‘Bullets sizzling in the air’: RSF gunmen open fire on Darfur hospital

Sudan's El Fasher South Hospital, which was recently stormed by the RSF and forced to close its doors
The RSF assaulted staff, looting drugs and medical equipment before stealing an ambulance - Sudan Tribune via Twitter

As bullets tore through the walls doctors and nurses threw themselves to the floor. The South Hospital in Sudan’s besieged city of El Fasher was under attack, and the staff had only moments to get themselves and their patients out.

“When you have guns, everybody suddenly has to lie down on the ground, bullets sizzling in the air around you,” said Joel Ghazi, a doctor with Médecins Sans Frontières’ (MSF) which ran the hospital – the only medical facility in the city centre where over 1,300 people sought treatment in May.

It is a picture repeated across the country which, for 14 months, has been torn apart by civil war. Healthcare facilities have become a target for gunmen looking to pillage supplies, often murdering those in the way.

Since April 2023, the war in Sudan has killed more than 15,000 people and displaced nine million. It is the largest internal displacement crisis globally, with a massive influx of people seeking safety from the horrors of war pushing the country to breaking point.

Impunity remains at the heart of the conflict: There have been extreme violations of international law, including starvation being used as a weapon of war and women and girls subject to sexual violence.

Experts fear it could soon tip into genocide.

Sudan's El Fasher South Hospital, which was recently stormed by the RSF and forced to close its doors
Healthcare facilities have become a target for gunmen looking to pillage supplies - Sudan Tribune via Twitter

The World Health Organization (WHO) condemned the attack on the South Hospital and other health facilities.

“WHO is appalled by the recent attack on South Hospital, the only facility with surgical capacity in El Fasher, Darfur,” it said in a post on X.

“The hospital’s closure following the attack has stretched the two other hospitals there beyond capacity, further limiting access to lifesaving services.”

Militiamen in the Rapid Support Forces (RSF), a paramilitary whose violence has haunting echoes of Sudan’s genocide that began almost 20 years ago, are facing off against the Sudanese Armed Forces (SAF).

Currently, the RSF controls the majority of Khartoum and most of western Sudan, while the SAF controls much of the north and east.

El Fasher, the capital city of North Darfur and the centre of much of the fighting, has been encircled entirely by the RSF.

The United States envoy to Sudan has warned that El Fasher could fall to the RSF imminently.

US envoy Tom Perriello said that some RSF members believe that capturing all of Darfur will help them establish it as a breakaway state.

He told the BBC that the US would not recognise an independent Darfur “under any circumstances”.

“I think if there’s anyone in RSF territory who thinks taking El Fasher means somehow they will have a right to the state of Darfur, they need to disillusion themselves of that myth,” he said. “It does not mean that.”

According to the UN, more than 800,000 civilians are in the direct firing line in El Fasher.

Mr Perriello said that upwards of a million people are being starved by the ongoing fighting and that many have been killed by bombings of hospitals.

“We see 45,000 pregnant women who not only have no real prenatal care but don’t even have enough meals a day to be nourished enough for a healthy pregnancy.

“And as bad as it is, it could get worse any day if El Fasher falls, not only the horrors that would come from the battle but as people flee.”

Sudan's El Fasher South Hospital, which was recently stormed by the RSF and forced to close its doors
South Hospital, the only facility with surgical capacity in El Fasher, Darfur, was forced to close - Sudan Tribune via Twitter

The South Hospital has been propped up by MSF, who described it as the last functioning one in the area.

Last month, MSF reported that 134 people had died at the facility within two weeks, with 979 other casualties attended to.

There have been reports for several days of shelling hitting the hospital, causing injuries and deaths.

On Saturday members of the RSF entered the hospital and opened fire – assaulting staff, looting drugs and medical equipment and stealing an ambulance.

Amid the chaos, MSF has of yet been unable to identify if there were any dead or wounded but said they had evacuated the remaining patients.

“We are seeing a total disregard of hospitals as safe places,” said Mr Ghazi. “There’s a lot of fear, a lot of trauma, a lot of uncertainty, not knowing where to go. It’s been a trend throughout the war, but is accelerating.”

‘The healthcare system is collapsing’

The hospital was the only one remaining in the area equipped to deal with mass casualties and one of two with surgical capacity.

Its closure marks a major setback for civilians trapped in the middle of fighting as it was the first point of call for treating war-injured people.

The South Hospital had been hit by shelling and bullets at least three times in 10 days before the Saturday raid.

