The last surgeons standing in the city’s only hospital

Dr. Mustafa Ali Abdulrahman Ibo and his colleagues bravely operate in the last hospital under increasing bombardment in el-Fasher, a city that has been under siege for the past nine months in Sudan’s western Darfur region.

In the past month, the hospital has recorded 28 deaths and over 50 injuries among its staff and patients due to intense shelling. This is the highest number of deaths recorded in one month since the beginning of the siege.

“The recent continuous attacks on the Arab Hospital have escalated dramatically, it has become part of our daily lives,” Dr Ibo, a Darfurian who has lived in el-Fasher since 2011, told the BBC.

She said the scariest day was when a group of doctors were performing an emergency caesarean section when the bombing started – a near-death experience for all.

“The first one hit the perimeter wall of the hospital… (then) another shell hit the maternity operating room, the debris damaged the electric generator, cut the power and plunged us into total darkness,” he said.

The surgical team had no choice but to use flashlights from their phones to complete the two-hour operation.

Part of the building had collapsed and the room was full of dust with shrapnel scattered everywhere.

Dr. Khatab Mohammed, who led the operation, described the risks.

“The situation was dire, the environment was not sterile,” the 29-year-old doctor told the BBC.

“After ensuring our safety and the safety of the patient’s shrapnel, we cleaned it and changed our surgical gown because the clothes were full of dust and proceeded with the operation,” he said, adding that the patient could have died from complications.

After the baby was successfully delivered, the doctors took the mother and newborn to another room to recover and then gathered for a group photo.

It was a testament to their survival, but Dr Mohammed added: “I thought it might be our last picture, I thought another shell would hit the same spot and we would all be killed.”

Two more emergency life-saving operations were carried out that day.

These doctors – most of whom are graduates of el-Fasher University – have been there since the civil war broke out in Sudan in April 2023.

The conflict has pitted the paramilitary army against the Rapid Response Force (RSF) and triggered the world’s largest humanitarian crisis, forcing more than 12 million people from their homes.

The two rivals had been allies—they came to power together in a coup—but they fell due to an internationally backed plan to gain civilian rule.

A year after the start of the conflict, the siege of el-Fasher began. It is the only city still under army control in Darfur, where the RSF has been accused of ethnic cleansing against non-Arab communities.

The RSF began attacking el-Fasher from three sides and cut off the supply routes. In a report published last month, the UN Human Rights Office said the fighting had left more than 780 civilians dead and more than 1,140 wounded – many of them victims of the crossfire.

The fighting has forced the closure of all other hospitals in el-Fasher.

The South Hospital, supported by the medical charity Médecins Sans Frontières (MSF), was the city’s main health facility to deal with war casualties.

It was close to the frontline and in June it was attacked by RSF fighters, who also stole medicine and equipment and attacked the workers.

The Saudi Hospital, run by the Ministry of Health and funded by non-governmental organizations, the UN and MSF, specializes in obstetrics and gynecology, but is now offering all medical services – the only place in North Darfur state with surgical capacity.

Between shortages of supplies, equipment and medical staff, the Saudi Hospital is “facing a dire situation that violates all international humanitarian laws and values,” its medical director, Mudathir Ibrahim Suleiman, 28, told the BBC.

He recalled how terrifying it was during the last bombings: “Pregnant women, children and workers were in shock and paralysis, some people were injured and they had to remove the rubble.

“All the current conditions make us consider stopping our work, but women and children have no other place to save their lives except this hospital,” he said.

“Hospital staff are doing the impossible to save lives.”

All normal aspects of life have completely disappeared since el-Fasher, especially in the north and east. The university, for example, operates through online learning, with exam centers set up in safe cities like Kassala in eastern Sudan.

As hunger and insecurity are widespread, the city has also been emptied. Half of the population has sought refuge in the nearby Zamzam camp, where today around 500,000 people live in a state of famine.

The Saudi Hospital also serves the camp, MSF operates ambulances to bring emergency cases.

But these too have recently come under attack, including earlier this month when a gunman opened fire on “an ambulance clearly marked with the MSF logo and flag”.

“We are horrified by this deadly attack on a humanitarian crew carrying out life-saving medical work where it is desperately needed,” MSF chief Michel Olivier Lacharité said in a statement.

Dr Ibo admitted that it was his colleagues – there are 35 doctors and 60 nurses at the Saudi Hospital – who followed him.

”Every day we lose people, and offices and rooms are destroyed, but thanks to the determination of the young workers, we continue to persevere.

“We draw our resilience from the people of el-Fasher – we are their children and graduates of the University of el-Fasher.”

Aid agencies warn that one of the worst maternal and child health emergencies is taking place in Darfur, where some areas are also being targeted by military airstrikes.

The World Health Organization (WHO) has called for an end to attacks on health facilities and compliance with international humanitarian law.

“The sanctity of health must be respected even in war,” Loza Mesfin Tesfaye, the WHO’s communications officer for Sudan, told the BBC.

Dr. Mohammed, who is originally from Sudan’s White Nile state but came to el-Fasher to study medicine in 2014, also pays tribute to his team, who rejected many chances to escape.

“Our souls refused to abandon the people of this city, especially given the catastrophic conditions we see every day.”

All the doctors, who communicated through WhatsApp chats and voice memos, stood at attention.

“We are determined to continue saving lives, wherever we can, even underground or under the shade of a tree, we pray for war to end and peace to prevail,” said Dr. Ibo.

Additional reporting by Sudanese journalist Mohammed Zakaria