Three weeks on from the large-scale ground offensive by the Rapid Support Forces (RSF) on Zamzam camp, Sudan, in early April 2025, reports of intensified fighting in El-Fasher continue, and more displaced people are arriving in Tawila, North Darfur state.¹ People have been arriving in Tawila in a vulnerable state; many are suffering from malnutrition, and others were injured during the attack on Zamzam camp. Médecins Sans Frontières’ (MSF’s) emergency and nutrition service at the hospital in Tawila has been overwhelmed.

“They came with their machine guns. They attacked and killed people – including children. They burnt our house, with everything we had inside. They raped the women. They killed, they looted,” says Mariam*, who reached Tawila three days after the attack on Zamzam took place. “Even before the attack, people had died of thirst and of starvation because of the siege that had been imposed on Zamzam for the past year. Everything was so expensive and so unaffordable in the end.”

Mariam* arrived with her mother, her sisters and their children- a household of 20 people. All of them now spend their days squeezed against each other under the makeshift shelter they built with a few branches and a piece of fabric.

“Here, there is no food. A few people in Tawila shared a bit of millet flour with us, which we used to make porridge. This is how we have survived so far: begging,” she says. “We get the water from a tank, but they only let us fill one jerrycan per family, and we are 20 in ours. We only have one blanket for all of us.” 

Since 12 April, when people first began reaching Tawila from Zamzam, the areas surrounding the town have been completely transformed, with tens of thousands of people now estimated to be living in makeshift shelters in fields that were totally uninhabited just a few weeks ago.

“For four days now, we have been staying here as you see us, with nothing: no walls, no roof,” says Ibrahim*, who fled Zamzam on foot with 11 of his family members. He carried one of his children on his shoulders and another on his back for five days. It’s the fourth time in ten years he has been displaced in similar circumstances. He described how soldiers entered people’s homes, brought them outside and opened fire. Three of his brothers were killed like this. On his way to Tawila, he got looted and witnessed people being beaten so harshly that they could no longer move.

“Under this tree, it is so crowded, we’re lacking water, or shelter… there is nothing to eat, everyone is hungry,” he says. “We’re getting some food from the community kitchens. Sometimes, we manage to get some rice when they distribute the meals, but if we don’t, we must wait until the next day to eat something. For water, we go to a borehole, but there are so many people, and we have to wait hours to be able to drink.” 

A handful of organisations are present in Tawila, but the number of people in need of assistance far exceed the capacity to respond. MSF teams have set up two health posts at the main arrival sites to provide the newcomers with water and immediate nutrition and medical support. We are also referring critical patients to Tawila local hospital, where MSF has been working since October 2024.

Tiphaine Salmon, MSF’s head nurse, was working in the Tawila hospital on 12 April, the day people began arriving with serious injuries.

“The emergency room was overwhelmed," she says. “Over the first few days, the number of patients in the hospital almost doubled. At one point, we had four patients in a bed because we did not have enough space.”

“A lot of people had gunshot wounds and blast injuries - we've treated 779 people over the past three weeks, including 138 children. 187 of all the patients were severe cases,” says Salmon. “The youngest I saw was a seven-month-old baby with a bullet wound that went under his chin and into his shoulder. We also received patients as young as one day old suffering from dehydration. Many children arrived without their parents – and many parents were searching desperately for their children.”

At the same time, MSF teams in the hospital witnessed an explosion of admissions in our intensive therapeutic feeding centre, which treats children under five-year-old suffering from severe acute malnutrition in addition of other comorbidities. In the week following the initial influx, admissions increased almost tenfold from an average of six or seven per week, to more than 60. They were mostly children from Zamzam, showing how desperate the nutrition situation was in the famine-stricken camp.

To make the situation even worse, a suspected measles outbreak began in Tawila in March. In the hospital, MSF treated more than 900 suspected measles cases since early February, with more than 300 people in such a severe condition that they required hospitalisation. This led our teams to launch a large-scale vaccination campaign in the city on the first week of April, reaching 18,000 children under five. But one week after the massive influx of people from Zamzam began, our teams saw several suspected cases among children who had just arrived.

Malnutrition and measles, in such sites with a highly dense population and poor hygiene conditions, can be an especially deadly combination for young children.

MSF is continuing to scale-up our intervention in Tawila. On top of carrying out hundreds of medical consultations per day, we have also donated dry food to local community kitchens, enabling them to prepare and distribute more than 16,000 meals per day. We are providing 100,000 litres of clean water daily and we have additional plans to construct 300 latrines.

People’s needs remain immense and far exceed our capacity to respond. Although other actors have also mobilised, and a first mass food distribution has taken place, the humanitarian response still needs to be urgently and rapidly scaled up. We urge UN agencies to substantially increase their presence on the ground so that they can coordinate a response of a magnitude that will meet the ever-growing needs.