At least 56 people died in El Fasher, the capital of Sudan’s North Darfur state, between last Friday and Wednesday, as “deadly fighting escalates,” Doctors Without Borders (MSF) said in a statement.

At the city’s South Hospital, 454 casualties have arrived since last Friday, of whom 56 “have succumbed to their injuries,” according to the humanitarian organization.

MSF added that “the wounded and death toll are likely far higher, since the fighting continues to be so intense that many people cannot reach the hospital.”

“North Darfur had been a relatively safe haven compared to other parts of Darfur,” MSF added. “Now, there are snipers in the streets, heavy shelling is taking place, and nowhere in the city is safe at all.”

Violence in North Darfur has intensified, as the paramilitary group Rapid Support Forces (RSF) has been encircling El Fasher.

A report from the Yale School of Public Health’s Humanitarian Research Lab on Wednesday confirmed “significant conflict-related damage in the eastern and southeastern neighbourhoods of El Fasher city between 10–14 May.”

That is consistent with reports that the RSF and Sudanese Armed Forces (SAF) “have engaged in expanded and repeated ground fighting and bombardment in the city", the Yale report added.

The UN Deputy Special Representative for Sudan Clementine Nkweta-Salami said Wednesday that “hostilities have been escalating” in El Fasher, “putting an entire city in peril.”

The United States sanctioned two RSF commanders on Wednesday for their role in leading the paramilitary group’s operations in Darfur.

“The RSF military operation to encircle and besiege El Fasher, North Darfur, has endangered the lives of hundreds of thousands of civilians,” a US Department of State spokesperson said.

Civil war in Sudan between the SAF and RSF broke out in April 2023. According to the UN Office for the Coordination of Humanitarian Affairs, since the war’s outbreak more than 8.8 million people have fled their homes and 24.8 million people are in need of assistance.