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A maternity hospital massacre in Sudan has left 460 people dead just days after a 48-hour killing spree saw more than 2,000 civilians executed by paramilitary rebels.
The World Health Organisation said the Saudi Maternity Hospital in El Fasher, the city's last remaining hospital, was on Sunday 'attacked for the fourth time in a month, killing one nurse and injuring three other health workers'.
Two days later, 'six health workers, four doctors, a nurse and a pharmacist, were abducted' and 'more than 460 patients and their companions were reportedly shot and killed in the hospital,' by Rapid Support Forces (RSF) paramilitaries, the organisation said.
Footage purportedly capturing the aftermath of the hospital massacre showed bodies scattered across the floor among debris and broken equipment.
'I was performing surgery in the hospital when heavy shelling occurred. A mortar hit the hospital. I was so worried because the woman's wounds were open, and everyone was running around me,' Dr Suhiba, a gynaecologist, told UNFPA, the United Nations sexual and reproductive health agency.
The northeast African nation was plunged into a deadly conflict in mid-April 2023, when long-simmering tensions about the future of the country between the Sudanese Armed Forces (SAF) and the head of the paramilitary rebel group erupted.
Following the most recent incident, allies of the army, the Joint Forces, said on Tuesday that the RSF 'committed heinous crimes against innocent civilians, where more than 2,000 unarmed citizens were executed and killed on October 26 and 27, most of them women, children and the elderly'.
The total death toll could not immediately be confirmed, but shocking satellite images taken after the fall of El Fasher showed evidence of the mass killings.
Body-sized objects were seen in satellite images clustered around vehicles and nearby an RSF sand berm built around the city. There were reports of civilians being gunned down as they attempted to break out and flee the bloodshed.
Analysis by the Yale School of Public Health Humanitarian Research Lab (HRL), which has been tracking the siege using open source images and satellite imagery, found clusters of objects 'consistent with the size of human bodies' and 'reddish ground discolouration' thought to be either blood or disturbed soil.
A video released by local activists and authenticated by AFP on Tuesday showed a fighter known for executing civilians in RSF-controlled areas shooting a group of unarmed civilians sitting on the ground at point-blank range.
Another video purportedly showed a child soldier murdering a grown man in cold blood, while one other clip showed RSF fighters executing civilians just moments after pretending to release them.
A report published on Monday said the actions of the RSF 'may be consistent with war crimes and crimes against humanity and may rise to the level of genocide'.
Mohammad Hamdan Daglo, the head of the RSF has vowed the country would be unified by 'peace or through war'.
The capture of El-Fasher, the last army holdout in the vast western region of Darfur, comes after more than 18 months of brutal siege, sparking fears of a return to the ethnically targeted atrocities of 20 years ago.
UN chief Antonio Guterres called for an immediate end to military escalation in Sudan on Thursday after reports of the maternity hospital atrocity.
Guterres said in a statement he was 'gravely concerned by the recent military escalation' in El-Fasher, calling for 'an immediate end to the siege & hostilities'.
International powers have struggled for months to mediate an end to the fighting between the paramilitaries and the regular army, raging since April 2023.
Daglo's paramilitaries now control most of western Sudan, Africa's third-largest country, while the regular army under Abdel Fattah al-Burhan dominates the north, east and centre.
While the army regained full control over the capital Khartoum in March, the RSF has set up a parallel administration in the southwestern city of Nyala.
Analysts warn that the country is now de facto partitioned and may prove very hard to piece back together.
Daglo said in a speech Wednesday that he was 'sorry for the inhabitants of El-Fasher for the disaster that has befallen them' and that civilians were off limits.
The RSF - descended from Janjaweed militias that attacked non-Arab communities in Darfur two decades ago - has again been accused of carrying out ethnic genocide against civilians, with graphic videos circulating on social media.
Sudanese Arabs are the dominant ethnic group in the country, but the majority in Darfur are from non-Arab communities such as the Fur people.
The seizing of El-Fasher has left the RSF in control of a third of Sudan, with fighting now concentrated in the central Kordofan region.
On Tuesday, the International Federation of Red Cross and Red Crescent Societies reported five Sudanese volunteers killed and three missing in Bara, a city in Kordofan captured by the RSF last week.
More than 33,000 people have fled El-Fasher since Sunday for the town of Tawila, about 40 miles to the west, which has already welcomed more than 650,000 displaced people.
AFP images from Tawila showed displaced people, some of them with bandages, carrying their belongings and setting up temporary shelters.
Around 177,000 people remain in El-Fasher, which had a population of more than one million before the war.
Access routes to El-Fasher and satellite-based communications in the city remain cut off - though not for the RSF, which controls the Starlink network there.
Sudan's war has killed tens of thousands of people, displaced millions and triggered the world's largest displacement and hunger crisis.
Fighting exploded in the capital Khartoum but rapidly spread, where it is now estimated that at least 150,000 people have been killed, including many civilians.
The civil war has forced more than 14 million people to flee their homes and left some families eating grass in a desperate attempt to survive as famine swept parts of the country.
An investigation by Amnesty International suggests that RSF rebels have waged a calculated campaign of sexual violence against defenceless civilians, using rape, murder and torture to terrorise, demoralise and subjugate the population living in areas they seized.
The army, which has been fighting the RSF for two-and-a-half years, has also been accused of war crimes.
The so-called Quad group - comprising the United States, Egypt, the United Arab Emirates and Saudi Arabia - held talks over several months towards securing a truce.
But those talks have reached an impasse, an official close to the negotiations said, with 'continued obstructionism' from the army-aligned government.
While diplomats have preached peace, outside powers, including Quad members, have been accused of interfering in the conflict.