A BBC investigation has found evidence that Sudanese paramilitary fighters systematically destroyed el-Fasher’s healthcare system during their long siege and subsequent takeover of the city in Darfur a year ago.
UN human rights chief Volker Türk called the findings “deeply disturbing”, saying multiple attacks by the Rapid Support Forces (RSF) on civilian infrastructure, including health facilities, were serious violations of international humanitarian law and may amount to war crimes.
The RSF has rejected the BBC’s findings.
The paramilitary group’s health minister described the allegations as propaganda and a deliberate attempt by the national army and its allies to smear the RSF’s reputation.
Using sources who were on the ground in el-Fasher, the BBC has found details of at least 43 separate attacks on hospitals and healthcare sites from May 2024 to October 2025 – some hit multiple times.
Under international law it is illegal to attack health facilities or their staff during conflict.
The investigation also reveals the toll on medical workers in the western city. In the period from April 2023 to October 2025, the BBC’s data shows 120 were injured, 55 killed and 10 forcibly “disappeared” or abducted.
“The RSF [were] trying to evacuate the hospitals, to put them out of service because the health system is the cornerstone of any city or any state,” says Dr Muhamed Suliman, a surgeon who was based in el-Fasher during the siege and spoke to the BBC.
“The RSF started hitting these areas so citizens have no longer any way to stay there. It was intense. It was deliberate. It was planned.”
The investigation comes a year after the fall of el-Fasher, one of the most brutal chapters of the civil war which erupted in April 2023 between the RSF and Sudan’s military.
Both sides have been accused of attacks on health facilities.
In March 2026, the World Health Organization (WHO) condemned the bombing of al-Daein hospital in RSF-held eastern Darfur, which killed dozens and forced the site to close. Sudan’s military is believed to have carried out the drone strikes, although it has denied responsibility.
But events in el-Fasher represent “one of the clearest and most severe examples of the wider impact of the conflict on health care in Sudan,” the WHO said in response to a BBC query.
UN investigators have reported that the fighting in el-Fasher bore the “hallmarks of genocide”, where historical ethnic animosities have seen Arab militias – now the backbone of RSF forces – target non-Arab groups such as those that populate the city.
The BBC’s investigation reveals for the first time a detailed chronology of attacks on healthcare during the long siege of the city.
Some medical facilities in el-Fasher closed down within weeks of the country’s civil war starting in April 2023.
Crucially this included one of the main hospitals – the Teaching Hospital – located in a conflict zone in the middle of the city.
Its operations were moved to el-Fasher’s South Hospital. There medical services continued, although increasingly hindered by power cuts and dwindling supplies.
The situation changed dramatically a year later, when the RSF mounted its siege of el-Fasher.
In late May and early June of 2024, the South Hospital was shelled several times as paramilitary fighters pushed forward from their positions in the east of the city.
The first bombing came as a shock, says Dr Suliman.
The area around the hospital that was hit was “very crowded because it was the only working hospital in the city providing surgical services”, he says.
On that day medical staff operated on 16 injured patients, he added.
The attacks culminated in an RSF raid on 8 June. Hospital staff were taken by surprise – many of them escaped over the back wall as the RSF fighters entered the building, says Dr Mustafa Ahmed, a pharmaceutical specialist.
But the director general of the hospital, surgeon Izzeldin Ahmed Dawaud Asow, encountered a group of the paramilitaries outside his office.
They did not know he was a doctor, he said, but denounced him with ethnic slurs.
“There are no citizens here. You are Falangi,” they said, using a derogatory term implying that non-Arab Sudanese are foreigners.
Dr Asow says he was beaten with rifle butts and lost consciousness at one point. Ultimately, he saved himself by pretending to be dead.
“They put their hand on my chest, and I stopped breathing. And they said: ‘Leave him, leave him. The rubbish has died. Leave him.’ They left me.”
That same day the RSF was driven out by the Sudanese military and its allies and Dr Asow returned to find the bodies of several patients and the surgical equipment in his operating room thoroughly destroyed, he said.
The hospital closed and later fell into RSF hands when the army retreated.
Dr Alaa Eldin Nugud, a prominent Sudanese surgeon who has joined the RSF-backed civilian government as health minister, insisted the South Hospital was being used as a military base.
According to international law, hospitals can lose their protection if they are used by a party to the conflict to commit an “act harmful to the enemy”.
In an interview with the BBC, Dr Nugud declared that missile launchers were set up on the grounds and shared a video showing remains of weapons filmed more than a year after the hospital closed, which he said supported his claim.
He also showed us what he called maps of landmines planted around the Teaching Hospital, which is located next to Sudanese military headquarters.
Doctors told us the hospital was not incorporated into the base and said they visited it to pick up medical equipment during the war.
The BBC has found no independent evidence of Dr Nugud’s allegations. And the government of the Darfur region categorically rejected the charges.
