As the conflict in Sudan nears the two-year mark, the army has in recent weeks won back large swaths of the capital and its surrounding areas from the paramilitary group.

RSF  still controls some key positions, including the central market, the presidential palace, and some of the southern and western residential districts.

It also holds parts of the central region of Kordofan, most of the western region of Darfur, and is besieging the army and its allies in the city of el-Fashir, the capital of north Darfur.

Residents and medics on Friday said the RSF attacked the famine-stricken Zamzam displacement camp, south of el-Fashir, as the group attempted to tighten its grip on the Darfur stronghold.

An estimated 11.4 million civilians have been forced from their homes since the conflict began in April 2023. Three million are refugees in neighbouring countries, while more than eight million are internally displaced. 

“Sudan’s regional neighbours say they want the conflict to end,” Al Jazeera’s Mohamed Vall said, reporting from Sudan’s Sennar. “Peace efforts were made in Jeddah, Cairo, Addis Ababa, Geneva and elsewhere. But all have so far failed.

“Both the RSF and the army say they’re ready to talk but with caveats and conditions unacceptable to the other side. Both still believe they can achieve total victory on the battlefield.”

Speaking  on Friday at a high-level humanitarian conference in the Ethiopian capital, Addis Ababa, UN Secretary-General Antonio Guterres described the situation in Sudan as a catastrophe on a “staggering scale and brutality”.

“It is a crisis that demands sustained and urgent attention,” he told participants, stressing the need to stop the movement of arms and ammunition into the country.

“This flow is enabling the continuation of tremendous civilian destruction and bloodshed,” Guterres added.

Nearly 25 million people are suffering from “acute” levels of hunger, according to UN figures, and delivering aid requires a ceasefire to be put in place.

Guterres called on world leaders to use their influence for peace and boost humanitarian aid efforts ahead of the holy month of Ramadan.

“We must do more – and do more now – to help the people of Sudan out of this nightmare.”

MSF and the Sudanese authorities said the paramilitary Rapid Support Forces (RSF) were responsible for Saturday’s attack in the city of Omdurman, which killed and injured more than 100 people – a claim the RSF has denied.

The majority of those killed at the market were women and children, the Sudanese Doctors’ Union says.

The RSF and Sudan’s army have been locked in a civil war that, over 22 months, has killed tens of thousands and sparked what the UN describes as one of the world’s worst humanitarian disasters.

In the past few weeks, the army has stepped up its offensive in Omdurman, which lies across the River Nile from capital city, Khartoum, aiming to regain complete control from the RSF.

Eyewitnesses told the AFP news agency that Saturday’s artillery shelling had come from western Omdurman, where the RSF remains in control.

Saturday’s explosion caused “utter carnage” at the nearby Al Nao hospital, which was overwhelmed with injured patients, MSF general secretary Chris Lockyear said.

The Sudanese Doctors’ Union appealed for nearby medics to assist at the hospital, saying there was an “acute shortage of medical staff”.

It added that one shell had fallen “metres away” from the hospital on Saturday.

One survivor of the market attack told the AFP news agency: “The shells hit in the middle of the vegetable market, that’s why the victims and the wounded are so many.”

Both sides have been accused of targeting civilians, including health workers, and indiscriminate shelling of residential areas.

The recent skirmishes have forced emergency response rooms to shut several health centres, affecting the provision of medical services to thousands of residents.

The Health Ministry said at least 158 people were also wounded in Saturday’s attack that was blamed on the paramilitary Rapid Support Forces (RSF).

Khalid al-Aleisir, minister of culture and government spokesperson, condemned the attack, saying the casualties included many women and children. He said the attack caused widespread destruction.

“This criminal act adds to the bloody record of this militia,” he said in a statement. “It constitutes a blatant violation of international humanitarian law.”

Witnesses said the artillery shelling came from western Omdurman, where the RSF remains in control, and was supported by drones.

One resident further south in Omdurman told the AFP news agency that the RSF was firing on multiple streets at once, adding that “rockets and artillery shells are falling.”

“The shells fell in the middle of the vegetable market, that’s why there are so many victims and wounded,” one survivor added.

Staff at the nearby al-Nao Hospital said they have been overwhelmed by the number of casualties and that wounded were “still being brought to the hospital”. A hospital volunteer said they were in dire need of “shrouds, blood donors and stretchers to transport the wounded”.

In a separate incident in Khartoum, two civilians were killed and dozens wounded in an air attack on an RSF-controlled area, the local Emergency Response Room (ERR) was quoted by AFP as saying.

The ERR is one of hundreds of volunteer committees across Sudan coordinating emergency care.

War between the Sudanese army and RSF broke out in April 2023 over the integration of the two forces. It has killed tens of thousands of people, driven millions from their homes and plunged half of the population into hunger.

Saturday’s attack comes a day after RSF commander Mohamed Hamdan Daglo pledged to retake the capital from the army.

“We expelled them [from Khartoum] before, and we will expel them again,” he told troops in a rare video address.

Sudan’s army retook several bases in Khartoum last month, including its pre-war headquarters, pushing the RSF increasingly into the city’s outskirts.

Staff at the nearby al-Nao Hospital said they have been overwhelmed by the number of casualties and that wounded were “still being brought to the hospital”. A hospital volunteer said they were in dire need of “shrouds, blood donors and stretchers to transport the wounded”.

