In the five days since intense fighting began between the Rapid Support Forces (RSF), Joint Forces, and Sudanese Armed Forces (SAF) on Friday 10 May, 454 casualties have arrived at South Hospital in El Fasher.

Fifty-six people have succumbed to their injuries, but the wounded and death toll are likely far higher, since the fighting continues to be so intense that many people cannot reach the hospital. Until now, North Darfur had been a relatively safe haven compared to other parts of Darfur. Now, there are snipers in the streets, heavy shelling is taking place, and nowhere in the city is safe at all.

On Friday, when the fighting began, there was heavy bombing and shooting close to the paediatric hospital, that MSF also supports. This hospital is not far from an RSF base, so the SAF were trying to destroy RSF war materials there.

There were 115 children receiving treatment in the hospital at that time. They were suffering from conditions like malaria, pneumonia, diarrhoea and malnutrition. However, when the fighting started to take place so close to the hospital, most of the patients and their caregivers vacated the premises in search of safety. Some went to South Hospital, but we do not know the whereabouts of the others.

We do know that 10 children remained in the intensive care unit (ICU), though, and that three remained in the neonatal unit. The medical team, doctors, and nurses also stayed in the hospital to continue providing treatment for these children.

On the same day of this heavy fighting, we received 160 casualties at South Hospital, including 19 children and 31 women. Twenty-five of the 160 arrived in critical condition, and sadly passed away as a result of their injuries.

The following day, the fighting started early in the morning. Again, it was close to the paediatric hospital, and it was very intense. During this fighting, there were a lot of bomb fragments that landed on the hospital. The roof of the ICU collapsed and two children in the ICU died as a result. Many of the caregivers were also wounded. One of them died and one of them lost his leg.

On Sunday, there was again heavy fighting and we received another 130 casualties at South Hospital. Sixteen died from their injuries and we continue to receive more and more as the fighting continues. The hospital is overwhelmed and there is a huge amount to do. Some patients have received surgery, but 40 are currently still waiting. If the situation continues like this, I am afraid that we will run out of supplies to handle all these cases. Currently, the fighting means that we cannot bring in more supplies, so we urgently need safe access and authorisation from the warring parties to be able to do this.

But it is not only that. With the paediatric hospital now out of action, we are one additional hospital down, when there were already far too few operational health facilities available in Sudan. The original paediatric hospital was looted at the start of the war, and the children were evacuated to the facility that was impacted by the air strike on Saturday.

This time last year, it was just a small health clinic with not enough space and not enough equipment. We were asked to rehabilitate it by the Ministry of Health last year. By June, we had expanded its bed capacity and established a neonatal ward, inpatient department, inpatient therapeutic feeding centre, as well as a triage area, outpatient department, emergency room and the ICU. The children who were killed on Saturday were in that ICU at the time. The hospital was full when the fighting started, with some departments over-capacity due to the numbers of children in need of hospital treatment.

What we need to do now is work out how to ensure that children in critical condition can continue to receive treatment. South Hospital is full, so the children who were taken there on Friday are in a very busy facility. We are looking into all options, but for now, there is no immediate solution.

What is clear is that the fighting has had a devastating impact on the lives of all people. It is vital that warring parties remember their obligations under International Humanitarian Law, which include ensuring the protection of civilians and the protection of health structures and health personnel.