After the South Hospital shut, its staff and remaining equipment were moved to the Saudi Maternity Hospital in the west of the city, where the army had its main bases.
Within days the pace of attacks on the facility picked up. At this stage the medical charity Médecins Sans Frontières (MSF) sounded the alarm.
“We do not know if hospitals are being intentionally targeted, but… the belligerents are not taking any precautions to spare them,” it said in a statement.
However, in the course of our investigation we spoke to six doctors who described a pattern of systematic targeting.
They told us how Saudi Hospital was repeatedly struck – on some days up to 25 times, with a mix of shelling and drones, the latter “intelligent rockets” with precision-guided attacks.
Smaller medical facilities also came under fire. The BBC’s timeline records the steady closure of private hospitals and neighbourhood clinics.
Furthermore, when some of these healthcare buildings shifted locations, the alternate venues were also attacked.
The Specialised Children’s Hospital, which shut down at the beginning of the war along with the Teaching Hospital, moved to two other locations, both of which were then shelled and forced to close.
Similarly, the main dialysis centre was struck and then attacked again after it relocated.
By the time the RSF seized the city in October 2025, the Saudi Hospital was the only functioning health facility left.
The medical staff there had rallied to try to keep working as conditions worsened.
Doctors described how sandbags were set up to protect the building.
They built underground bunkers out of steel containers and established a number of alternative sites to house and receive patients and conduct surgery as the threat of attacks and the damage to the main structure steadily increased.
Dr Asow said this makeshift surgery was attacked five times in 2025.
In one case, he says, he was operating on a patient’s neck when the building was shaken by an explosion – the medical staff ran out in fear, but he stayed.
In another case, health workers had prepared the theatre for an operation, but he told them to move the patient elsewhere because it needed a deep clean given the relentless case load. Shortly afterward the room was destroyed by shells – and the patient survived.
“From that day, some of my staff called me ‘Mr Deep Cleaning’ because they think that the issue of deep cleaning saved that patient,” he said.
Dr Asow also describes how drones tracked the movement of patients.
On 15 March 2025, people carrying the injured from the site of an attack to one of the temporary wards were followed by a hunting drone, he says.
It struck as they reached the gate of the building, killing nine people.
On 17 August of the same year a donkey cart was transferring patients to the alternative operating theatre because all the ambulances had been destroyed, Dr Asow told the BBC.
It was hit by a drone, killing two patients, the driver and the donkey, he says.
The RSF health minister dismissed these accounts as “a continuation of lies” by the military (SAF) and their local allies, known as the Joint Forces.
“Even the medics, and many of the people who were there, because of this conflict, these tribal issues, these racial issues, they are allied with the Joint Forces and with the SAF. That’s why you don’t depend on that narrative,” he said.
Doctors told the BBC they believed RSF fighters deliberately targeted medical facilities because army or allied fighters were among their patients.
The onslaught of shelling and bombing culminated on 25 October 2025 with the RSF storming the hospital amid allegations of a massacre that killed more than 460 patients and their companions.
The RSF has denied a massacre occurred, although the WHO condemned the reported killings and satellite imagery appeared to show clusters of bodies on the blood-soaked grounds of the hospital.
The BBC shared details of its investigation with the UN human rights chief, who said our findings were “deeply disturbing”, and consistent with the analysis of his office.
“Our monitoring and documentation shows the RSF repeatedly struck el-Fasher’s main hospitals and makeshift health facilities, destroying or seriously damaging them and severely impacting access to health services for thousands of civilians trapped in the city,” Türk said.
Healthcare in el-Fasher is now being run by the RSF-backed government. It has released several videos showing the Saudi Hospital and the Teaching Hospital re-opened, cleaned up and seeing some patients.
Dr Nugud says South Hospital is also set to reopen. He denied that doctors were forcibly abducted, telling the BBC that instead they had chosen to stay on to work.
“I have a video in front of the children’s hospital when we freed a consultant, a doctor and six of the medical staff who were working with the SAF, and then when el-Fasher got liberated, there was a forgiveness for all of them.
“We liberated them,” he said.
The BBC spoke to one of the doctors in the video, Dr Al-Haj Mohamed Ahmed. He told us he had no choice: “I was forced to be there.
“If I spoke out of line, they’d put a bullet through my head.”
He was among several medical workers captured while trying to escape the city and sent back, along with Dr Mustafa Ahmed.
They distinguished themselves by bringing a cholera epidemic in a temporary prison at the paediatric hospital under control and were subsequently taken to Saudi Hospital.
“They started to say that you are the people of the city, and we take the city, so we need to work together for the sake of the city,” says Dr Mustafa Ahmed, who describes waking up several mornings in a row at the prison to find 50 inmates dead of cholera.
A year on from the fall of el-Fasher, the trauma of this dark period in Sudan’s civil war is still painfully sharp.
The front lines have shifted elsewhere with no signs of a resolution to the conflict. And attacks on healthcare continue as part of a wider and devastating humanitarian crisis.