Humanitarian Crisis Report: The Collapse of Health and Safety in El Fasher, Darfur

Situation Overview: A System on the Brink of Collapse

The unfolding situation in El Fasher, North Darfur, represents a catastrophic and interconnected humanitarian disaster. Understanding the strategic interplay between escalating violence, oppressive siege conditions, and a rapidly worsening public health emergency is critical to grasping the full scale of the crisis. The city has become a trap for its civilian population, where the fundamental pillars of survival—safety, health, and access to basic necessities—are systematically being dismantled.

For the more than 260,000 people who remain trapped in the city, the conditions are dire. They face a convergence of life-threatening challenges that have pushed them to the absolute brink:

Escalating, Indiscriminate Violence: Civilians, including children, are being killed as the conflict intensifies, with no safe refuge available.

Critically Limited Access to Food and Water: The population has almost no access to clean water or adequate food, fueling widespread hunger and disease.

A Collapsing and Fragile Health System: The city's already overstretched medical infrastructure is collapsing under the weight of sustained attacks and overwhelming needs.

The Severing of Humanitarian Aid: El Fasher has been completely cut off from humanitarian assistance since February 2024, leaving the population without external support.

This comprehensive breakdown of the city's life-support systems is tragically exemplified by the direct and repeated attacks on its remaining healthcare infrastructure.

The Assault on Healthcare: A Violation of International Humanitarian Law

In any conflict zone, healthcare infrastructure serves as a vital lifeline, offering care to the wounded and sick and representing a sanctuary of neutrality. The targeted destruction of these facilities and the killing or abduction of medical personnel are therefore not merely collateral damage; they are a grave breach of International Humanitarian Law and a direct assault on the civilian population's right to life and health.

Targeting of Medical Facilities and Personnel

Recent events at the Saudi Maternity Hospital—the only partially functioning hospital left in El Fasher—illustrate a horrific pattern of aggression. On October 26th, the hospital was attacked for the fourth time in a single month, an assault that killed one nurse and left three other health workers injured. Just two days later, on October 28th, the violence escalated dramatically. Six health workers—four doctors, a nurse, and a pharmacist—were abducted from the hospital. In a subsequent and profoundly shocking event on the same day, more than 460 patients and their companions were reportedly shot and killed within the hospital's premises.

Cumulative Human Toll on the Health Sector

The impact of this targeted violence extends far beyond these recent incidents. Since the conflict began, the human cost to the health sector in El Fasher has been devastating:

• 46 health workers have been killed, including the Director of Primary Health Care for the State Ministry of Health.
• 48 health workers have been injured.

Furthermore, the operational environment has become so perilous that the status of personnel working in three nongovernmental organizations in El Fasher remains unknown, deepening the information vacuum and highlighting the extreme risks faced by all humanitarian actors.

The World Health Organization has unequivocally condemned these actions:

"WHO condemns these horrific attacks on health care in the strongest terms and calls for the respect of the sanctity of health care as mandated under International Humanitarian Law."

The systematic dismantling of the health system has not only created a medical vacuum but has also shattered any remaining sense of safety, contributing directly to the mass displacement of civilians desperate to escape the violence.

Mass Displacement and a Worsening Protection Crisis

The collapse of security and basic services in El Fasher is no longer a risk; it is a reality confirmed by the massive exodus of its population. This forced displacement is driving a new, highly concentrated humanitarian crisis in surrounding areas, stretching already limited resources and placing an immense burden on host communities.

The scale of this recent and anticipated displacement is alarming:

• Approximately 28,000 people have been recently forced to flee El Fasher Town.
• Of these, 26,000 have moved to the relative safety of rural areas within the El Fasher locality.
• Up to 2,000 have managed to reach the town of Tawila.

An additional 100,000 people are expected to seek refuge in Tawila in the coming days and weeks.

This new wave of displacement will compound the existing crisis, adding to the 575,000 internally displaced persons already sheltering in Tawila and other areas.

The displaced population is exceptionally vulnerable. Many are women and unaccompanied children who arrive with nothing, facing acute shortages of shelter, protection, food, water, and healthcare. They are traumatized, exhausted, and in immediate need of lifesaving assistance. These precarious and overcrowded conditions have become a fertile breeding ground for disease outbreaks, which are now flourishing among the weakened population.

Public Health Emergency: Cholera, Malnutrition, and Compounding Threats

The siege, mass displacement, and lack of sanitation have created the perfect storm for a public health catastrophe. With no access to safe drinking water, disease surveillance and response activities are severely reduced as a result of the deteriorating security situation. Consequently, a deadly cholera outbreak is spreading rapidly through the population with devastating consequences.

Cholera Outbreak

The statistics from El Fasher and the wider Darfur region paint a grim picture of an uncontrolled epidemic:

• El Fasher (This Year): 272 suspected cases have been reported, resulting in 32 deaths.
• El Fasher Case Fatality Rate (CFR): The CFR stands at a highly alarming nearly 12%, far exceeding the emergency threshold of 1% and indicating a severe lack of access to basic treatment.

Across Darfur: The outbreak is widespread, with 18,468 cases and 662 deaths recorded across 40 localities.

The Malnutrition Crisis

Compounding the threat of infectious disease is a sharply rising malnutrition crisis. The humanitarian blockade in place since February 2024 has cut off food supplies, forcing families to exhaust their food stocks and lose access to markets. Malnutrition, especially among children and pregnant women, is weakening immune systems and dramatically increasing the population's vulnerability to cholera, malaria, and other infectious diseases. This vicious cycle—where hunger fuels disease and disease worsens malnutrition—is accelerating the humanitarian decline.

Amidst these catastrophic conditions, humanitarian organizations are working relentlessly to mount a response, though their efforts are severely hampered by the lack of access.

Humanitarian Response Efforts and Access Constraints

Despite the severe access restrictions and the deteriorating security situation, the World Health Organization and their partners are actively working to deliver lifesaving aid to the most vulnerable populations, particularly those newly displaced from El Fasher. Our operational focus is on reaching those we can and pre-positioning aid to be deployed the moment a window of opportunity opens.

Current and planned actions include:

Aid Mobilization: A shipment of 20 metric tons of WHO medicines and emergency kits is currently being moved from Nyala to Tawila. This includes essential supplies for treating cholera and managing severe acute malnutrition with medical complications.

Cross-Border Supply Chains: Health supplies previously handed over to partners in Abeche, Chad, are being fast-tracked for delivery to displacement sites in Tawila and other gathering locations for those fleeing the violence.

Frontline Medical Care: WHO is coordinating with health partners at reception sites in Korma, a key transit point between El Fasher and Tawila, to stabilize critically ill and injured people and facilitate their referral for further care.

Rapid Response Preparedness: We are preparing to deploy rapid response teams within Tawila and its surrounding localities to meet the urgent health needs of the thousands of people arriving from El Fasher.

Convoy Readiness: WHO trucks are on standby in Darfur, ready to join a United Nations aid convoy carrying vital humanitarian supplies, including food and our own medicines and lifesaving health items, into El Fasher as soon as humanitarian access is granted.

These critical efforts, however, remain insufficient as long as safe and unimpeded humanitarian access to the civilian population trapped inside El Fasher itself continues to be denied.

Conclusion and Urgent Calls to Action

The crisis in El Fasher has reached a breaking point. The deliberate targeting of civilians and healthcare, combined with a crippling siege, has triggered a complete collapse of health and safety, driving mass displacement and fueling a deadly public health emergency. This is a man-made catastrophe that demands an immediate and decisive response from the international community to prevent further loss of life.