dr. Mustafa Ali Abdulrahman Ibo and his colleagues bravely perform surgery under increasing bombardment in the last remaining hospital in el-Fasher, a town that has been under siege for the past nine months in Sudan’s West Darfur region.
Over the past month, the hospital has recorded 28 deaths and more than 50 injuries among its staff and patients due to intense shelling. This is the highest number of victims recorded in a month since the beginning of the siege.
“The recent sustained attacks targeting a Saudi hospital have intensified dramatically, it has become part of our daily lives,” Dr. Ibo, a Darfurian living in el-Fasher since 2011.
He said the scariest day was when a team of medics were performing an emergency C-section when the shelling began – a near-death experience for all of them.
“He hit the wall of the hospital first… [then] another shell hit the operating room of the maternity ward, the fragments damaged the electric generator, cut off the electricity and threw us into complete darkness,” he said.
The surgical team had no choice but to use the flashlights on 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 dangers.
“The situation was terrible, the environment was no longer sterile,” the 29-year-old doctor told the BBC.
“After ensuring our safety and the safety of the patient from the shrapnel, we cleaned her and changed the surgical gowns because our clothes were full of dust and continued the operation,” he said, adding that the patient could have died from complications.
After successfully delivering the baby, the doctors moved the mother and newborn to another room for recovery and then gathered to take a group photo.
It was proof of their survival, but dr. Mohammed added: “I thought it might be our last photo, believing that another shell would hit the same spot and we would all die.”
They went on to perform two more life-saving emergency surgeries that day.
These doctors – most of whom graduated from el-Fasher University – have remained there since Sudan’s civil war broke out in April 2023.
The conflict pitted the army against the paramilitary Rapid Support Force (RSF) and sparked the world’s biggest 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 – but fell out over an internationally backed plan to move towards civilian rule.
A year after the conflict, the siege of el-Fasher began. It is the only town still under military control in Darfur, where the RSF has been accused of carrying out ethnic cleansing of non-Arab communities.
The RSF began attacking 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 injured more than 1,140 – many of them victims of crossfire.
The fighting forced all other hospitals in el-Fasher to close.
The Southern Hospital, supported by the medical charity Médecins Sans Frontières (MSF), was the city’s main health facility dealing with war victims.
It was located near the front line and in June it was captured by RSF fighters, who also looted medicine and equipment and attacked the staff.
The Saudi hospital, run by 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 capacity.
Amid shortages of medical supplies, equipment and staff, the Saudi hospital is facing “an appalling situation that violates all humanitarian and international laws and values,” its medical director, 28-year-old Mudathir Ibrahim Suleiman, told the BBC.
He recalled how terrifying it was during the recent bombings: “Pregnant women, children and staff were in shock and paralyzed, some people were injured and had to be pulled from the rubble.
“All the current conditions make us think about suspending work, but women and children have no other place to save their lives than this hospital,” he said.
“Staff at the hospital are doing the impossible to save lives.”
All normal aspects of life have completely disappeared from el-Fasher, especially in the northern and eastern parts. The university, for example, operates through online learning, with exam centers set up in safer cities like Kassala in eastern Sudan.
With widespread hunger and insecurity, the city also emptied. About half of the population sought refuge in the nearby Zamzam camp, where an estimated 500,000 people are now living in conditions of famine.
A Saudi hospital also serves the camp and MSF operates emergency ambulances.
But they too have come under attack recently, including an incident earlier this month when a gunman shot at a “clearly marked ambulance with an MSF logo and flag”.
“We are appalled by this deadly attack on a humanitarian team carrying out life-saving medical work where it is desperately needed,” MSF’s Michel Olivier Lacharité said in a statement.
Dr Ibo acknowledged that it was his colleagues – the Saudi hospital has 35 doctors and 60 nurses – who kept him going.
“Every day we lose people, destroy offices and premises, but thanks to the determination of the young staff, we continue to persevere.
“We derive our resilience from the people of el-Fasher – we are his children and graduates of the University of el-Fasher.”
Aid agencies warn that one of the worst maternal and child health emergencies is unfolding in Darfur, with some areas also targeted by military airstrikes.
The World Health Organization (WHO) has called for an end to attacks on health facilities and respect for international humanitarian law.
“The sanctity of health must be respected even in war,” WHO communications officer in Sudan Loza Mesfin Tesfaye 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 ignored many opportunities to escape.
“Our souls have refused to leave the people of this city – especially given the catastrophic conditions we witness every day.”
All the medics, who communicated via WhatsApp chats and voice notes, sounded 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 Mohammed Zakaria
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