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Relentless violence has devastated Sudan, and large-scale fighting has escalated in and around the only capital in Sudan's western Darfur region not held by paramilitary forces, the United Nations top humanitarian official said Wednesday.

Acting humanitarian chief Joyce Msuya told the UN Security Council that famine has already struck Zamzam camp, about 15 kilometres (10 miles) from North Darfur's embattled capital of Al-Fashir. She said a large-scale humanitarian operation is "a matter of life and death."

Sudan plunged into conflict in mid-April 2023 when long-simmering tensions between its military and paramilitary leaders broke out in the capital, Khartoum, and spread to other regions, including Darfur. The UN says over 14,000 people have been killed and 33,000 injured.

Msuya urged the council to demand that the warring government and paramilitary Rapid Support Force refrain from targeting civilians, hospitals, schools and other civilian infrastructure and allow unimpeded delivery of humanitarian aid through all border crossings and across conflict lines.

She also called on the UN's 193 member nations to pressure the parties "to agree to a humanitarian pause to save lives, give civilians respite and allow us to deliver assistance."

Two decades ago, Darfur became synonymous with genocide and war crimes, particularly by the notorious Janjaweed Arab militias, against populations that identify as Central or East African. Up to 300,000 people were killed, and 2.7 million were driven from their homes.

That legacy appears to have returned, with the International Criminal Court's prosecutor, Karim Khan, saying in January there are grounds to believe both sides may be committing war crimes, crimes against humanity, or genocide in Darfur.

Msuya said "the world should not abide in Al-Fashir the atrocities we witnessed in West Darfur."

In June, the Security Council adopted a resolution calling for "an immediate halt to the fighting and for de-escalation in and around Al-Fashir."

Regrettably, Msuya said, both sides ignored the call, and fighting escalated in the past week with "constant and heavy" shelling and bombing.

"Civilians, especially women and children, have been hit (and) civilian sites and infrastructure, including hospitals and internally displaced persons' camps, have been hit," she said.

"Of the three main hospitals in Al-Fashir, only one is functioning, although only partially following an attack that caused extensive damage in August."

In August, international experts confirmed there is famine in Zamzam camp, which houses around 500,000 displaced people.

Msuya said close to 1.7 million people in North Darfur face "acute food insecurity," adding that 13 other localities in Sudan have been identified as at risk of famine.

In February, Doctors Without Borders reported that a child was dying every two hours in Zamzam camp, she said. The latest screening by the medical aid organisation and the Ministry of Health between 1 September and 5 September indicates the situation is getting worse.

"About 34 percent of the children are malnourished, including 10 percent who are severely malnourished," Msuya said.

Fighting and flooding have impeded aid deliveries, but Msuya said that as floodwaters subside in the coming weeks, the UN will be able to start moving food and other assistance to Al-Fashir and other areas at risk of famine.

The acting undersecretary-general for humanitarian affairs stressed that two keys to addressing "the atrocious humanitarian situation" are a de-escalation in fighting and a willingness on both sides to facilitate access to those in need.

"Be in no doubt: Without safe and predictable access and a steady supply of food and humanitarian supplies, we will see a dramatic spike in mortality, including children, in Zamzam and other areas around Al-Fashir," she said.

"The same goes for the situation across Sudan," Msuya said, especially the capital, Khartoum and neighbouring Sennar and Jazeera states in southeast Sudan, which continue to be devastated "by relentless violence."