Kidney dialysis patients are dying and dead bodies have been left to decompose in a morgue and in city streets as Sudan's war rages on, despite efforts by volunteers and aid workers to keep critical healthcare running.
Sudan's health sector was already on the edge of collapse due to a lack of resources before the conflict, and it has been shattered by nearly two months of fighting between the army and the Rapid Support Forces (RSF) across the country.
More than 60 hospitals in conflict zones have been put out of service, and the 29 that are still operating are threatened by closure due to power and water cuts and shortage of staff, according to the United Nations.
"Despite all the best efforts of Sudanese doctors... who are working in extremely difficult conditions, this is certainly not a sustainable situation," International Committee of the Red Cross regional director for Africa Patrick Youssef told Reuters.
Dr Mohammed Wahbi, who manages one of Sudan's largest children's hospitals in Omdurman, across the Nile from the capital Khartoum, said it normally received up to 300 paediatric patients a day.
"Once the war broke out, RSF forces stationed their vehicles in front of the hospital and its soldiers entered the building, which made the facility unsafe for patients," he said. "Many stayed away, except those who were desperate for dialysis treatment."
Two weeks ago, the hospital stopped providing treatment as dialysis supplies dwindled.
In El-Obeid, southwest of Khartoum, a power outage lasting more than two weeks has put a kidney dialysis unit at risk of shutdown and led to the death of at least 12 dialysis patients, a doctors' union statement said on Sunday.
Residents say roads into the strategically located city are under blockade, with supplies of food and medicine cut off. Engineers tried to reach a local power station to restore electricity, but were assaulted before they could arrive, the doctors' union said.
Renal disease constitutes an important health problem in Sudan, where treatment is limited and expensive. According to the International Society of Nephrology, an estimated 8,000 people in Sudan depend on dialysis to live.
In Ombada, on the outskirts of Omdurman, the main hospital has had to halve the frequency of patient visits, and shut down their operating rooms, said general director Alaa El Din Ibrahim Ali, because of power cuts and lack of fuel for the generator.
Nearby, a local morgue was unable to keep its refrigeration system working and 450 bodies began to decompose, seeping blood onto the floor.
The army has accused the RSF of forcibly evacuating and taking over key hospitals. The RSF said in a statement earlier this week that monitors had observed several of those hospitals, as well as power and water stations, were free of fighters.
With international humanitarian agencies struggling to scale up aid due to the pervasive danger of violence, one of many local volunteer units trying to maintain basic health services attempted to fix the outage.
"We faced problems buying equipment and fuel to get the cooling facilities up and running again," said Moussa Hassan, a member of the group, who said the price of a gallon of fuel had soared to between $58 and $83, from $11 before the war.
The police and other authorities vanished when the conflict started, blocking burial procedures, he said.
"No death certificates have been issued. The dead cannot be buried anyway given the constant fighting happening around us," Hassan said.
The situation in Darfur, in western Sudan, is even more desperate. El Geneina, the worst affected city, has been hit by waves of attacks by Arab militias backed by the RSF while cut off from humanitarian relief and phone networks.
"There are practically no health services (there) at all. It’s a city of death," said Yasir Elamin, president of the Sudanese American Physicians.
The Geneina Teaching Hospital, the most visited hospital in West Darfur State, was forced to close in late April, its patients and doctors evacuated.
A secondary school teacher from the city, Hisham Juma, said he saw fighters take the hospital over before he fled to neighbouring Chad earlier this month.
"Many patients died, including my neighbour who needed dialysis every three days," he told Reuters by phone from Chad. Reuters was unable to verify his account or ascertain how many patients had died.
Moussa Ibrahim, a logistics supervisor in El Geneina for medical aid group MSF which supported the hospital, said fighting in the city had made it dangerous to fetch basic necessities, or to retrieve dead bodies from the streets.
"Access was finally gained but by that point the bodies had decomposed to the extent that they couldn't be removed. Now, the best that can be done is to gather the bodies in a single location," he said in a statement.