An investigation has found evidence that Sudanese paramilitary fighters systematically destroyed the healthcare system in el-Fasher during their long siege and takeover of the city in Darfur, which took place a year ago. The findings describe repeated attacks on medical facilities and the staff who worked in them.
UN human rights chief Volker Türk called the findings “deeply disturbing”. He said multiple attacks by the Rapid Support Forces (RSF) on civilian infrastructure, including health facilities, were serious violations of international humanitarian law and may amount to war crimes. The RSF has rejected the findings, and its health minister described the allegations as propaganda aimed at damaging the group’s reputation.
Repeated strikes on el-Fasher hospitals during the siege
Using sources who were on the ground in el-Fasher, the investigation identified at least 43 separate attacks on hospitals and healthcare sites between May 2024 and October 2025. Some facilities were hit several times. International law prohibits attacks on health facilities or their staff during conflict.
Some medical facilities in el-Fasher closed within weeks of the civil war starting in April 2023, including the Teaching Hospital in the middle of the city. Its operations moved to the South Hospital, which kept working for a time despite power cuts and dwindling supplies. That changed in late May and early June 2024, when the South Hospital was shelled several times as RSF fighters advanced from the east.
The attacks culminated in an RSF raid on 8 June 2024, according to the account of Dr Mustafa Ahmed, a pharmaceutical specialist. Many staff escaped over the back wall as fighters entered the building. The hospital’s director general, surgeon Izzeldin Ahmed Dawaud Asow, was confronted by a group of fighters outside his office. He said he was beaten with rifle butts and lost consciousness, and that he survived by pretending to be dead.
When he returned, Dr Asow said, he found the bodies of several patients and his operating room badly wrecked. The hospital closed and later fell into RSF hands when the army retreated.
Drone and shelling attacks on Saudi Hospital
After the South Hospital shut, its staff and remaining equipment moved to the Saudi Maternity Hospital in the west of the city, where the army had its main bases. Attacks on that facility soon increased. The medical charity Médecins Sans Frontières said in a statement that it did not know whether hospitals were being intentionally targeted, but that the warring sides were taking no precautions to spare them.
Six doctors interviewed by the investigation described a pattern of systematic targeting. They said Saudi Hospital was struck repeatedly, on some days up to 25 times, with a mix of shelling and drones. Smaller private hospitals and neighbourhood clinics were also forced to close, and the investigation’s timeline records their steady closure.
When some healthcare buildings relocated, the new sites were also attacked. The Specialised Children’s Hospital moved twice, and both locations were shelled and forced to close. The main dialysis centre was struck and then attacked again after it moved. By the time the RSF seized the city in October 2025, Saudi Hospital was the only functioning health facility left.
Dr Asow said staff built sandbag defences and underground bunkers from steel containers, and set up alternative sites to receive patients. He said this makeshift surgery was attacked five times in 2025. On 15 March 2025, he said, a hunting drone followed people carrying injured patients to a temporary ward and struck as they reached the gate, killing nine people. On 17 August of the same year, a drone hit a donkey cart transferring patients to an alternative operating theatre after the ambulances had been destroyed, killing two patients, the driver and the donkey, he said.
Denials from the RSF and the government
The RSF health minister dismissed these accounts as “a continuation of lies” by the army and its local allies, known as the Joint Forces. He argued that medics and others in the city were aligned with the army and the Joint Forces because of the conflict’s ethnic and tribal dimensions. Doctors told the investigation they believed RSF fighters deliberately targeted medical facilities because army or allied fighters were among their patients.
Dr Alaa Eldin Nugud, a surgeon who now serves as health minister in the RSF-backed civilian government, said the South Hospital was being used as a military base. He showed a video of weapons remains and maps he said showed landmines around the Teaching Hospital. The investigation said it found no independent evidence of his allegations, and the government of the Darfur region rejected the charges. Doctors told the investigation the hospital was not part of any base.
The onslaught culminated on 25 October 2025, when the RSF stormed the hospital amid allegations of a massacre that killed more than 460 patients and their companions. The RSF has denied that a massacre occurred. The World Health Organization condemned the reported killings, and satellite imagery appeared to show clusters of bodies on the grounds.
The investigation also reported on the toll on medical workers. From April 2023 to October 2025, its data showed 120 health workers were injured, 55 were killed and 10 were forcibly disappeared or abducted. Dr Nugud denied that doctors had been abducted, saying they had chosen to stay and work. One doctor, Dr Al-Haj Mohamed Ahmed, told the investigation he had been forced to remain and said he would have been shot if he had spoken out.
Türk said the UN’s own monitoring showed the RSF had repeatedly struck el-Fasher’s main hospitals and makeshift facilities, severely affecting access to health services for thousands of civilians trapped in the city. Healthcare in el-Fasher is now run by the RSF-backed government, which has released videos showing the Saudi Hospital and Teaching Hospital reopened and treating some patients.
