CAIRO (AP) — Humanitarian organizations are warning about attacks on health care facilities across Sudan, alleging they are happening as mass atrocities are being committed against civilians.

Doctors without Borders, also known as Médecins Sans Frontières or MSF, said Thursday that 70% of medical facilities in Sudan have either closed or are barely operational with no end to the war in sight.

Sudan’s civil war broke out in April 2023 after simmering tensions between the Sudanese army and the paramilitary Rapid Support Forces (RSF), escalated to fighting across the country. Some 40,000 people have been killed and nearly 13 million displaced, including to other countries, according to U.N. agencies. War has left many facing food insecurity and risk of famine and exposure to disease outbreaks like cholera, which remains hard to contain due to Sudan’s collapsed health care system.

In a report released Thursday, MSF warned that access to health care is nearly impossible due to systematic attacks, while the remaining operational facilities remain under constant threat.

“We call to all warring parties to stop violence against the civilian health facilities and civilian infrastructure and to facilitate a large-scale humanitarian response,” Michel-Olivier Lacharité, MSF's head of emergency operations, said in a news conference.

Another group, Save the Children, warned Thursday that attacks on hospitals nearly tripled after two years of war. The group said in a statement that at least 933 people, including children, were killed during the first half of 2025.

This figure is a 60-fold increase over the deaths recorded during the same period of the previous year, according to the group. Those killed were either seeking medical care or accompanying a loved one in a hospital.

Major hospitals, clinics, health facilities, ambulances and medical convoys all saw fatal attacks in a country where half the population requires humanitarian assistance, according to Save the Children.

“We are concerned that in most cases, the hospitals that have come under fire also happen to be the only remaining hospitals in those areas, putting health care out of reach for millions, including displaced people,” said Francesco Lanino, deputy country director of programs and operations for Save the Children in Sudan.

MSF particularly warned against violence in El Fasher city, the capital of North Darfur province, that made it near impossible for residents there and nearby displacement camps to access health care.

As of April, only one hospital with surgical capacity remained partially operational, serving an estimated population of over 1 million. Over the past year, many patients and their caretakers have been killed while inside an MSF-supported medical facility.

MSF urged the warring parties to “halt indiscriminate and ethnically targeted violence and facilitate an immediate large-scale humanitarian response, particularly referring to threats of attacks on the hundreds of thousands of people in El Fasher, where fighting intensified since May 2024.

Last month, Sudan’s military accepted a U.N. proposal for a weeklong ceasefire in El Fasher to allow aid delivery. However, the RSF did not explicitly agree to the truce and engaged in renewed clashes with the army in the southern part of the city this week.

MSF urged the international community — especially countries engaging with both the Sudanese army and the RSF — to take stronger action to address the crisis in Sudan.

“They must use all the leverage to prevent further mass atrocities. They must place protection of civilians at the core of their engagement with the warring parties,” said Christopher Lockyear, secretary general of MSF International.