WAD MADANI, Sudan: In war-torn Sudan, a Blue Nile river town has become a relative sanctuary from the fighting, but survivors living there endure overcrowding, widespread disease and creeping hunger.

One of the internally displaced people who made it to Wad Madani, a 200-km drive southeast of the embattled capital Khartoum, was mother-of-three Fatima Mohammed.

Then, 10 days ago, she succumbed to illness, leaving behind three children — Ithar, 11, Dalal, nine, and Ibrahim, seven — who now largely fend for themselves in the courtyard of the Al-Jeili Salah school.

They are among hundreds of thousands who have run for their lives since the war erupted in mid-April between two rival generals in the northeast African country.

More than 2,000 people have died in the conflict between the forces of army chief Gen. Abdel Fattah Al-Burhan and his former deputy Gen. Mohammed Hamdan Dagalo who commands the paramilitary Rapid Support Forces.

Many people have found refuge in makeshift camps set up in schools, university dormitories and other buildings in Wad Madani, nestled on a bend of the Blue Nile in a cotton farming region of Al-Jazirah state.

Another survivor, Soukaina Abdel Rahim, now lives with six of her family members in a room in the girls’ dormitory at Al-Jazirah University in the east of Wad Madani.

“For a family, the accommodation is uncomfortable, there is a lack of space and privacy,” she said. 

“We share the showers and toilets with 20 other rooms on the floor, each of which accommodates an entire family.”

Basic services are scarce in the region which is now sweltering in summer heat and frequent rainy season downpours.

“Often, there are long water and electricity cuts,” said Hanan Adam, who has been displaced with her husband and their four children.

“With the high temperatures and the proliferation of mosquitoes, all my children have contracted malaria,” she added about the disease that was a major killer in the country even before the war.

However, managing to see a doctor in Wad Madani today amounts to a minor miracle.

In one of the town’s camps, the aid group Doctors Without Borders has been able to dispatch just one medical doctor and four nurses for about 2,000 displaced people.

Humanitarian aid groups long active in Sudan have been overwhelmed, and at times targeted, in the war. Many of their Sudanese staff are exhausted or holed up in their homes, while foreign staff wait for visas.

For years millions of Sudanese relied on aid, and now food shortages are becoming ever more dire.

“We have received food parcels but there is no infant milk in them,” said Soumaya Omar, a mother of five children aged six months to 10 years.

However, she said, amid Sudan’s runaway inflation and massive shortages, “we do not have the means to buy it.”

Sometimes it is neighbors who jump in and provide meals for those in desperate need, including at the Abdallah Moussa school in the west of Wad Madani.

A small team of young volunteers was distributing plates to families who are unable to cook because the building lacks kitchen facilities.

But such initiatives are not enough in a country where, even before the war, one in three people suffered from hunger.

A doctor who works across the town’s 13 displacement camps said that “malnutrition is beginning to affect children.”

He added: “We are already seeing worrying cases arrive in the clinics of the camps for the displaced.”

Sudan’s own capacity to produce food has deteriorated further, having already been impacted by water scarcity and decades of sanctions under former President Omar Bashir, who was toppled in 2019.

UNICEF said one of Sudan’s many buildings destroyed in the war was Khartoum’s Samil factory which had previously met 60 percent of the nutritional needs for children in need.

According to the UN children’s agency, some 620,000 Sudanese children now suffer from acute malnutrition, and half of them could die if they do not receive help soon.

However, UN and non-government aid agencies are short of funds and, above all, unable to transport what relief goods they have as fighting rages in multiple hotspots across the country.