Streets littered with corpses, families separated by violence and survivors travelling for days without food or water. These are the accounts emerging from people who have fled the western Sudanese city of el-Fasher after it fell to paramilitary forces a week ago following an asphyxiating 18-month siege.

Fatima Yahya has arrived in Tawila, a town west of el-Fasher in Sudan’s North Darfur State that is controlled by a neutral force in the conflict. She was still traumatised from the three days she went hungry before finally escaping. Her husband and uncle are missing. The memories of what happened in el-Fasher were difficult for her to put into words.

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“The dead bodies were everywhere – in the streets, inside houses and at the gates of many houses,” Yahya told Al Jazeera. “Wherever you are in el-Fasher, you will see dead bodies scattered.”

Her testimony is one of several accounts from people who fled North Darfur’s capital after the Rapid Support Forces (RSF), a paramilitary group fighting Sudan’s regular army, captured the city on October 26. The RSF’s takeover gave the group control of the last major city in Darfur to have been held by the Sudanese armed forces (SAF), solidifying its grip across the vast western region.

Since the fall of el-Fasher, a city that was home to more than 1 million people before the war, reports have mounted of mass executions, sexual violence and widespread looting.

Satellite imagery analysed by Yale University’s Humanitarian Research Lab has identified at least 31 locations where objects consistent with human bodies have appeared since the city’s capture, accompanied by what researchers describe as reddish ground discolouration.

Families separated in the chaos

For those who fled, injuries from the initial fighting made their journey even more gruelling. Farhat Said left el-Fasher with her daughter despite both suffering injuries in artillery fire before the RSF’s final assault on the city. Her husband, who had suffered a severe hip fracture as a result of the bombardment, she said, had to be left behind.

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“We had to stay for six to seven months under siege and the shelling and bombardment,” she told Al Jazeera. “It was difficult to move him at all,” she added.

“When the fighting was too much and the shelling was unbearable, my son, who is 11 years old, asked me to run away from home to save our lives,” she said. Her son stayed behind with his father – the couple feared that even though he is a child, as a male, it would be too dangerous for him to cross RSF lines.

The two-day journey on foot, which would have been impossible for Said’s husband, involved “walking and even running under the heavy shelling out of el-Fasher” and brought them through RSF checkpoints. The mother and daughter arrived in Tawila, roughly 65km (40 miles) west of el-Fasher, without money or possessions. Her daughter still requires medical treatment for her injuries, Said told Al Jazeera.

Khadiga Abdalla, 46, experienced similar trauma. She lost her husband to the RSF bombardment a year ago and was herself wounded. The siege conditions had forced residents to survive on whatever they could find.

“We did not get our usual food, the sorghum, for six months,” she told Al Jazeera. Abdalla said she was forced to eat ambaz, a residue left over from pressed oilseeds that are normally fed to livestock because there was no other food available in el-Fasher.

After three days on the road without eating, Abdalla reached Tawila with her two children. One was immediately admitted to hospital, suffering from severe psychological trauma after witnessing the violence. Her brother’s children remain unaccounted for while an uncle was killed in the shelling.

These accounts align with wider evidence of systematic violence. The World Health Organization (WHO) confirmed that at least 460 patients were killed in RSF attacks on the Saudi maternity hospital in el-Fasher. Health workers were also taken during the initial assault, according to WHO spokesperson Christian Lindmeier.

Those reaching safety face severe health challenges. Medical teams from Doctors Without Borders working in Tawila have screened arriving children and said malnutrition was affecting all those under the age of five.

Survivors bear physical evidence of their ordeal, including torture and bullet wounds from their escapes and digestive problems caused by months of eating food meant for livestock.

Far fewer arrivals than expected

The International Organization for Migration estimated that more than 70,000 people have been displaced from el-Fasher and the surrounding areas since October 26. However, humanitarian workers in Tawila, which already shelters more than 652,000 displaced people, reported that the arrivals there have been far smaller than el-Fasher’s population would suggest.

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Yale’s Humanitarian Research Lab noted that unlike previous RSF takeovers across Darfur, such as the assault on the Zamzam displacement camp in April, there were no visible signs of a mass exodus from el-Fasher in recent imagery.

When Zamzam’s estimated 500,000 inhabitants fled, researchers were able to identify hundreds of people and donkey carts on roads heading away from the camp. But with el-Fasher, “The majority of civilians are dead, captured or in hiding,” the Yale researchers concluded.

International Committee of the Red Cross President Mirjana Spoljaric described the situation as “horrific” and warned that tens of thousands of people may be trapped without access to food, water or medical assistance.

International calls for accountability

Pope Leo XIV on Sunday joined growing international condemnation of the death and destruction in el-Fasher, denouncing “indiscriminate violence against women and children, attacks on unarmed civilians and serious obstacles to humanitarian action”.

He called for an immediate ceasefire and the opening of humanitarian corridors.

United States senators from both parties have demanded stronger action. Republican Senator Jim Risch, chairman of the Senate Foreign Relations Committee, called for the RSF to be formally designated as a “foreign terrorist organisation”, describing the violence as intentional rather than accidental.

The RSF announced it has arrested several fighters, including a commander named Abu Lulu, who appeared in videos of executions verified by Al Jazeera’s Sanad agency.

For survivors like Yahya, Said and Abdalla, now in overcrowded displacement camps with minimal support, questions about accountability feel distant.

Activists at the Tawila camp told Al Jazeera that the sudden surge in arrivals has meant aid workers have found it difficult to shelter people and provide them with other essential supplies.

“We pray to God to help us,” Said said, speaking for thousands who made the same desperate journey out of el-Fasher.