Repeated strikes on el-Fasher’s hospitals left a city without safe care
A BBC investigation has documented a sustained assault on el-Fasher’s health system during Sudan’s siege and takeover of the city in Darfur, tracing at least 43 separate attacks on hospitals and healthcare sites from May 2024 to October 2025. The pattern described by doctors on the ground is stark: hospitals were shelled, raided, relocated, and then struck again, until only one facility remained functioning in the city. In a conflict already marked by mass displacement and famine, the destruction of medical care became its own weapon.
The findings carry direct legal and clinical weight. Under international humanitarian law, health facilities and medical staff are protected in conflict. Repeated attacks on hospitals, especially when they continue after staff have moved services to alternate sites, raise the question of whether the aim was not just collateral damage but the systematic removal of civilian care. Volker Türk, the UN human rights chief, described the findings as “deeply disturbing” and said the attacks on civilian infrastructure may amount to war crimes.
South Hospital became the last surgical lifeline
The first major pressure point came early in the war, when the Teaching Hospital closed and services shifted to South Hospital. For a time, care continued there despite worsening electricity failures and dwindling supplies. Then the siege tightened. In late May and early June 2024, the hospital was shelled several times as paramilitary forces advanced from the east of the city, and medics were treating 16 injured patients on the day of the first bombing.
What followed was not a single devastating incident but a sequence of blows. Staff described an assault on 8 June in which RSF fighters entered the hospital grounds, beat the director general with rifle butts, and left surgical equipment destroyed. Patients died inside the facility. The hospital closed and later passed into RSF hands when the army withdrew.
The clinical consequence was immediate and devastating. Each destroyed ward increased the distance between injury and treatment, while each closed theatre reduced the city’s ability to perform emergency surgery, manage trauma, and stabilise women in labour. In a setting where one working hospital was already serving most of the city, every shell hit had a multiplier effect.
Medical workers were hunted along with the buildings
The BBC’s data on el-Fasher’s healthcare workers adds another layer of gravity: from April 2023 to October 2025, 120 medical workers were injured, 55 killed, and 10 forcibly disappeared or abducted. Those figures describe more than staffing loss. They erase the expertise needed to run trauma care, obstetrics, dialysis, paediatrics, and infection control under siege conditions.
Dr Muhamed Suliman, a surgeon who worked in the city during the siege, said the attacks were designed to put hospitals out of service because health care is the cornerstone of any city or state. His account aligns with the broader pattern visible in the BBC timeline: smaller clinics closed, mobile services were struck after relocation, and no alternative site stayed safe for long. The Specialised Children’s Hospital moved twice and both new locations were shelled. The main dialysis centre was hit, then hit again after it moved.
The effect on patients would have been severe even without the ongoing violence. People with kidney failure cannot miss dialysis indefinitely. Children with infection or dehydration cannot wait days for care. Pregnant women need safe delivery rooms, blood, and surgical backup. In a city under fire, the collapse of these services quickly turns treatable conditions into preventable deaths.
Makeshift wards and bunker surgery replaced a formal hospital system
As the Saudi Maternity Hospital became the last functioning health facility, staff tried to adapt with sandbags, steel container bunkers, and temporary operating spaces. Those improvisations kept some care alive, but they also reveal how completely the formal system had been broken. Dr Izzeldin Ahmed Dawaud Asow said one makeshift surgical site was attacked five times in 2025.
One episode stands out for the brutal arithmetic of war medicine. Dr Asow said he was operating on a patient’s neck when an explosion shook the building. In another case, he delayed an operation to clean the theatre properly, only for the room to be destroyed shortly afterward. The patient survived. “Mr Deep Cleaning” became his staff’s nickname for him, an ironic reminder that sterile technique, normally a matter of infection prevention, may have helped save a life in a city where shellfire came first.
There was no stable separation between evacuation routes and targets. Dr Asow described a drone following injured people as they moved toward a temporary ward, then striking at the gate and killing nine. On another day, a donkey cart carrying patients because ambulances had been destroyed was hit by a drone, killing two patients, the driver, and the donkey. These are not isolated wartime anecdotes. They describe a health system stripped down to improvised transport, then attacked again at the point of movement.
Claims of military use remain disputed, but the health damage is not
RSF officials rejected the allegations and argued that hospitals were being used as military bases. International law does allow a hospital to lose protection if it is used to commit an act harmful to the enemy, but those claims require independent proof. The BBC found no independent evidence supporting the allegation that South Hospital functioned as a military base in the way described by the RSF-backed health minister. Doctors who worked there said the facility was used for patients and surgical care, not as a military installation.
The deeper public health issue is independent of any single legal argument: once hospitals are bombed, raided, and abandoned, the population loses access to trauma care, infection control, maternal services, and chronic disease treatment at once. That loss persists even after the fighting shifts elsewhere. WHO described el-Fasher as one of the clearest and most severe examples of the wider impact of the conflict on health care in Sudan, and the investigation shows why. A health system can be destroyed not only by a final siege, but by repetition—one shell at a time, one closed ward at a time, one displaced surgeon at a time.
Medical collapse outlasts the battlefield
The city’s health infrastructure is now being run by the RSF-backed government, which has released videos showing hospitals reopened and cleaned up. Those images do not erase the chronology documented by doctors, satellite imagery, and field reports. They also do not answer the central clinical question left by the siege: how many civilians died, became disabled, or lost survivable conditions because care was unreachable when it was most needed.
A year after el-Fasher fell, the war continues elsewhere in Sudan, and attacks on health care have not stopped. The city stands as a record of what happens when hospitals become targets: surgery ends, maternal care collapses, chronic disease care disappears, and the injured are left to die before they can even reach a functioning ward. The unanswered evidentiary gap is not whether the system was shattered. It was.