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A BBC investigation has found evidence that Sudan’s paramilitary Rapid Support Forces (RSF) repeatedly attacked hospitals and other healthcare sites during the siege and takeover of el-Fasher in Darfur.
The investigation documented at least 43 separate attacks between May 2024 and October 2025, some on facilities that were hit more than once. According to the BBC, the findings are based on accounts from people who were in the city.
UN human rights chief Volker Türk described the findings as “deeply disturbing”. He said attacks by the RSF on civilian infrastructure, including health facilities, were serious violations of international humanitarian law and might amount to war crimes.
The RSF rejected the findings. The group’s health minister called the allegations propaganda and a deliberate attempt by Sudan’s army and its allies to damage the RSF’s reputation.
International law prohibits attacks on healthcare facilities and their staff during conflict. The BBC’s data shows that from April 2023 to October 2025, 120 medical workers in el-Fasher were injured, 55 were killed and 10 were forcibly “disappeared” or abducted.
Dr Muhamed Suliman, a surgeon who was based in el-Fasher during the siege, told the BBC that the RSF was trying to evacuate hospitals and put them out of service because healthcare was “the cornerstone of any city or any state”. He said the attacks were intended to leave civilians with no way to remain in the city.
The investigation comes a year after the RSF seized el-Fasher, one of the most brutal episodes in the civil war that began in April 2023 between the paramilitary group and Sudan’s military. Both sides have been accused of attacking healthcare facilities.
In March 2026, the World Health Organization (WHO) condemned the bombing of al-Daein hospital in RSF-held eastern Darfur. Dozens were killed and the facility was forced to close. Sudan’s military is believed to have carried out the drone strikes, but has denied responsibility.
The WHO told the BBC that events in el-Fasher were “one of the clearest and most severe examples of the wider impact of the conflict on health care in Sudan”. UN investigators have said the fighting in the city bore the “hallmarks of genocide”, with Arab militias, now the backbone of RSF forces, targeting non-Arab groups that make up the population.
The BBC’s account traces attacks on healthcare during the siege. Some facilities closed within weeks of the war’s outbreak in April 2023, including the Teaching Hospital, one of the city’s main hospitals, which was in a conflict zone in the centre of el-Fasher. Its services moved to South Hospital, where treatment continued amid power cuts and dwindling supplies.
The situation changed in 2024, when the RSF laid siege to the city. In late May and early June, South Hospital was shelled several times as paramilitary fighters advanced from positions in the east.
Dr Suliman said the first bombing came as a shock. The area hit was crowded because South Hospital was the only facility in the city providing surgical services. Medical staff operated on 16 injured patients that day, he said.
The attacks culminated in an RSF raid on 8 June. Pharmaceutical specialist Dr Mustafa Ahmed said staff were caught by surprise, and many escaped over a back wall as fighters entered the building.
The hospital’s director general, surgeon Izzeldin Ahmed Dawaud Asow, said RSF fighters confronted him outside his office. He said they did not know he was a doctor but used ethnic slurs against him, calling him “Falangi”, a derogatory term implying that non-Arab Sudanese are foreigners.
Dr Asow said he was beaten with rifle butts and lost consciousness. He survived by pretending to be dead, he told the BBC, recalling that the fighters felt his chest and then left him when they thought he had died.
That day, Sudan’s military and its allies drove the RSF out. Dr Asow said he returned to find several patients dead and the surgical equipment in his operating room destroyed. The hospital closed and later came under RSF control after the army withdrew.
Dr Alaa Eldin Nugud, a prominent surgeon who joined the RSF-backed civilian government as health minister, said South Hospital had been used as a military base. Under international law, a hospital can lose its protection if a party to a conflict uses it to commit an “act harmful to the enemy”.
In an interview with the BBC, Dr Nugud said missile launchers had been set up on the hospital grounds. He showed a video of what he described as remnants of weapons, filmed more than a year after the hospital closed, and said it supported his claim. He also showed what he called maps of landmines around the Teaching Hospital, next to Sudanese military headquarters.