Two children were killed by a bombing on another hospital run by MSF in El Fasher in May.

The attacks represent the lawlessness of the conflict in Sudan, where there are no rules for fighting and both the RSF and SAF have been accused of widespread abuses.

It is also indicative of the situation medical facilities across the country face.

“The country’s whole healthcare system is collapsing. It was already fragile before this war, but it hadn’t collapsed,” Mr Ghazi added. “One year of war has been enough pressure to make it crumble.”

Sudan's El Fasher South Hospital, which was recently stormed by the RSF and forced to close its doors
The hospital had been targeted with shelling in the days leading up to the raid - Sudan Tribune via Twitter

In the capital Khartoum, just a handful of hospitals are currently operational.

The price of essential medicines continues to soar, with no supplies of Oxycontin at Umdawanban Hospital, and dwindling stocks of basic equipment, like medical gloves and antiseptic for cleaning wounds at Bashair Teaching Hospital.

In the Turkish hospital, MSF receives over 100 patients a day, most of them children and pregnant women.

Many arrived critically injured after being forced to make the terrifying choice of travelling through volatile areas.

MSF reported that many have had to travel for miles by foot and across frontlines as there is no ambulance service and very few transport options available.

“A four-year-old girl was brought to our emergency room after being hit in the abdomen by a stray bullet that entered her home,” said Guy Vataux, MSF Head of Mission in Khartoum.

“Her mother took her to three other hospitals before she was finally able to get surgical treatment at the Turkish Hospital.”

The WHO also condemned “another attack” on a health facility in Wad Al-Nura in Al-Jazirah state south of Khartoum.

The attack caused the death of a nurse who was on duty and caring for patients at the time.

“WHO strongly condemns attacks on healthcare. Health workers and patients should not have to risk their lives to provide and access health services,” WHO said after shelling by the RSF on the village killed 100 people.

A looming malnutrition catastrophe

Mr Ghazi said that the situation in Sudan is one of the worst he has seen throughout his decade-long tenure at MSF.

“I’ve personally been in Ukraine and Syria and Haiti. I’ve seen my share. For me, Khartoum is pretty much on the top in terms of how complex and difficult it is to function.”

He worries that the healthcare system could collapse if the looming malnutrition catastrophe comes to fruition.

Around 18 million people in Sudan are acutely food insecure, according to the World Food Programme (WFP), including nearly five million who are now in the grip of emergency levels of hunger.

“This is the highest number ever recorded during the harvest season… Around 90 per cent of those in emergency are in areas where access is extremely limited due to heavy fighting and restriction,” the WFP said.

Last month MSF found a major malnutrition crisis in Zamzam camp in North Darfur, home to 120,000 people.

Refugees at the Zamzam camp in North Darfur
The Zamzam camp in North Darfur, now home to 120,000 people, is facing a malnutrition crisis - Mohamed Zakaria/Handout via REUTERS

It screened more than 46,000 children, with results showing that a staggering 30 per cent were suffering from acute malnutrition, and eight per cent severe acute malnutrition (SAM).

Similar figures were found among the more than 16,000 pregnant and breastfeeding women who were screened: 33 per cent were acutely malnourished, with 10 per cent having SAM.

There are similar famine alerts across the rest of the country.

“We’re going to see thousands if not tens of hundreds of thousands of people dying out of hunger,” said Mr Ghazi.

“This is what is currently looming around Sudan. The casualties from this will be much bigger compared to casualties from armed clashes.”

More people than any other conflict in the world have fled from fighting.

Gezira state, to the south of Khartoum, was captured by the RSF and the group has been accused of carrying out extensive abuse against the civilian population.

In the village of Wad al-Nourah, at least 150 people, including 35 children, were massacred by suspected RSF forces last week.

Rights groups have accused the RSF of using rape as a weapon of war and launching a campaign of ethnic cleansing.

On Tuesday, ICC Prosecutor Karim Khan said that his ongoing investigation “seems to disclose an organised, systematic and a profound attack on human dignity”.

“The evidence my office has collected to date seems to show credible, repeated, expanding, continuous allegations of attacks against the civilian population, in particular, attacks directed against camps for internally displaced persons,” he said.

“It seems to show the widespread, prevalent use of rape and other forms of sexual violence. It seems to disclose consistently the shelling of civilian areas, the looting of properties and attacks against hospitals,” he added.

Mr Ghazi said: “If it stays like this, it is going to push hospitals already on the edge to breaking point.”

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