The last surgeons in the only hospital in town

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

In the last 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 casualties recorded in a month since the beginning of the siege.

“The recent continuous attacks targeting the Saudi hospital have increased dramatically and this has become part of our daily life,” Dr Ibo, a Darfurian who has lived in El Fasher since 2011, told the BBC.

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.

“The first one hit the perimeter wall of the hospital … (then) another shell hit the delivery 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 their phones' torches 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 medic told the BBC.

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

After successfully delivering the baby, the doctors moved 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 this might be our last photo, believing 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 are graduates of El-Fasher University – remained in place after the outbreak of Sudan's civil war 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 from their homes.

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

A year after the start of the conflict, the siege of el-Fasher began. It is the only town still under army control in Darfur, where the RSF has been accused of carrying out ethnic cleansing against 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 left more than 780 civilians dead and more than 1,140 wounded – many of them victims of crossfire.

The fighting forced all other hospitals in El Fasher to close.

The Southern Hospital, which was supported by the medical charity Médecins Sans Frontières (MSF), was the main health facility in the city that dealt with war casualties.

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

The Saudi hospital, which is 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 – it is the only place in North Darfur state with surgical capacity.

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

He remembers how terrifying it was during the last bombings: “Pregnant women, children and staff were in shock and paralysis, some people were injured and had to be pulled from the rubble.

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

“The 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, works through online learning with exam centers established in safer cities such as Kassala in eastern Sudan.

With mass starvation and insecurity, the city also emptied. About half the population sought refuge in the nearby Zamzam camp, where about 500,000 people now live in conditions of famine.

The Saudi hospital also serves the camp, with MSF operating ambulances to transport emergencies.

But they have also recently come under attack, including an incident earlier this month when a gunman fired at a “clearly marked ambulance with the 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 Lasharette said in a statement.

Dr Ibo acknowledged that his colleagues – there are 35 doctors and 60 nurses at the Saudi hospital – supported him.

“Every day we lose people, offices and rooms are destroyed, 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 alumni of the University of el-Fasher.”

Aid agencies are warning that one of the worst maternal and child health emergencies is unfolding in Darfur, where some areas are also under 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 times of war,” the WHO's communications officer in Sudan, Loza Mesfin Tesfaye, told the BBC.

Dr Mohamed, who is originally 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 abandon 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 from wherever we can, even underground or under the shade of a tree, we pray that war will end and peace will prevail,” said Dr. Ibo.

Additional reporting by Sudanese journalist Mohamed Zakaria