Before it fell into their hands last October, the city Al- Fashir was besieged by the Rapid Support Forces (RSF). Inside the Saudi Hospital– the last function medical facility in the city, a medical team tended to the wounded. Shells rained down on the area of the hospital, injuring civilians and fighters alike. The medical staff stitched wounds and cast broken limbs using mosquito-net fabric as they ran out of gauze and bandages. One nurse said it felt like “dooms day”. “We had to jump over dead bodies to reach the wounded. We couldn’t bury them because drones were flying overhead.” Abdullah Youssef, a merchant who was abducted by RSF gunmen on October 27, told Reuters he saw bodies of children, women and elderlies scattered throughout the hospital compound, adding that patients could not flee the hospital due to their medical condition. He said he witnessed RSF fighters taking people out of the hospital, detaining some for ransom, and killing others.
The World Health Organization reported that shells landed at the Saudi Hospital and killed a nurse and wounded three other healthcare workers on October 26. It added that another attack took place on October 28, during which “more than 460 people — patients and their escorts — were killed by gunfire.” Satellite imagery from October 28 reveals signs of mass killings at the Saudi Hospital. According to an analysis by the Yale Humanitarian Research Lab, the images show piles of human-sized bodies. The lab added that later images appear to show bodies being burned, with elongated white shapes “clearly charred, while black smoke bellowed from the site”.
The October attacks on the Saudi Hospital are a striking example of what doctors described as a systematic RSF campaign to dismantle al-Fashir’s healthcare system during its siege. The campaign was part of broader efforts to expel civilians and seize the capital city of North Darfur State. The RSF, in a statement issued in October before the fall of Al-Fashir , said “its enemies were using hospitals in the city as military barracks and launching points for attacks”. Medics in al-Fashir rejected the accusation, saying the facilities were used solely to treat civilians and wounded soldiers.
Under international humanitarian law, soldiers who are incapacitated due to injury or illness are protected from attack as well as the hospitals treating them. According to data from Insecurity Insight, which compiles information for a group of international NGOs called the Coalition for Safeguarding Health in Conflict, healthcare facilities in North Darfur have been attacked, damaged, or obstructed at least 130 times since Sudan’s war began in April 2023. The data indicates that the RSF is responsible for at least 71% of these incidents, while the Sudanese Armed Forces (SAF) account for 3%. Most of the remaining cases involve unknown actors or are caused by fighting between the RSF and SAF. At least 40 health workers have been killed, according to the same data.
Responding to questions from Reuters, a senior Sudanese army official denied the reported attacks by the SAF on medical facilities and added: “The army was defending the citizens of al-Fashir before the RSF entered it. That is the army’s duty anywhere in Sudan.” Hospitals in al-Fashir were lost one after the other. On May 11, 2024, an airstrike by SAF hit approximately 50 meters from the Babiker Nahar Children’s Hospital. The ceiling of the intensive care unit collapsed, and two children and one care provider were killed, according to the data and a report by Médecins Sans Frontières (MSF).
Surgeon Az Eldeen Asso said he was performing surgery at South Hospital in June 2024 when RSF artillery struck the operating room. He added that RSF fighters raided the hospital the next day and assaulted him. The hospital was permanently shut down, forcing his team to move to the Saudi Hospital. Residents told Reuters that advances by RSF forced them to move from one destroyed medical facility to another. International humanitarian law prohibits targeting civilians or civilian infrastructure and grants special legal protection to hospitals and medical units. Tom Dannenbaum, a professor at Stanford Law School, said the repeated attacks on healthcare facilities in al-Fashir constitute clear violations, calling for an investigation in possible “war-crimes.”
