MSF is extremely concerned about the threats of a full-blown assault on the hundreds of thousands of people in the state capital of El Fasher, which would lead to further bloodshed. As the conflict has intensified in the area since May 2024, civilians have continued to be the main victims.
The report, “Besieged, Attacked, Starved,” depicts a desperate situation for civilians in and around El Fasher that requires immediate attention and response. “People are not only caught in indiscriminate heavy fighting between the Rapid Support Forces (RSF) and the Sudanese Armed Forces (SAF) and their respective allies—but also actively targeted by the RSF and its allies, notably on the basis of their ethnicity,” said Michel Olivier Lacharité, MSF head of emergencies.
Systematic violence against civilians
Based on MSF data, direct observations, and over 80 interviews conducted between May 2024 and May 2025 with patients and people who were displaced from El Fasher and nearby Zamzam camp, the report exposes systematic patterns of violence that includes looting, mass killings, sexual violence, abductions, starvation, and attacks against markets, health facilities, and other civilian infrastructure.
“As patients and communities tell their stories to our teams and asked us to speak out—while their suffering is hardly on the international agenda—we felt compelled to document these patterns of relentless violence that have been crushing countless lives amid general indifference and inaction over the past year," said Mathilde Simon, MSF humanitarian affairs advisor.
“Besieged, Attacked, Starved” also details how the RSF and their allies conducted a large-scale ground offensive in April on Zamzam displacement camp, outside of El Fasher, causing an estimated 400,000 people to flee in less than three weeks under appalling conditions. A large portion of the camp population fled to El Fasher, where they remained trapped—out of reach of humanitarian aid and exposed to attacks and further mass violence. Tens of thousands more escaped to Tawila, about 37 miles away, and to camps across the Chadian border, where hundreds of survivors of the violence received care from MSF teams.
Targeted ethnic violence against non-Arab communities
"In light of the ethnically motivated mass atrocities committed against the Masalit in West Darfur back in June 2023, and of the massacres perpetrated in Zamzam camp in North Darfur, we fear such a scenario will be repeated in El Fasher,” said Simon. “This onslaught of violence must stop.”
Several witnesses report that RSF soldiers spoke of plans to ‘clean El Fasher’ of its non-Arab community. Since May 2024, the RSF and their allies have besieged El Fasher, Zamzam camp, and other surrounding localities, cutting communities off from food, water, and medical care. This has contributed to the spread of famine and debilitated the humanitarian response.
Repeated attacks on health care facilities forced MSF to end our medical activities in El Fasher in August 2024 and in Zamzam camp in February 2025. In May 2024 alone, health facilities supported by MSF in El Fasher endured at least seven incidents of shelling, bombing, or shooting by all warring parties. Indiscriminate airstrikes conducted by the Sudanese Armed Forces (SAF) had devastating consequences.
“The SAF bombed our neighborhood by mistake, then came to apologize,” said one woman affected. “SAF planes sometimes bombed civilian areas without any RSF [presence]. I saw it in different places.”
The dangers of fleeing
The harrowing level of violence on the roads out of El Fasher and Zamzam means that many people are trapped or take life-threatening risks to flee. Men and boys are at high risk of being killed or abducted, while women and girls are subjected to widespread sexual violence. Most witnesses also report increased risks for Zaghawa communities. “Nobody could get out [of El Fasher] if they said they were Zaghawa,” said a displaced woman. Another man told us that RSF and its allies were “asking people if they belonged to the Zaghawa, and if they did, they would kill them.”
“They would only let mothers with small children under the age of 5 through,” recalled a woman about her journey fleeing to eastern Chad. “Other children and adult men didn’t go through. Men over 15 can hardly cross the border [into Chad]. They take them, they push them aside and then we only hear a noise, gunshots, indicating that they are dead, that they have been killed […] Fifty families came along with me. Not even one boy of 15 years old or above was among us.”
The catastrophic nutritional situation has continued deteriorating as the siege has tightened: “[Three months ago] in Zamzam, we sometimes had three days a week without eating,” one man told our teams.
“Children died from malnutrition. We were eating ambaz [the residue of peanuts ground for oil], like everyone, although usually it’s used for animals,” said a displaced woman.
“Zamzam was completely blocked,” another displaced person told us. “Water wells depend on fuel and there was no access to fuel, so all of them stopped working. Water was very limited and very expensive.”
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Time is running out to respond
MSF urges the warring parties to spare civilians and respect their obligations under International Humanitarian Law. The RSF and their allies must immediately stop ethnic violence perpetrated against non-Arab communities, lift the siege of El Fasher, and guarantee safe routes for civilians fleeing violence. Safe unrestricted access to El Fasher and its surroundings must be granted for humanitarian agencies to provide critically needed assistance. International actors, including UN institutions and member states, and states who provide support to the warring parties, must urgently mobilize and exert pressure to prevent further mass violence and allow emergency aid delivery. The recent unilateral announcements of a possible local ceasefire have not yet been translated into concrete change on the ground. Time is running out.
