Dr. Mustafa Ali Abdulrahman Ibo and his colleagues braved increasing bombardment at the last hospital in el-Fasher Surgery was performed. el-Fasher is a city in Sudan’s western Darfur region that has been under siege for the past nine months.

Last month, heavy shelling of the hospital killed 28 staff and patients and injured more than 50 people. This is the highest number of casualties recorded in a month since the siege began.

“The ongoing attacks on Saudi hospitals have intensified dramatically recently and it has become part of our daily lives,” Dr Igbo, a Darfurian who has lived in El Fasher since 2011, told the BBC.

The scariest day, he said, was when the shelling began and a team of medics were performing an emergency caesarean section, a near-death experience for all of them.

“The first shell hit the hospital wall… (then) another shell hit the maternity operating room and the fragments damaged the generator, cutting off the power supply and plunging us into complete darkness,” he said.

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

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

Dr. Khattab Mohammed, who led the operation, described the dangers of the operation.

The 29-year-old doctor told the BBC: “The situation is serious and the environment is no longer sterile.”

“After making sure that we and the patient were protected from shrapnel, we cleaned her body and changed her surgical gown because our clothes were full of dust, and then we continued with the surgery,” he said, adding that the patient might Will die from complications.

After the successful delivery, the doctors moved the mother and newborn to another room to recover, and then gathered together to take a group photo.

It was proof of their survival, but Dr Mohammed added: “I think this may be our last picture and believe another shell will hit the same spot and we will all die.”

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

Most of these doctors are graduates of El Fasher University and have remained in place since the outbreak of Sudan’s civil war in April 2023.

The conflict pits the army against the paramilitary Rapid Support Forces (RSF) and has triggered the world’s worst humanitarian crisis, forcing more than 12 million people from their homes.

The two rivals, once allies who came to power together in a coup, have fallen out over an internationally backed plan for civilian rule.

A year after the conflict, the siege of El Fasher began. It is the only city in Darfur still under military control, and Doctors Without Borders has been accused of ethnic cleansing of non-Arab communities.

Médecins Sans Frontières began attacking Fasher from three directions and cutting off supply routes. The United Nations High Commissioner for Human Rights said in a report released last month that the fighting had killed more than 780 civilians and injured more than 1,140, ​​many of them casualties caused by crossfire.

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

The Southern Hospital is supported by the medical charity Médecins Sans Frontières (MSF) and is the city’s main medical facility for the casualties of the war.

It is close to the front lines and was attacked by Médecins Sans Frontières fighters in June, who also stole medicine and equipment and attacked staff.

The Saudi hospital, run by the Ministry of Health and funded by NGOs, the United Nations and Doctors Without Borders, specializes in obstetrics and gynecology but currently provides all medical services – it is the only hospital with surgical capabilities in North Darfur.

Mudathir Ibrahim Suleiman, the 28-year-old medical director of Saudi hospitals, told the BBC that Saudi hospitals were facing a “heartbreaking situation due to shortages of medical supplies, equipment and staff, which violates all humanitarian and international laws and values”.

He recalled how horrific the recent bombings were: “Pregnant women, children and staff were in a state of shock and paralysis, and some were injured and had to be pulled out of the rubble.

“All the current circumstances force us to consider stopping work, but there is nowhere else for women and children to save their lives other than this hospital,” he said.

“Hospital staff are doing everything they can to save lives.”

All normal aspects of life in El Fasher have completely disappeared, especially in the northern and eastern regions. For example, the university operates through online learning, setting up examination centers in safer cities such as Kassala in eastern Sudan.

The city also emptied out due to widespread hunger and insecurity. About half the population has sought refuge in the nearby Zamzam refugee camp, An estimated 500,000 people are currently living in famine.

Saudi hospitals also serve the camp, and Doctors Without Borders ambulances transport emergency cases.

But these have also come under attack recently, including an incident earlier this month when a gunman opened fire on an ambulance “visibly bearing the MSF logo and flag.”

Michel Olivier Lacharité of Médecins Sans Frontières said in a statement: “We are shocked by the deadly attacks on humanitarian aid workers who are providing life-saving medical care where it is urgently needed. Work.”

Dr. Igbo admits that it is his colleagues – there are 35 doctors and 60 nurses at the Saudi hospital – who keep him going.

“We are losing people every day, offices and rooms are being destroyed, but we carry on because of the determination of our young staff.

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

Aid agencies have warned that one of the worst maternal and child health emergencies is unfolding in Darfur, with parts of the region also being 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.

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

Dr Mohammed, who is from Sudan’s White Nile state and came to El Fasher in 2014 to study medicine, also paid tribute to his team for ignoring many opportunities to escape.

“Our souls refuse to abandon the people of this city – especially given the devastating conditions we witness every day.”

All the medical staff communicated through chats and voice messages on WhatsApp and sounded attentive.

“We are determined to continue saving lives wherever we are, even underground or under the shade of trees, and we pray that the war ends and peace prevails,” Dr Igbo said.

Additional reporting by Sudanese journalist Mohamed Zakaria