UN human rights chief Volker Türk called the findings "deeply disturbing", saying multiple attacks by the RSF on civilian infrastructure, including health facilities, were serious violations of international humanitarian law and may amount to war crimes. The World Health Organization said el-Fasher represents "one of the clearest and most severe examples of the wider impact of the conflict on health care in Sudan."
The RSF rejected the investigation. Its health minister, Dr Alaa Eldin Nugud, described the allegations as propaganda and a deliberate attempt by the national army and its allies to smear the RSF's reputation. He insisted the South Hospital was being used as a military base, telling the BBC that missile launchers had been set up on its grounds and sharing video of weapons remains filmed more than a year after the hospital closed. Under international law, a hospital can lose its protection if it is used to commit an "act harmful to the enemy."
Doctors who worked in el-Fasher denied that the hospital was incorporated into a military base, saying they visited it during the war to collect medical equipment. The BBC said it found no independent evidence for Dr Nugud's allegations, and the Darfur regional government categorically rejected the charges.
The investigation sets out a detailed chronology of the siege. The Teaching Hospital closed within weeks of the civil war starting in April 2023, and its operations moved to el-Fasher's South Hospital, which became the city's only working surgical facility. In late May and early June 2024, as the RSF mounted its siege, the South Hospital was shelled several times.
"The RSF [were] trying to evacuate the hospitals, to put them out of service because the health system is the cornerstone of any city or any state," said Dr Muhamed Suliman, a surgeon based in el-Fasher during the siege. "It was intense. It was deliberate. It was planned."
The attacks culminated in an RSF raid on 8 June. The hospital's director, surgeon Izzeldin Ahmed Dawaud Asow, told the BBC he was beaten with rifle butts and saved himself by pretending to be dead after paramilitaries denounced him with ethnic slurs and left him for dead. The hospital closed and later fell into RSF hands when the army retreated.
Staff moved to the Saudi Maternity Hospital in the west of the city, where the pace of attacks quickly picked up. The medical charity Médecins Sans Frontières warned: "We do not know if hospitals are being intentionally targeted, but... the belligerents are not taking any precautions to spare them." Six doctors later described a pattern of systematic targeting to the BBC, with the Saudi Hospital struck on some days up to 25 times by shelling and precision-guided drones. Clinics and private hospitals closed one by one, and facilities that relocated were shelled again in their new locations. By the time the RSF seized the city in October 2025, the Saudi Hospital was the only functioning health facility left.
Both sides in the conflict have been accused of attacking health facilities. In March 2026 the WHO condemned the bombing of al-Daein hospital in RSF-held eastern Darfur, which killed dozens and forced the site to close; Sudan's military is believed to have carried out the drone strikes, though it has denied responsibility. UN investigators have reported that the fighting in el-Fasher bore the "hallmarks of genocide", with Arab militias, now the backbone of the RSF, targeting non-Arab groups such as those who populate the city.