Shelling by Sudan's paramilitary Rapid Support Forces on a famine-stricken displacement camp in North Darfur has killed at least six people, activists said on Monday.
The Zamzam camp, just south of state capital El-Fasher, has been under intense rocket and artillery bombardment by the Rapid Support Forces (RSF) for a second consecutive day, according to the local resistance committee.
The "indiscriminate" attack killed at least six people and wounded 13 others, said the committee, one of hundreds of volunteer groups coordinating aid in Sudan.
Medical charity Doctors without Borders (MSF) said on Monday that its teams had received eight injured people the day before, including women and children as young as four with "severe injuries such as chest trauma and fractures".
It said four critically injured patients were transferred to another facility on Monday morning, just before renewed shelling hit areas near a market and the MSF's field hospital in the camp.
MSF has evacuated its hospital, including three intensive care patients who were dependent on oxygen to survive.
"The situation is beyond chaotic: patients and medical staff are leaving the camp and trying to run for their lives," the charity said on X.
"Not only have people been starving, but they are also now being bombed and forced to flee again," MSF's head of emergency operations Michel-Olivier Lacharite said.
A UN-backed report in July confirmed that famine had taken hold in the camp after a months-long RSF siege disabled nearly all trade and aid access.
Since April last year, a war between the regular army and the RSF has killed tens of thousands, displaced more than 11 million and created what the UN has called the worst humanitarian crisis in recent memory.
- 'Cover' for atrocities -
Both sides face accusations of war crimes, including targeting civilians, shelling residential areas, and blocking or looting aid.
In recent weeks, the RSF has tightened its grip on El-Fasher, launching attacks on multiple fronts against Sudan's military and allied armed groups.
At least twice last year, in central and west Darfur, the RSF has used the proximity of refugee camps to army bases "as cover to conduct mass atrocities including mass killings", according to a report by Yale University's Humanitarian Research Lab.
Zamzam refugee camp is home to at least half a million people, according to the United Nations.
Satellite imagery verified by Yale's research lab has shown "a significant increase" in displaced people flocking to the camp, as well as the "creation of defensive positions" inside the camp in anticipation of expected RSF attacks.
According to the UN, which managed to deliver its first aid convoy to Zamzam in months in November, families have been reduced to eating peanut shells to survive as children die of malnutrition.
Nearly 26 million people -- about half the population -- face the threat of mass starvation in Sudan as both warring sides have been accused of using hunger as a weapon of war.