The last surgeons are standing in the only hospital in the city

Dr. Mustafa Ali Abdulrahman Ibo and colleagues bravely operate under increasing bombardment at the last remaining hospital in el-Fashera, a town under siege for the past nine months in Sudan’s western Darfur region.

Over the past month, the hospital has recorded 28 deaths and more than 50 injuries among staff and patients due to intense shelling. This is the highest number of victims in a month since the beginning of the blockade.

“The recent continuous attacks on the Saudi hospital have escalated dramatically, it has become part of our daily lives,” Dr Ibo, a Darfuri who has lived in El-Fashira since 2011, told the BBC.

He said the scariest day was when the medical team were doing an emergency C-section when the shelling started – it was almost fatal for all of them.

“The first shell hit the perimeter of the hospital … (then) another shell hit the maternity operating room, the debris damaged the electrical generator, cutting off the electricity and plunging us into total darkness,” he said.

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

A part of the building collapsed and the room was full of dust, shards were scattered everywhere.

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

“The situation was terrible, the environment was no longer sterile,” the 29-year-old medic told the BBC.

“After ensuring our safety and the safety of the patient from the shrapnel, we cleaned her and changed the surgical gowns as our clothes were full of dust and we continued with the operation,” he said, adding that the patient could have died from complications.

After the successful delivery, the doctors moved the mother and newborn to another room for recovery 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 photograph, thinking another shell would hit the same spot and we’d all die.”

They performed two more emergency life-saving surgeries that day.

These doctors, most of whom are graduates of El Fasher University, remained in place after the start of the Sudanese civil war in April 2023.

The conflict has pitted the army against the paramilitary Rapid Support Force (RSF) and caused the world’s worst humanitarian crisis, forcing more than 12 million people to flee their homes.

The two rivals were allies – they came to power together in a coup d’état – but fell out over an international plan to transition to civilian rule.

After a year of conflict, the siege of El Fasher began. It is the only town in Darfur still under the control of the army, where the RSF is accused of carrying out ethnic cleansing against non-Arab communities.

The RSF began to attack El Fasher from three sides and cut off the supply routes. In a report released last month, the UN Human Rights Office said the fighting had killed more than 780 civilians and wounded more than 1,140 – many of them victims of crossfire.

The fighting forced the closure of all other hospitals in El Fashira.

The Southern Hospital, which was supported by the medical charity Doctors Without Borders (MSF), was the main medical facility in the city dealing with war victims.

It was close to the front line and was stormed in June by RSF fighters, who also looted medicine and equipment and attacked staff.

The Saudi hospital, under the Ministry of Health and funded by NGOs, the UN and MSF, specializes in obstetrics and gynecology, but now provides all medical services – the only place in North Darfur state with surgical capabilities.

With shortages of medical supplies, equipment and staff, the Saudi hospital faced a “horrific situation that violates all humanitarian and international laws and values,” its medical director, Mudathir Ibrahim Suleiman, 28, told the BBC.

He recalled how terrible it was during the recent bombings: “Pregnant women, children and staff were shocked and paralyzed, some people were injured and had to be pulled from the rubble.

“All the current conditions push us to stop our work, but there is no other place for women and children 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 in El Fashira, especially in the northern and eastern parts. The university, for example, operates online with exam centers set up in safer cities such as Kassala in eastern Sudan.

Due to widespread hunger and danger, the city was also deserted. About half of the population took refuge in the nearby Zamzam camp, where an estimated 500,000 people now live in conditions of famine.

A Saudi hospital also serves the camp, and MSF operates ambulances that deliver emergencies.

But they have also recently begun to come under attack, including an incident earlier this month in which a gunman shot at a “clearly marked ambulance with the MSF logo and flag”.

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

Dr Ibo acknowledged that his colleagues – the Saudi hospital’s 35 doctors and 60 nurses – supported him.

“Every day we lose people and offices and rooms are destroyed, but thanks to the determination of young employees we continue to stand.

“We derive our resilience from the people of El Fashir – we are its children and graduates of the University of El Fashir.”

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

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

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

Dr Mohamed, who hails from Sudan’s White Nile state but came to El Fasher to study medicine in 2014, also paid tribute to his team, who ignored many opportunities to escape.

“Our souls have refused to leave the people of this city – especially given the catastrophic conditions we witness daily.”

All the medics, who were communicating via WhatsApp chats and voice notes, seemed focused.

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

Additional reporting by Sudanese journalist Mohamed Zakaria