In a separate incident in Khartoum, two civilians were killed and dozens wounded in an air attack on an RSF-controlled area, the local Emergency Response Room (ERR) was quoted by AFP as saying.

The ERR is one of hundreds of volunteer committees across Sudan coordinating emergency care.

War between the Sudanese army and RSF broke out in April 2023 over the integration of the two forces. It has killed tens of thousands of people, driven millions from their homes and plunged half of the population into hunger.

Saturday’s attack comes a day after RSF commander Mohamed Hamdan Daglo pledged to retake the capital from the army.

“We expelled them [from Khartoum] before, and we will expel them again,” he told troops in a rare video address.

Sudan’s army retook several bases in Khartoum last month, including its pre-war headquarters, pushing the RSF increasingly into the city’s outskirts.

Sudan’s capital has turned into a shell of its former self and tens of thousands have been killed across the country due to the violence.

Entire neighbourhoods have been emptied out and taken over by fighters and at least 3.6 million people have fled the capital, according to the United Nations.

At least 106,000 people are also estimated to be suffering from famine in Khartoum, according to the UN-backed Integrated Food Security Phase Classification, with a further 3.2 million experiencing crisis levels of hunger.

The attack on Friday killed 67 people and injured dozens, local activists and a medical source told the AFP news agency on Saturday, updating an earlier toll.

“Thirty-seven of those injured in the drone strike yesterday died today, bringing the number of victims up to 67,” the was cited as saying by AFP, requesting anonymity for fear of retaliation.

Regional governor Mini Minawi posted graphic images of bloodied bodies on his X account on Saturday, saying that the attack “exterminated” more than 70 patients, including women and children.

It was not immediately clear which of Sudan’s warring sides carried out the attack.

The Sudanese army has been at war with the paramilitary RSF, who have seized nearly the entire vast western region of Darfur, since April 2023.

The RSF has besieged el-Fasher, the state capital of North Darfur, since May, but army-aligned armed groups have repeatedly pushed its fighters back, preventing them from claiming the city.

Attacks on healthcare facilities have been rampant in el-Fasher, where medical charity Doctors Without Borders said this month the Saudi Hospital was “the only public hospital with surgical capacity still standing”.

Across the country, up to 80 percent of healthcare facilities have been forced out of service, according to official figures.

The war, which broke out after disputes on the integration of the two forces, has killed tens of thousands of people, driven millions from their homes and plunged half of the population into hunger.

In the area around el-Fasher, famine has already taken hold in three displacement camps – Zamzam, Abu Shouk and Al-Salam – and is expected to expand to five more areas including the city itself by May, according to a UN-backed assessment.

The attack on the hospital in el-Fasher occurred as the Sudanese army claimed to have broken an RSF siege of its headquarters in Khartoum, in place since the war broke out.

In a statement, the army said troops in Khartoum North and Omdurman had “merged with our forces stationed at the General Command of the Armed Forces”.

Sudan’s capital, Khartoum, comprises three main cities – Khartoum, Omdurman, and Khartoum North – separated by the Nile River and collectively referred to as the triangular capital.

The army added that it had “expelled” the RSF from the strategically important al-Jili oil refinery north of the capital, the country’s largest.

The RSF said in a statement that it rejected the Sudanese army’s claims as “propaganda” designed to boost morale, and accused it of spreading falsehoods through doctored videos.

In a statement on Thursday, the US Treasury Department said that, under al-Burhan’s leadership, the SAF has “committed lethal attacks on civilians, including airstrikes against protected infrastructure including schools, markets, and hospitals”.

“The  SAF is also responsible for the routine and intentional denial of humanitarian access, using food deprivation as a war tactic,” it said.

The move comes just days after the Biden administration imposed sanctions on Mohamed Hamdan Dagalo, the leader of the Rapid Support Forces (RSF), a Sudanese paramilitary group that has been locked in a war with the SAF since April 2023.

Under Dagalo’s leadership, “the RSF has engaged in serious human rights abuses, including widespread sexual violence and executing defenseless civilians and unarmed fighters”, the Treasury Department said on January 7.

Washington also accused the RSF and its allied militias of committing genocide in western Sudan’s Darfur region.

The war in Sudan has killed thousands of people and pushed the country into a dire humanitarian crisis.

More than 8 million Sudanese have been internally displaced, while 3 million others have fled to neighbouring countries, according to United Nations figures.

A UN-backed group that monitors global hunger also warned late last month that famine was spreading rapidly across Sudan, with famine conditions confirmed in parts of Darfur, among other regions.

When asked about Thursday’s sanctions during a briefing in Washington, DC, US Secretary of State Antony Blinken told reporters that the Sudanese Armed Forces “continues to target civilians” in the country.

“It’s obstructed the advancement of a peace process. It’s refused to participate on numerous occasions in ceasefire talks that we’ve sought to convene,” Blinken said.

“And together with the RSF, it’s caused what is the world’s worst humanitarian crisis that people are suffering through every day.”

Blinken  also voiced hope that the incoming administration of President-elect Donald Trump, who takes office on Monday, would keep trying to end the conflict.

“It is for me, yes, another real regret that when it comes to Sudan, we haven’t been able, on our watch, to get to that day of success,” he said.

Speaking earlier on Thursday, al-Burhan was defiant about the prospect that he might be targeted.