Sudan’s civil war has faded from the headlines, but monitors say it’s the world’s largest humanitarian crisis

The number of Sudanese risking their lives to escape the besieged town of El Fasher in North Darfur is increasing as the paramilitary Rapid Support Forces (RSF) intensify their attacks on the regional capital, according to aid agencies including Medecins Sans Frontières (MSF).

“The numbers are still increasing (from) mid-August until now,” said Romain Madjissembaye, MSF project manager in Tawila. Located about 60 kilometers west of El Fasher, it has become a major hub for displaced people.

He said last week they saw about 90 people arriving in critical condition. “A lot of them are malnourished and they’re facing executions on the road, some shootings,” Madjissembaye told CBC News via a Zoom interview.

An estimated 260,000 civilians, including 130,000 children, remain trapped in El Fasher according to United Nations agencies. Surrounded by RSF militias on three sides, the town has now endured more than 500 days of siege, cut off from food, medicine or a safe exit.

Some media reports suggest that people must eat animal foods to survive.

MSF withdrew from El Fasher – one of the few places not under RSF control in Darfur – in August 2024, just months after the siege began in May.

“The situation has become very, very delicate,” Madjissembaye said. “We (faced) a lot of security issues, bombing. Our team, our patients, they don’t feel safe.”

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Doctors use mosquito nets to dress wounds

He says they have now appealed to those who manage to get to Tawila d’El Fasher for more information on conditions inside.

One man, who arrived last month with gunshot wounds to his shoulder and leg, told MSF that doctors at El Fasher’s last standing hospital were using mosquito nets to dress.

Madjissembaye said another man had also described dire conditions at the hospital.

“He found many patients (with) bullets in their bodies. Some of them needed amputation. But there are few doctors (left). And they also lacked medicine.”

He said there were also numerous reports of women who had been raped or abused on the road to El Fasher.

Tawila has now become a massive refugee camp with hundreds of thousands of people displaced from El Fasher and the Zamzam displacement camp on the outskirts of the city.

Last week, during Tawila’s visit, UN humanitarian coordinator Denise Brown called it “one of the epicenters of a humanitarian catastrophe.”

“It took us five days, in three countries, three different planes and three days of driving. We had to go around because there are so many front lines in Sudan,” she said, highlighting the challenges of aid travel.

“Stop the violence, stop the war, let us through.”

Agencies struggled to provide help

Sudan has been caught in the grip of a devastating war since April 2023, when two generals who had joined forces to stop a transition to civilian rule fell and turned on each other.

The RSF has been pitted against the Sudan Armed Forces (SAF) ever since, now controlling most of Darfur and neighboring Khordofan, while the SAF controls the north and east of the country.

When the SAF retook Khartoum earlier this year, the RSF turned its attention to El Fasher, the last SAF stronghold in Darfur.

Reports from the ground suggest that civilian gathering points like communal kitchens are increasingly being targeted by RSF bombardments as fighters move closer to the city center.

Last month, a drone attack on a mosque killed more than 70 people.

On Saturday, an umbrella group of various “resistance committees” in El Fasher made up of local residents, said on Facebook that the town had become an “open morgue.”

The group said residents were facing deliberate and indiscriminate shelling with attacks on markets and hospitals.

Despite its absence from the world’s headlines, Sudan is the world’s largest humanitarian crisis, according to international monitors.

The United Nations says more than 12 million people have been moved since spring 2023.

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Aid agencies say they fear an even greater humanitarian crisis if the RSF overruns the city.

Madjissembaye says MSF’s capacity has already been pushed to the limit.

The town and surrounding areas are controlled by a group called the Sudan Liberation Movement (SLM), which has adopted neutral positions in the past. But aid must come from the border with Chad, and these convoys face enormous challenges.

“It may take weeks to receive an offer,” Madjissembaye said. “And sometimes (activists) stop the convoy on the road. Sometimes they target the convoy.”

‘Horror technology has evolved’

International monitors have accused both sides in the conflict of atrocities.

The RSF today, led by General Mohamed Hamdan Dagalo, grew out of the notorious Janjaweed militias accused of genocide against non-Arab tribes in Darfur in the early 2000s.

On Monday, the International Criminal Court in The Hague delivered its first war crimes verdict for Darfur in years.

Ali Muhammad Ali Abd-Al-Rahman – a leader of the Janjaweed militia known as Ali-Khoshayb – was convicted of crimes against humanity, including murder, rape and torture.

Dr Mukesh Kapila was the UN representative in Sudan in 2003-2004, witnessing the horrors. More than 20 years later, he says what’s happening on the ground now is even more brutal.

“And the reason is that horror technology has evolved. Twenty years ago, when Ali-Khoshayb was ruling the roost, he was using camels and horses and land rovers and Toyotas and things like that,” said Kapila, now emeritus professor of global health and humanitarian affairs at the University of Manchester.

“Today we have drones. We have missiles. We have more lethal weapons, better targeted weapons, but still with mass area effects.”