CAIRO/DUBAI: Residents are fleeing missile fire and sheltering without food and water amid escalating fighting in the Sudanese city of Al-Fashir, witnesses and aid workers said, adding to fears of an all-out battle.
The city is the Sudanese army’s last stronghold in the western Darfur region. Its capture would be a major boost for the rival Rapid Support Forces (RSF) as regional and international powers try to push the sides to negotiate an end to a 13-month war.
Locals and aid workers fear the clashes could also lead to a new round of bloodletting after ethnically-driven violence blamed on the RSF and its allies elsewhere in Darfur last year.
Many of Al-Fashir’s 1.6 million residents arrived during the violence between Arabs and non-Arabs that killed hundreds of thousands of people in the early-2000s. The RSF’s origins lie in the Arab janjaweed militias accused of ethnic cleansing and genocide then.
In recent weeks the RSF has almost surrounded Al-Fashir, capital of North Darfur state, while soldiers from the army and allied non-Arab armed groups fill the city.
In a sign of mounting ethnic tensions, Mini Minnawi, head of one of the groups, said on X he had made a wide call for fighters to come and defend Al-Fashir, in response to what he said was a similar call by the RSF.
Al-Fashir residents report snipers, stray missiles and army air strikes causing fires in the east and north of the city. Many civilians have taken up arms.
“The situation in the city has been difficult the past few days. Missiles from both sides are falling inside neighborhoods and homes, and getting to hospitals is dangerous,” said 38-year-old resident Hussein Adam.
Medical aid agency MSF said on Thursday that the city’s South Hospital had seen 489 casualties since May 10, including 64 deaths, though it said the real toll was far higher.
Another hospital it supports, which saw 27 people killed last weekend, was forced to shut down after an army air strike 50 meters away, MSF said.
The RSF and army blame each other for the violence.
On Wednesday, the United States imposed sanctions on two top RSF commanders, including the force’s head of operations, for the attacks on Al-Fashir.
“We are prepared to take further action against those who actively escalate this war – including any offensive actions on El Fasher – create barriers to humanitarian access, or commit atrocities,” US ambassador to the United Nations Linda Thomas-Greenfield posted on X.
Experts have raised warnings of impending famine in the displacement camps that dot Al-Fashir. The city also suffers from water shortages, network outages, and high prices.
In one of those camps, Abu Shouk in the north of the city, nine people were killed by stray missiles, camp leaders said on Sunday.
Residents say displaced people from eastern neighborhoods are sheltering under trees and in open squares.
“Most families have moved west, women and children with nothing to eat or drink,” said resident Mohamed Jamal, a volunteer with the local emergency response room.
The army has so far insisted that international aid delivered via Chad for other parts of Darfur pass through Al-Fashir, something that the escalating violence prevents.
Carl Skau, Chief Operating Officer of the World Food Programme, said the agency had trucks ready in the Chadian border town of Tina, but they needed to be able to move soon.
“The window is closing, the rains are coming and we need action in the next couple of weeks,” he told Reuters after a trip to Port Sudan where he tried to negotiate with the army for better access this week.
The UN’s World Food Programme expects more people are being driven to the brink of starvation in other parts of Sudan worst affected by the war including the capital Khartoum, El Gezira state and the Kordofan regions.
“We really need to step up a concerted effort to avoid an even worse catastrophe,” Skau said.

JERUSALEM: At a field hospital that has become one of Gaza’s leading trauma centers, a doctor who has worked in a dozen war zones described the situation as the most “catastrophic” he had ever seen.
“It is devastating,” said Javed Ali, the head of International Medical Corps’ emergency response in Gaza.
Speaking this week from a field hospital northwest of the areas of Rafah ordered evacuated by Israel, he said the situation around the far southern city was “dire.”
The hospital, in the coastal area of Al-Mawasi, which Israel has designated a “humanitarian zone,” has swelled in a matter of months into a more than 150-bed facility made up of numerous white tents and shipping containers.
Since the first evacuation orders for Rafah were issued on May 6, ahead of a long-feared ground invasion of the southernmost part of Gaza, nearly half of the 1.4 million people who had been sheltering there have left, according to UN agencies.
“There has been a massive population movement,” Ali said, adding that most had avoided Al-Mawasi, which was already dramatically overcrowded, heading instead for the war-scarred city of Khan Younis, a battleground until last month.
Those arriving were “exhausted, they are scared, they don’t have resources,” Ali said, adding that many patients were asking for “money, support ... so they can move their families to safety.”
Gaza’s bloodiest war began with Hamas’s unprecedented Oct. 7 attack on Israel.
Israel’s retaliatory offensive has killed more than 35,000 people in Gaza, mostly civilians, according to the territory’s Health Ministry.
While the number of people sheltering in Al-Mawasi’s sea of tents may not have grown much in recent weeks, the pressure on the field hospital there certainly has.
With access to hospitals in Rafah largely cut off, the facility has seen the number of daily visits to its emergency department balloon from around 110 to close to 300, Ali said, describing “polytrauma cases with broken bones in every part of the body.”
The situation has been exacerbated by last week’s temporary closure of two major aid crossings into Rafah, which disrupted the supply of medicines and fuel for hospital generators.
Ali said the field hospital “saw this coming” and prepared surplus stocks but had not predicted the surging number of patients.
“It’s getting totally out of hand,” he said. “Our supplies will not last.”
He said the field hospital already saw shortages of “very critical items.”
It had, for instance, run out of “all pediatric formulations of antibiotics and painkillers” at a time when around 20 children were recovering from surgery.
Ali said the biggest worry was “space,” with major surgeries doubling from the previous average of around 25 a day.
There has also been a dramatic rise in the workload of the maternity ward, which has gone from around 10 deliveries a day to about 25, along with up to eight C-sections.
With expectant mothers unable to access the specialist maternity hospital in Rafah, there has also been a “massive increase in the number of complicated pregnancies,” he said.
Ali, who during a 15-year career has worked in war zones from Afghanistan and Sudan to Nigeria and Ukraine, said the situation in Gaza was “far more catastrophic.”
“The immense number of trauma cases, the lack of resources, the interrupted supply chain ... It’s something that I’ve never seen.”
In most wars, men account for the majority of gunshot and shrapnel wounds, but in Gaza the number of women and children injured “is very, very high,” Ali said, describing young children “with shattered limbs.”
With only a third of Gaza’s 36 pre-war hospitals even partially functional, according to the UN, and with displaced people often stuck far from health facilities “access has become extremely compromised.”
Ali said the field hospital in Al-Mawasi has grown to be the “main trauma referral center” in southern Gaza, “and we are working in a tent.”