Fighting in Sudan between the army and paramilitaries has been ongoing for almost one year.

Two generals, Abdel Fattah Burhan and Mohammed Hamdan Dagalo, are fighting for control over Africa's third-largest country and its vast resources.

Burhan leads the Sudanese Armed Forces, while Dagalo, better known as Hemedti, controls the Rapid Support Forces (RSF) paramilitary group.

The bloody conflict has killed thousands and sparked a humanitarian disaster. According to the United Nations, around 25 million people — more than half the population — need aid, and nearly 18 million face acute food insecurity.

The two primary warring factions have now launched attacks in and around civilian areas.

The US special envoy for Sudan, Tom Perriello, wrote on the social media platform X that "the Sudanese army's bombing raids in El Fasher, where thousands of civilians from across Darfur have sought refuge, have failed to avoid civilian locations, resulting in dozens of casualties."

He added that the RSF's attacks on villages in the state of El Gezira had also led to civilian deaths and the displacement of thousands.

In another message on X, Perriello said that "reports of growing famine and attacks on civilians must be heard as a call to action for all of us, as this war nears its tragic first anniversary."

Sudan's grim year of devastation

Since fighting erupted on April 15, 2023, more than 8.5 million people have been displaced, many of whom have sought refuge in neighboring Chad and South Sudan.

Thousands have fled to the border town of Renk in South Sudan. Conditions there are grim, with camps severely overcrowded due to the high influx of refugees each day.

Sanitation is woefully insufficient, with, for example, up to 200 people sharing one latrine. There has been a rise in cholera and measles, as well as an increase in cases of severe malnutrition.

Aid agencies have said they are struggling to meet the needs of exhausted and traumatized families, many of whom have walked for days with little food and water.

Khalida Ibrahim Salateen, who was displaced from Sudan's capital, Khartoum, described the situation as dire. "We sleep on the ground. There's no food. There's water, but it's not clean, and children get sick with no nearby hospital. The situation is very difficult," she told DW.

Despair amid prayers

Fatim Douka, originally from El Gezira, is now living in a sprawling camp in Renk. She told DW that this year, the Islamic holy month of Ramadan had been full of despair, hopelessness, and unyielding prayers.

"We're struggling in this camp as we cannot find anything to eat," she said. "Many people who are fasting can't even find anything to break their fast. They have only been drinking water since Ramadan started. Even the medications provided to us are only for general purposes, like paracetamol. However, medications for hypertension and diabetes are unavailable."

Madina Zakaria Hamdallah, who was displaced from Khartoum, has experienced a similar ordeal. "It's Ramadan, and we need to receive aid," she said. "Children are hungry, but there's no food, water, or clothes for them. We don't get it. They keep telling us that an NGO is coming to help, but no one has arrived."

UN warns of widespread death due to hunger

The long and desperate wait for food aid could continue.

Perriello has accused both the military and the Rapid Support Forces of obstructing humanitarian assistance and the free movement of civilians across the country.

This comes as the Integrated Food Security Phase Classification initiative, backed by the United Nations, has warned that immediate action is needed to "prevent widespread death and total collapse of livelihoods and avert a catastrophic hunger crisis in Sudan."

Regarded as a global authority on food security, the UN initiative was due to issue an update to its December analysis, which found nearly 5 million people on the verge of catastrophic hunger. However, due to the ongoing war, it was unable to do so.

As the refugee crisis worsens, the international community is facing mounting moral pressure for urgent action.

"It is all about saving lives ... asking for resources, for sustainability," said Mamadou Dian Balde, a regional director with the UN refugee agency UNHCR.

This article has been adapted by George Okach from a radio report that was broadcast on DW's daily podcast AfricaLink