At a makeshift clinic in Tawila, North Darfur, starving children lie motionless while men with infected wounds wait for urgent surgeries. They are among the thousands who escaped the Sudanese city of El Fasher, now under the control of the Rapid Support Forces (RSF) following an 18-month siege.

El Fasher was the last major city in Darfur held by the Sudanese army. For months, the city endured relentless bombardment, starvation, and siege before falling to the RSF last week. Witnesses have reported mass killings, while thousands remain missing or unaccounted for.

The RSF claims it instructed its forces to protect civilians and that any violations will be punished. However, human rights groups and US officials have long accused the group of committing atrocities and ethnic cleansing in Darfur.

Read more: Quad powers push for Sudan truce following RSF massacres in El Fasher

Desperate escapes by donkey cart and foot

The International Organization for Migration (IOM) estimates that over 60,000 people fled the city, though their current location is unknown. An additional 200,000 civilians are believed to be trapped inside El Fasher.

At the Doctors Without Borders (MSF) clinic in Tawila, survivors shared harrowing stories of their escapes.

Fatuma, a woman who arrived with an orphaned infant, said she fled on a donkey cart after the parents of three children in her care were killed in a drone strike.

“They made us lay the baby on the ground and took everything we had,” she said, describing how RSF fighters stopped her on the road.

Another survivor, Abdallah, waiting for surgery, told Reuters, “I saw more than a thousand bodies on the road… People left in chaos — carrying children in wheelbarrows, on donkey carts, or on foot. Everyone was injured.”

Reuters stated in their report on the matter that they could not independently verify his account.

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Widespread hunger, medical emergency

All children screened by MSF staff in Tawila were malnourished, with 170 arriving unaccompanied, according to MSF coordinator Sylvain Penicaud.

“People are arriving extremely emaciated,” Penicaud told Reuters.

A global hunger monitor found that famine had already gripped El Fasher before its fall, a crisis expected to continue into early 2026.

MSF teams have treated nearly 1,000 trauma cases from attacks along escape routes and inside the city itself.

“The city’s last hospital was under constant attack and deprived of antibiotics and gauze,” Mouna Hanebali, an MSF medical worker, told Reuters. “We’re seeing infected wounds and unstable fractures that need repeat surgeries.”

Read more: Thousands flee Sudan’s El Fasher on foot without food or water: UNICEF

Cholera concerns amid sanitation breakdown

Though MSF’s medical supplies in Tawila remain sufficient for now, concerns are growing over sanitation and water access. The area experienced a cholera outbreak during the rainy season, and a new case was confirmed on Sunday.

“We’re still assessing, but the conditions are dire,” Penicaud told Reuters.

With tens of thousands missing, widespread famine, and families torn apart, aid agencies warn that Sudan’s ongoing conflict, now in its third year, has become one of the world’s most severe humanitarian disasters.