At least 27 people were killed in clashes in El-Fasher, Sudan

Clashes broke out again between the Sudanese army and rival paramilitaries in the key Darfur town of El-Fasher earlier this week, the United Nations said on Sunday, killing at least 27 people in one day.

Eyewitnesses have reported that the city has been hit by air strikes, artillery fire and machine gun battles since Friday, when an hours-long battle displaced an estimated 850 people, according to the United Nations.

At least 27 people also died that day, according to “unconfirmed reports” from the UN, as the city suffers a near-total communications blackout, with doctors and human rights defenders barely able to relay messages to the world.

Fighting has continued since then, witnesses said Sunday, reporting airstrikes and artillery shelling that left “houses ablaze,” one resident said AFP.

French medical charity Doctors Without Borders (MSF) said two children and a nurse were killed in an intensive care unit on Saturday following a nearby military airstrike.

Since April last year, a devastating war has raged in Sudan between the army led by de facto leader Abdel Fattah al-Burhan and the paramilitary Rapid Support Forces (RSF) under the command of his former deputy Mohamed Hamdan Daglo.

The RSF has captured four of five state capitals in Darfur, a region about the size of France and home to about a quarter of Sudan’s 48 million people.

El-Fasher is the last major city in Darfur that is not under paramilitary control. The international community, including the UN and the United States, have been warning for weeks of an impending offensive against the city.

Doctors Without Borders said Sunday that an airstrike by the army – which has a functional monopoly on airspace – landed 50 meters (164 feet) from Babiker Nahar Children’s Hospital.

As a result, the roof of the intensive care unit collapsed, resulting in “the deaths of two children still being treated there and the death of at least one nursing staff,” according to a statement.

“The children killed were in critical condition in our intensive care unit, but their lives could have been saved,” said Michel-Olivier Lacharite, head of emergency operations at Médecins Sans Frontières.

According to the United Nations, over 70 percent of hospitals across Sudan were taken out of service during the war, leading to multiple health crises.

Militants have targeted medical workers, turned hospitals into barracks and regularly looted and prevented the movement of medical supplies.

Lacharite added that “115 children were treated in this hospital – now no one is being treated” after many patients fled the fighting to the nearby El-Fasher Southern Hospital, the city’s only remaining facility.

A medical source at that hospital said so AFP “The morgue was completely full of bodies on Friday.”

MSF said that “160 injured people – including 31 women and 19 children” had arrived at the hospital, which the United Nations said only had “a capacity of 100 beds.”

“During the fighting, the hospital did not have an ambulance to transport the injured and had limited medical equipment and medicines needed to treat the injured, as well as no surgical supplies,” the United Nations said in its statement Statement from Sunday.

Fears have been growing for weeks of what the US is calling a “catastrophe of epic proportions” if the warring parties descend on the city with full force.

The once-fragile peace in El-Fasher had made it a key hub for displaced people and aid deliveries to the rest of Darfur, where the United Nations says 1.7 million people are on the brink of famine.

The city itself is home to 1.5 million people, including around 800,000 displaced during this and previous conflicts.

Across Sudan, the conflict has killed tens of thousands of people, plunged millions into dire hardship and displaced more than 8.7 million people – more than anywhere else in the world.