver babies, and perform surgeries on empty stomachs.

“Some of my colleagues started to lose weight rapidly. Some of them cannot produce milk to breastfeed their babies. This is not just burnout this is real physical starvation.”

Dr. Saeed Salah, medical director of the Patient’s Friends Benevolent Society Hospital in northern Gaza, described the food shortages as the “greatest crisis” his colleagues and patients have faced.

“Some members of our medical staff themselves are malnourished and can no longer sustain the energy needed to perform their duties,” he said, in response to Arab News questions passed through the charity Medical Aid for Palestinians.

“Our emergency ward is overwhelmed with people who haven’t eaten for days and are in urgent need of IV fluids. In over 21 months of operating under crisis, we’ve never seen days like these.”

Summer Al-Jamal, a finance and admin assistant for MAP based at Nasser Hospital in southern Gaza, described the situation there as “deeply distressing.”

The hospital has been inundated with victims from shooting attacks on Palestinians gathered at aid distribution hubs nearby, as well as patients injured from Israeli bombings, or who are sick.

Increasingly, they have been treating malnourished families and their children.

“The hospital is heavily burdened with departments overwhelmed by trauma cases and critically injured patients,” she said after a recent visit to the facility. “The scale of suffering and the intensity of the emergency were unlike anything I had witnessed before.

“The medical staff appear exhausted, physically and emotionally. Many looked pale, fatigued, and undernourished. The toll of the past weeks had left them drained.”

After Israel launched its latest Gaza campaign in response to the Hamas-led attack in October 2023, the territory’s health service soon came under fire.

Casualties surged into hospitals, and the facilities also became targets for Israeli airstrikes. Nearly two years into the conflict, the health service is broken.

Of the 36 hospitals in the territory before Israel’s current war on Gaza, only 18 remain partially operational, and less than 40 percent of primary health care facilities are still functional, according to the World Health Organization.

All the facilities have been damaged and are flooded with patients far beyond their maximum operating capacities.

Gaza’s Health Ministry says Israeli forces have killed more than 1,500 Palestinian health workers since October 2023, with the WHO recording at least 700 attacks on health care facilities in the territory. 

Doctors and hospital staff have been detained, and more than 10,000 critically ill patients need to be evacuated.

And then there is the dwindling medical supplies. Israel imposed a complete 11-week blockade on Gaza in March, leading to desperate shortages of medicines and equipment for hospitals, along with basic food for the entire population.

The main UN agency distributing aid was forced to stop operating and was eventually replaced by the US- and Israeli-run Gaza Humanitarian Foundation. Some supplies have resumed but at a fraction of what aid agencies say is required.

The dire situation for the health sector was further exacerbated by the sharp increase in casualties last month as Israel ramped up its campaign in the face of an international outcry and widespread accusations of genocide. 

The WHO reported 13,500 injuries in Gaza in July — the highest since the first three months of Israel’s war on the territory. Many of these took place when Israeli troops repeatedly opened fire on crowds of Palestinians as they waited to collect food from GHF distribution points.

Amid all the carnage, the shortage of food means Gaza’s people are now dying from starvation. 

Late last month, the Integrated Food Security Phase Classification, a global initiative that analyses food security, warned that the “worst-case scenario of famine is currently playing out in Gaza.” The body said there would be “widespread death” without immediate action.

The Gaza Health Ministry said on Monday that 263 Palestinians had died of malnutrition and starvation, including 112 children, since the war started.

Images of emaciated children being treated at hospitals have shocked the global community in recent weeks.

Israeli officials have claimed the numbers are inflated and that the children died from pre-existing health conditions. Prime Minister Benjamin Netanyahu has dismissed reports of severe hunger as Hamas “lies” and insisted last week there is “no policy of starvation.”

His claims are at odds with those of doctors working in the territory, who have seen a surge in severe malnutrition cases.

Rowida Sabbah, MAP’s nutrition program lead in southern Gaza, described a recent case of a mother and her two children, aged 5 and 7, who had not eaten any bread for two months. 

“For two days she had only been able to give them just water,” Sabbah said. The mother finally reached a medical hub for help. “She was crying when she received the supplies,” she said. 

“Every time I see children suffering from severe hunger and wasting away, my heart breaks. They beg for anything … even just a slice of bread with a pinch of salt. That’s all they hope for.” 

For medical staff, the food shortages have pushed them to breaking point. Accounts given to Arab News describe the daily battle to source the most meagre of supplies, and desperate searches for small quantities of flour now selling at vastly inflated prices.

“Even health workers, already stretched to their physical and mental limits, are working long hours on little food, growing weaker as shortages persist,” Dr. Rik Peeperkorn, the WHO representative for the occupied Palestinian territory, told Arab News.

“No one can sustain this, yet they keep showing up because patients have no one else. We call for large-scale aid, including diverse and nutritious food, to be allowed via all routes.”

Support for Gaza’s medical teams has also come from more than 100 fellow health workers around the world who have spent time working in the territory during the conflict.

Last week they signed a letter expressing solidarity with their Palestinian colleagues as they are “starved and shot by Israel” as part of a “methodical attack” of the health system.

“Doctors, nurses, and first responders are all rapidly losing weight due to forced starvation at the hands of the Israeli government,” the letter stated. 

“Many suffer from hunger, dizziness and fainting episodes while performing operations and triaging patients in emergency rooms. Most have been displaced into tents after being forced from their homes, and many are surviving on less than a single serving of rice a day.” 

The letter called for the immediate release of detained health workers, an end to attacks on medical facilities, and the lifting of Israel’s blockade of humanitarian supplies.

With little sign of progress on a ceasefire and Israel’s ramping up of military operations around Gaza City, doctors in the territory are bracing for things to get even worse.

Yet despite their hardship, they are working to provide the best treatment possible to a people brutalized by Israel’s war.

“We are also facing a severe shortage of therapeutic infant formula,” Salah at the PFBS hospital said, focusing on the immediate challenges.

“Mothers are dehydrated and unable to breastfeed, and pregnant women are suffering complications and are at increased risk of miscarriage. Malnourished patients are deteriorating.

“Without urgent intervention, more lives will be lost.”