At least 53 people, including 14 children and 15 women, were killed when Sudan’s paramilitary Rapid Support Forces attacked a displacement shelter in the besieged city of El Fasher in North Darfur state, according to a Sudanese medical advocacy group.

The Sudan Doctors’ Network said on Saturday that the RSF, which has been at war with the Sudanese army, attacked the Dar al-Arqam displacement centre at the Omdurman Islamic University.

The shelling and drone attack late on Friday wounded another 21 people, including five children and seven women, said the Sudan Doctors’ Network, a group of medical professionals tracking the Sudanese civil war. Most of the wounded suffered serious injuries, it said.

The El Fasher Resistance Committee, a local activists organisation, said at least 60 people were killed in what it called a “massacre”.

“Children, women and the elderly were killed in cold blood, and many were completely burned,” said the committee, as it called for an international intervention. “The situation has gone beyond disaster and genocide inside the city, and the world remains silent.”

The attack represents the latest in an intensifying pattern of strikes on civilian areas in the city, with the brutal civil war now well into its third year. The United Nations Office of the High Commissioner for Human Rights documented at least 53 civilians killed between October 5-8 alone in attacks across el-Fasher locality, with women and children among the dead.

El-Fasher is the last major city held by the government-aligned Sudanese Armed Forces (SAF) in the vast western Darfur region, and has faced intensified attacks from the paramilitary RSF since the army recaptured the capital, Khartoum, in March this year.

The RSF has been fighting SAF for control of the country since April 2023, when two generals leading both forces fell out. The war has triggered what humanitarian organisations have said is the world’s largest humanitarian emergency.

Tens of thousands of people have been killed, and millions have been externally and internally displaced due to the fighting.

Approximately 260,000 people remain trapped inside, but el-Fasher’s overall population has now shrunk by 62 percent from its pre-war level of 1.11 million to just 413,454 people, according to the International Organization for Migration (IOM).

An individual in the city, who requested anonymity, told Al Jazeera that people had spent much of the day “living underground in shelters” built around their homes to avoid heavy shelling. “The situation is extremely bad,” he said.

“Generally, the RSF have relied on air strikes to force civilians out of the city so they can take it over,” said Mohamed Badawi, a human rights activist with the Uganda-based African Centre for Justice and Peace Studies, which monitors the conflict in Sudan.

Under the months-long blockade, el-Fasher faces catastrophic humanitarian conditions.

A UN Development Programme report published this week said: “El Fasher faces collapsed markets, a complete collapse of food availability and affordability, and no road access for aid, forcing residents to survive on animal feed and food waste”.

Satellite imagery analysed by the Yale Humanitarian Research Lab reveals a systematic campaign of destruction surrounding el-Fasher. Researchers documented widespread burning of villages and displacement camps in a 57-kilometre radius around the city, with evidence of ethnic targeting primarily affecting non-Arab communities.

Yale researchers identified a 57-kilometre earthen berm encircling el-Fasher that restricts civilian movement and humanitarian access.

Last week, El Fasher’s only functioning hospital, the Saudi Maternity Hospital, came under attack three times, killing six people, including a child.

Tedros Adhanom Ghebreyesus, the WHO chief, called for the “immediate protection of health facilities”, whilst Hadja Lahbib, the EU crisis management commissioner, said the attacks were “mindless”.

The International Committee of the Red Cross said health facilities across Sudan are routinely attacked and looted, with ambulances blocked at checkpoints or destroyed. In Khartoum, 70-80 percent of health facilities have closed or barely remain operational, according to the World Health Organization.

“The magnitude of humanitarian need in Sudan is quite staggering,” said Samuel Sileshi, emergency coordinator for Doctors Without Borders (Medecins Sans Frontieres). “Unfortunately, cuts to international aid are adding insult to injury.”