Mass killings and starvation threaten hundreds of thousands of people trapped in El Fasher, the capital city of North Darfur, as fighting closes in, the charity Doctors Without Borders has warned its latest report.
The medical NGO, known by its French name Médecins Sans Frontières (MSF), said a full-scale attack could lead to more bloodshed, as seen in the massacres that struck other parts of Darfur last year.
Its report, published on Thursday, documents killings, sexual violence, looting and attacks by the paramilitary Rapid Support Forces (RSF) and their allies.
"People are not only caught in indiscriminate heavy fighting between the Rapid Support Forces and the Sudanese Armed Forces and their respective allies – but also actively targeted by the RSF and its allies, notably on the basis of their ethnicity,” said MSF head of emergencies, Michel Olivier Lacharité.
UN urges action on Sudan's 'forgotton war' as humanitarian crisis takes hold
Food and water cut off
The conflict in North Darfur has worsened since May 2024. The RSF and its allies have surrounded El Fasher and the nearby Zamzam camp, a large settlement for displaced people just outside the city, blocking people from getting food, water or medical aid.
MSF’s report is based on its own field data, direct observations and more than 80 interviews carried out between May 2024 and May 2025 with patients and displaced people.
One man told MSF that in Zamzam, people sometimes went three days a week without eating.
Another woman said children died from malnutrition and families survived on scraps meant for animals. “We were eating ambaz [the residue of peanuts ground for oil], like everyone, although usually it’s used for animals,” she said.
Fuel shortages have shut down wells, leaving water scarce and expensive.
“Zamzam was completely blocked,” another displaced person said. “Water wells depend on fuel and there was no access to fuel, so all of them stopped working.”
RSF drone strikes pound Port Sudan, putting aid deliveries at risk
Fears of ethnic cleansing
Some witnesses said that RSF soldiers had spoken of plans to “clean El Fasher” – with the goal of removing its non-Arab community.
“In light of the ethnically motivated mass atrocities committed against the Masalit in West Darfur in June 2023, and of the massacres perpetrated in Zamzam camp in North Darfur, we fear such a scenario will be repeated in El Fasher,” MSF humanitarian affairs advisor Mathilde Simon said.
In April, the RSF and its allies launched a ground attack on the Zamzam camp, forcing an estimated 400,000 people to flee in less than three weeks. Many went to El Fasher, where they now remain trapped without aid.
Many who try to escape face huge risks. Roads are dangerous, and men and boys risk being killed or abducted, while women and girls face sexual violence. Witnesses say the danger is even worse for Zaghawa communities.
“Nobody could get out [of El Fasher] if they said they were Zaghawa,” one displaced woman said.
Another described fleeing to eastern Chad: “They would only let mothers with small children under the age of five through. Other children and adult men didn’t go through. Men over 15 can hardly cross the border [into Chad]. They take them, they push them aside and then we only hear a noise – gunshots – indicating that they are dead.”
World court opens hearings on Sudan case against UAE over Darfur war
Healthcare in ruins
Most health centres in El Fasher and Zamzam have been damaged or destroyed in the past year.
“Currently, there is only one hospital with surgical capacity that functions partially, for a population estimated at nearly 1 million people,” Simon said.
One woman told MSF the SAF bombed her neighbourhood by mistake, then came back to apologise. She said SAF planes sometimes struck civilian areas even when there were no RSF fighters. “I saw it in different places,” she said.
Repeated attacks forced the charity to shut down its work in El Fasher in August 2024 and in Zamzam in February this year. Recent promises of a local ceasefire have not changed conditions on the ground, MSF said, warning that time is running out for people trapped in El Fasher.
