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Shelling by Sudanese paramilitaries killed at least 23 people on Saturday in the besieged Darfur city of El-Fasher, activists said.

The capital of North Darfur state is the largest city in the vast western region not yet under the control of the paramilitary Rapid Support Forces (RSF), who have been battling the regular army for more than a year and have laid siege to El-Fasher since May.

The El-Fasher Resistance Committee said in a statement published on its Facebook page that "deliberate bombing" by the paramilitary forces resulted in "23 martyrs", all civilians, and 60 wounded.

RSF shelling of El-Fasher last week killed at least 65 people, said the committee, one of hundreds across Sudan that used to organise pro-democracy protests and have coordinated frontline aid since the war began in April last year.

Medical charity Doctors Without Borders (MSF) has said that by late June, at least 260 people had been killed in the fighting in El-Fasher.

The war, which pits the RSF, led by Mohamed Hamdan Daglo, against the army headed by General Abdel Fattah al-Burhan, has killed tens of thousands of people with some estimates as high as 150,000, according to United States envoy Tom Perriello.

The United Nations says Sudan faces the world's largest internal displacement crisis, with more than 10 million forced to flee internally or abroad.

The conflict has ravaged the country's infrastructure, put more than three-quarters of health facilities out of service and sparked warnings of famine.

A UN-backed assessment published Thursday found that "famine is ongoing" in Zamzam, a displacement camp outside El-Fasher that hosts hundreds of thousands of people.

UNHCR, the UN refugee agency, urged international donors to step up support for Sudan, where civil war has raged since April 2023 and left tens of thousands dead according to the UN.

"The warning signs were there for months," said Mamadou Dian Balde, UNHCR's regional refugee coordinator for the Sudan situation.

"Displaced women, children and men are dying of hunger, malnutrition and disease," he said.

"With appalling human rights atrocities, the forced displacement of over 10 million people since the start of the war last year, and the lack of the most basic services for a large percentage of the population, the world's most pressing humanitarian catastrophe is growing and deepening every day, threatening to engulf the whole region."

Balde is also UNHCR's East and Horn of Africa and Great Lakes regional director.

He said the volume of refugees and internally displaced people was stretching host communities to a breaking point.

"Urgent action is vital to avert even more death and suffering."

Both sides have been accused of war crimes including deliberately targeting civilians.