The besieged Sudanese city of El-Fasher has been declared “uninhabitable", with new evidence revealing the destruction of most homes and alarming levels of malnutrition among residents trapped inside.

Once a bustling regional capital, El Fasher has now become a devastated enclave where nearly 250,000 people endure relentless artillery and drone fire, squeezed into an ever-shrinking area of survival.

For more than 549 days, fighters from the Rapid Support Forces (RSF) have surrounded the city, blocking humanitarian aid and attempting to capture the Sudanese army’s last stronghold in western Sudan.

Eyewitness accounts from nearly 900 escapees, many others were reportedly killed or abducted while trying to flee, describe a population “pushed to the edge of survival.”

'I smell death'

The testimonies were collected last month by the US-based medical charity MedGlobal, offering one of the clearest pictures yet of life under siege.

According to the report, over 90 percent of households said their homes were destroyed, damaged, or looted before they escaped. One in four families had lost a member within the previous three months.

Medical screenings of survivors who reached Al Dabbah in Northern State after days of walking revealed widespread malnutrition. Three-quarters said they “never or rarely” had food, and half said they “never or rarely” had access to water.

“The 500-day siege of El Fasher has pushed its inhabitants to the edge of survival,” said Joseph Belliveau, MedGlobal’s executive director. “Some of those who recently arrived to Northern State shared what life was like in El Fasher: ubiquitous violence, destroyed homes, severe shortages of food and water, and almost no access to healthcare. As one woman put it: ‘In El Fasher I smell death rather than life and hope.’”

The city remains under constant bombardment, with RSF artillery and drone strikes hitting civilian areas. A recent attack on a displacement shelter killed at least 57 people, including 22 women and 17 children.

Forced to relocate several times

Three-quarters of those interviewed said they had been forced to relocate at least three times, while 81 percent reported they “never felt safe” moving around.

“The destruction of homes and health infrastructure has made El Fasher uninhabitable,” MedGlobal concluded.

Hopes of a humanitarian breakthrough briefly surfaced last month when Massad Boulos, Donald Trump’s senior advisor for African affairs, claimed he and the United Arab Emirates (UAE), repeatedly accused of backing the RSF, had reached an agreement to allow aid into the city.

Those efforts have since unraveled, with the RSF tightening its siege and encircling El Fasher with massive earthen berms, further trapping civilians.

In a surprising turn, Sudanese military airdrops recently provided limited supplies to defenders inside the city, but food remains extremely scarce.

One in five children under five is acutely malnourished 

MedGlobal found that one in five children under five is acutely malnourished, rising to 27.5 percent among those younger than 18 months.

The report also highlighted that 38% of pregnant and lactating women are malnourished, increasing the risks of premature or underweight births. Among adolescent girls aged 15–19, the rate of “wasting” reached 60%, the highest of all groups.

Although communication blackouts have isolated El Fasher, 86% reported little or no phone or internet access. 

One resident, Abdessalam Kitir, 50, described using milk from his only surviving goat, the other killed in a drone strike, to keep a newborn alive after the child’s entire family was killed when an RSF shell struck their home.

“The baby lost his mother and father and three brothers and sisters. He was evacuated to the hospital,” Kitir told The Guardian.

Even Al Saudi Hospital, the city’s last functioning medical facility, is frequently shelled. Thirteen people were killed there last week.

With indiscriminate shelling continuing, many families spend days hiding in trenches or makeshift bunkers. Half of the respondents said they had been victims of violence, while 71 percent witnessed attacks on neighbors or others in the city.

Last week, UN human rights chief Volker Turk condemned the ongoing killings in El Fasher.

'A war on children'

The Sudanese military has also faced accusations of war crimes, including a recent drone strike that killed at least 16 people in a nearby town east of El Fasher.

On Tuesday, the Raoul Wallenberg Centre for Human Rights described Sudan’s conflict as a “war on children,” citing widespread starvation, forced displacement, and deliberate attacks on minors.

Lawyers at the center warned that states such as the UAE, which deny supporting the RSF, are breaching their obligations under the Genocide Convention through involvement in the conflict.

A new report by the UK’s Independent Commission for Aid Impact (ICAI), published on Wednesday, commended London for doubling its aid to Sudan to £230 million last year and prioritizing the crisis amid the growing humanitarian catastrophe.