A horrific attack at a hospital in Sudan’s Darfur region has left at least 460 people dead, according to a statement from the World Health Organization on Friday. The assault, carried out by groups of gunmen, unfolded in several waves. These attackers reportedly abducted medical staff, including doctors and nurses, before opening fire on employees, patients, and civilians seeking refuge within the facility.

The violent incident occurred on Tuesday as part of a broader offensive by the Rapid Support Forces, a formidable paramilitary organization. These forces seized control of the strategic city of el-Fasher after maintaining a siege for 18 months.

Eyewitnesses have recounted shocking scenes of fighters going door-to-door, targeting civilians and committing acts of sexual violence.

While comprehensive details about the hospital attack and other acts of violence in the city have been slow to surface, the exact number of casualties remains uncertain.

The capture of el-Fasher marks a significant turning point in the ongoing, brutal conflict between the RSF and Sudan’s military, a war that has ravaged Africa’s third-largest country for two years.

United Nations figures estimate the war has claimed more than 40,000 lives. However, humanitarian organizations warn that the actual death toll could be much higher. Additionally, the conflict has displaced over 14 million people and triggered disease outbreaks, which are believed to have resulted in thousands more deaths.

Famine has been declared in parts of Darfur, a region the size of Spain, and other parts of the country.

Communications are down in el-Fasher, located deep in a semi-desert region some 800 kilometres southwest of Khartoum, the capital.

Aid groups that had been operating there have largely been forced out.

Some survivors have staggered into a refugee camp about 64 kilometres away in the town of Tawila.

More than 62,000 people are believed to have fled el-Fasher between Sunday and Wednesday, the UN migration agency said. But far fewer have made it to Tawila.

The RSF is largely made up of fighters from the Arab Janjaweed militia, which is accused of carrying out a government-backed genocidal campaign in Darfur in the 2000s in which some 300,000 people were killed.

The Janjaweed were initially recruited by the military to fight Darfur insurgents, who were rebelling against power concentrated in the north. The militia was later reorganised into the RSF as an official force.

The military and the RSF were briefly allied in ruling Sudan following popular protests that ousted longtime leader Omar al-Bashir. They had a falling out in 2023 in a power struggle.