Heavy clashes have been reported across Sudan for the fourth day running as a power struggle between the country's two top military commanders has descended into deadly violence. Sudan's Ministry of Health announced today that 270 people have been killed and more than 2,600 wounded. In a sign of the deteriorating security situation in the capital, a U.S. diplomatic convoy came under attack on Monday, a day after the European Union's ambassador was assaulted in his residence.

General Abdel-Fattah Burhan, head of the Sudanese army, and General Mohammed Hamdan Dagalo, leader of the paramilitary Rapid Support Forces (RSF) are former allies. The two generals united to overthrow Sudan's former dictator Omar al-Bashir in 2019 as well as dissolving the subsequent transitional government in 2021. The uneasy alliance between the two leaders has now imploded, threatening to destabilize the country and wider region.

Civilians in the capital are bearing the brunt of the clashes, with millions trapped in their homes, humanitarian workers unable to deliver supplies and medical facilities under attack.

NPR spoke to Dr. Ghazali Babiker, country director for medical charity Médecins Sans Frontières in Sudan, who is in Khartoum.

What's happening where you are?

The situation is very tense and chaotic. There has been an increase in the intensity of fighting since Saturday with Khartoum and the region of Darfur witnessing the worst. We have five teams in Khartoum which have been separated and unable to move due to the bombardment by aerial forces, tanks in the streets and heavy artillery movements. Our main concern is access to health care for civilians and the security of our staff.

Is it possible to move around the city?

There is fighting in the streets and snipers on top of buildings. The humanitarian assistance has been completely jeopardized. We have medical supplies, but we can't move them. The situation is too unpredictable, we can't take the risk to move our staff when we have zero guarantee of their safety. Most people are sheltering wherever they were on Saturday, so in the worst areas people have been trapped for four days. In other areas movement is possible but limited due to armed vehicles roaming around the neighborhood.

Are hospitals functioning?

Some hospitals are being targeted by the warring parties, forcing patients to leave still with intravenous tubes connected to their bodies. [There have been reports that wounded soldiers have been filling hospitals, which have also been hit by shelling.] We hear that ambulances have been turned back and shot at while transferring patients. Health workers are fearing for their own lives. The doctors' union are reporting that many hospitals in Khartoum are out of service. At others, supplies are dwindling, and staff are tired or leaving as there is nobody to replace them. It's going to be more difficult in the coming period. If this keeps up, many more hospitals won't be operational.

What is the risk to civilians?

The majority of the injuries to civilians are from bullets and shrapnel, from people being caught in the crossfire. The heavy use of artillery and street fighting is also preventing the injured to reach hospitals. There are dead bodies lying in the streets and nobody can retrieve them. We have received 183 wounded patients at the MSF-supported hospital in El Fasher in North Darfur. Eleven have died.

Has there been looting of your medical facilities?

MSF premises in Nyala, South Darfur have been looted, including one of our warehouses. This is a structure that should be protected, it's for humanitarian purposes, there is no justification for it to be targeted.

Is there water and electricity in Khartoum?

In my office we have electricity, but stray bullets have hit the water pipes. Other parts of the city have had no electricity or water for four days. I saw people queuing for water yesterday, despite the risk of crossfire. So far, the phone network is operational, though sometimes weak. But without electricity people can't charge phones. Even if you have a generator, it is difficult to refuel it as gas stations are not open. If this situation continues the suffering will increase.

Has there been any information from the government?

The only instructions we have received is to stay indoors and away from the windows.

Meanwhile we have heard reports about attacks on diplomats, as well as videos of shelling and stray bullets going through people's houses. The clashes have been very loud since Saturday. While I'm talking to you, I am hearing anti-aircraft fire.

Are citizens in the city able to access supplies?

The fighting erupted suddenly early Saturday morning, so it was a shock and surprise for everyone. Nobody had time to stock up for an extended period. We are now on the fourth day and supplies have been depleted. Medicine access is very difficult. Food was partially available in the first two days but all the stocks in markets and small shops have finished without being able to be replenished. If this continues, we will have food shortages and most people will try to leave the city to the villages if they can.

What next?

Our priority is to get our staff from the intense fighting areas and restore access to health facilities. We are ready and prepared; we have stocks [of medical supplies] and manpower but very little access. We are on standby for whenever a humanitarian corridor opens.

Andrew Connelly is a British freelance journalist focusing on politics, migration and conflict.

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