Doctors said the Teaching Hospital was not part of the military base and that they had visited it during the war to collect medical equipment. The BBC said it found no independent evidence for Dr Nugud’s allegations. The government of the Darfur region rejected the claims.
After South Hospital closed, staff and remaining equipment were moved to the Saudi Maternity Hospital in the west of the city, where the army had its main bases. Attacks on the facility intensified within days. The medical charity Médecins Sans Frontières (MSF) said it could not determine whether hospitals were being deliberately targeted, but that the parties to the conflict were not taking precautions to spare them.
Six doctors interviewed by the BBC described what they said was a pattern of systematic attacks. They said Saudi Hospital was repeatedly struck, sometimes up to 25 times in a day, by shelling and drones carrying what they described as precision-guided “intelligent rockets”.
Smaller facilities were also hit, according to the BBC’s timeline, which records the steady closure of private hospitals and neighbourhood clinics. Some facilities were attacked again after moving to new locations. The Specialised Children’s Hospital, which closed at the start of the war along with the Teaching Hospital, moved twice, and both replacement sites were shelled and forced to shut. The main dialysis centre was also struck and attacked again after relocating.
By the RSF’s seizure of the city in October 2025, Saudi Hospital was the only functioning health facility left. Staff used sandbags to protect the building, built underground bunkers from steel containers and set up alternative sites to receive patients and perform surgery as the threat and damage grew.
Dr Asow said the makeshift operating theatre was attacked five times in 2025. On one occasion, he was operating on a patient’s neck when an explosion shook the building. Staff fled, but he stayed.
In another incident, staff had prepared an operating theatre but moved the patient elsewhere because the room needed a deep clean after a relentless workload. Shells destroyed the room soon afterwards, and the patient survived. Dr Asow said some colleagues later called him “Mr Deep Cleaning”, believing the decision had saved the patient.
Dr Asow also said drones tracked people moving patients. On 15 March 2025, a drone followed people carrying injured patients from an attack site to a temporary ward and struck as they reached the building’s gate, killing nine people, he said.
On 17 August 2025, a drone hit a donkey cart carrying patients to an alternative operating theatre because all the ambulances had been destroyed, Dr Asow told the BBC. He said the attack killed two patients, the driver and the donkey.
The RSF health minister dismissed the doctors’ accounts as “a continuation of lies” by Sudan’s military, known as the SAF, and its local allies, the Joint Forces. He said medical workers and others in the city were aligned with those forces because of tribal and racial issues, and that their accounts should not be relied on.
Doctors told the BBC they believed RSF fighters deliberately targeted medical facilities because army or allied fighters were among the patients.
The attacks culminated on 25 October 2025, when the RSF stormed the hospital amid allegations that more than 460 patients and their companions were killed. The RSF denied that a massacre took place. The WHO condemned the reported killings, while satellite imagery appeared to show clusters of bodies on the hospital grounds.
Türk told the BBC that the UN’s monitoring and documentation showed the RSF had repeatedly struck el-Fasher’s main hospitals and makeshift health facilities, destroying or seriously damaging them and severely limiting access to healthcare for thousands of civilians trapped in the city.
Healthcare in el-Fasher is now run by the RSF-backed government, which has released videos showing the Saudi Hospital and Teaching Hospital reopened, cleaned and treating some patients. Dr Nugud said South Hospital was also due to reopen. He denied that doctors had been abducted, saying they had chosen to remain and work.
Dr Nugud said a consultant, a doctor and six medical staff who had worked with the SAF had been freed when the city was “liberated” and forgiven. The BBC spoke to one of them, Dr Al-Haj Mohamed Ahmed, who said he had no choice but to stay and that he would have been shot if he spoke out of line.
Dr Al-Haj Mohamed Ahmed was among medical workers captured while trying to flee the city and sent back, along with Dr Mustafa Ahmed. The two helped bring a cholera outbreak in a temporary prison at the paediatric hospital under control and were later taken to Saudi Hospital.
Dr Mustafa Ahmed said the RSF told them they were residents of the city and should work together for its sake. He said he woke on several consecutive mornings in the prison to find 50 inmates dead from cholera.
A year after el-Fasher fell, the trauma of this period in Sudan’s civil war remains acute.
