Nurses maneuver through gunfire and shelling to make house calls, delivering babies and providing care to those who can’t reach hospitals. Families barely eat in order to conserve dwindling food and water supplies, as temperatures rise. And the few good Samaritans who venture out to help the elderly or put out a blazing fire face intimidation and arrest by the fighters in the streets.
It’s been almost a month since the rivalry between two generals burst into an open war in Sudan, plunging the country deep into a humanitarian crisis and reshaping life in one of Africa’s largest and most geopolitically important nations.
The Sudanese capital, Khartoum, has endured the most intense fighting, prompting embassies and the United Nations to evacuate their nationals and staff members — leaving behind millions who now face shortages of water, food, medicine and electricity.
The clashes — between the Sudanese Army and the paramilitary group known as the Rapid Support Forces — have continued despite repeated cease-fires purportedly agreed to by both sides.
Talks that began in Saudi Arabia last weekend between the warring parties, brokered by Saudis and Americans, have so far yielded no breakthrough — even though these talks have only the modest goal of reaching an actual cease-fire, to allow humanitarian aid into the country.
“We are feeling increasingly desperate as there’s no end in sight,” said Tagreed Abdin, a 49-year-old architect who has been sheltering with her three sons and husband in Al-Diyum, a neighborhood close to Khartoum’s international airport, the scene of some of the fiercest fighting.
Ms. Abdin, who spoke by phone, said she spends most of her days shuttling her boys from one side of their apartment to the other as shelling volleys overhead. When things grow quiet, she allows them to sit by the open windows to escape searing heat.
“It’s an unseen tragedy,” she said, adding that she has started to prefer the noise of war over the humming silence. “At least when there’s gunfire, I know they are running out of ammunition.”
Four years ago, Khartoum was at the heart of a popular uprising that promised to usher in democracy after decades of dictatorship in the northeast African nation of 45 million people. But in the last month, the city of about five million people, which sits at the confluence of the Blue Nile and White Nile, has become the center of a violent power struggle between Gen. Abdel Fattah al-Burhan, the head of the military, and Lt. Gen. Mohamed Hamdan, who leads the paramilitary Rapid Support Forces.
The paramilitary fighters have extended their grip on the capital, controlling roadblocks. They have also been accused of looting and turning hospitals and apartments into defensive positions. The army is mostly shelling from the air.
The clashes have spread to several towns and regions, and have raged in Bahri and Omdurman, Khartoum’s adjoining cities across the Nile. At least 600 people have been killed and over 5,000 others injured, the World Health Organization said on Tuesday. The conflict has displaced over 700,000 people, according to the United Nations, and 160,000 others have fled to bordering nations many of them encumbered with their own economic and political crises.
Residents of Khartoum say they have stayed behind either because they are sick, caring for aging relatives, or lack passports or money for transportation. Others, like Ms. Abdin, opted to stay after hearing of people being attacked and robbed on the road, and spending long days at border crossings.
Yet by remaining, they are stuck in the crossfire and the deteriorating situation on the ground.
Water and electricity infrastructure have been damaged. Banks have been looted and A.T.M.s wrecked. Phones and internet networks are patchy, cutting off communication and hindering mobile money transactions that act as a lifeline. Factories and businesses have been destroyed and looted, depriving many of income in an economy that was already in distress.
On social media, people plead for painkillers or eye drops, and seek suggestions on where to find running water or to bury a relative in neighborhoods under siege from snipers.
It is now difficult to reach any residents by phone. But Ms. Abdin provided a glimpse of what she saw recently when she drove out of her apartment for the first time since the fighting began on April 15 to find medicine for her 80-year-old mother, who is bedridden and has hypertension. The streets near her home, usually clogged with people and traffic, were deserted, she said. A building several doors down from her place was damaged by shelling. Trash and debris were piled on the corner. Taxis thronged a fuel station looking for gasoline. A crowd hoped a bakery would open and offer some bread.
“It was totally surreal,” Ms. Abdin said.
As the fighting has intensified, hospitals, clinics and laboratories, which were already operating under strain, have increasingly come under attack.
A majority of the city’s health facilities have closed, the U.N. said, and only 16 percent are operating normally. The Sudan Union of Pharmacists said Khartoum’s central medical supplies facility, which holds crucial medications for diabetes and blood pressure, closed after it was seized by the Rapid Support Forces.
The U.N. Population Fund also said that medical care for 219,000 pregnant women in Khartoum alone had been disrupted, with supplies “running dangerously low.” More than 10,000 women are in immediate need of obstetric care, including C-sections.
Medical workers in the city have faced reprisals too.
The Sudan doctors’ union said on Monday that the army had arrested two medical volunteers who were evacuating patients from a hospital in Khartoum. The two were later released following an uproar on social media.
At checkpoints manned by paramilitary fighters, many people, and doctors in particular, reported being harassed or having their phone messages and photos checked to determine their allegiances.
“The doctors are not supporting either of these groups,” Dr. Sara Abdelgalil, a pediatric consultant, said in a phone interview. “We don’t want this war.”
Ms. Abdelgalil, who has been fund-raising and coordinating support for the medical workers from Britain, where she lives, said that she was inundated with requests from Khartoum in the past few days. Doctors, she said, have been asking families and patients to vacate hospitals because they were running out of oxygen, drugs or fuel to run machines.
“It is so inhumane,” she said. “It is so cruel.”
Some residents in Khartoum who stuck it out until now are starting to run to the city’s suburbs.
Aya Elfatih and her family recently fled to a small village in the northern suburbs of Khartoum after bullets hit their home and chunks of their roof fell in. Ms. Elfatih, 33, works with a nongovernmental organization, and just a few weeks ago, was helping refugees from other countries settle in Sudan. Now, she and her family have been driven from their home, and are afraid the violence will spread to the now-tranquil countryside.
“I never imagined that I would live to see my situation turn to this,” she said. “Sudan deserves peace. We deserve better.”