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A man walks past a burnt-out bank branch in southern Khartoum on May 24. Fighting continued in the capital although clashes seemed to be less intense as the latest ceasefire entered its second day.-/AFP/Getty Images

Humanitarian groups are struggling to bring food and medicine to the hardest-hit regions of Sudan, with ceasefire violations widely reported across the country in a brutal conflict that has now forced nearly 1.4 million people to flee their homes.

Fighting continued on Wednesday in the capital, Khartoum, although the clashes seemed to be less intense as the latest fragile ceasefire entered its second day. But there were growing concerns about violent attacks in several regions of Darfur, in Western Sudan, where some cities are almost completely cut off from any communications or humanitarian aid.

Dozens of hospitals across the country have been shut down or occupied by fighters, and less than 20 per cent are still functioning. About 25 million people, more than half of Sudan’s population, are in need of emergency help, according to relief agencies, but the aid effort has been stalled by the continued violence and the lack of security.

Mandeep O’Brien, the country representative in Sudan for the United Nations children’s agency, UNICEF, said she was heartbroken to learn of the deaths of six newborn children in a hospital in East Darfur as a result of the disruption of health services.

“This is sadly only a fraction of the impact on children and their families in Sudan,” she said on Twitter on Wednesday.

The fighting erupted on April 15 between the Sudanese military and its former ally, a paramilitary group known as the Rapid Support Forces, which has its origins in the notorious Janjaweed militia of Darfur. The clashes began as a power struggle between the two forces, but it has increasingly taken on an ethnic dimension, with the RSF dominated by Arab fighters from Western Sudan, and with tribal militias also mobilizing in some regions.

“The growing ethnicization of the conflict risks engulfing the country in a prolonged conflict,” UN special envoy Volker Perthes told the UN Security Council in a briefing this week.

In Khartoum, sporadic fighting and artillery shelling was reported on Wednesday. The RSF claimed to have shot down a Sudanese warplane in the adjoining city of Omdurman, across the Nile River from Khartoum. Social-media videos showed the fighter jet on fire and two pilots descending by parachute. Other videos showed one of the pilots badly injured and captured by celebrating RSF fighters, and a wounded civilian who was reportedly a victim of the plane’s crash into the city.

Saudi and U.S. mediators, who helped negotiate the latest ceasefire, said on Tuesday night that both sides had broken the agreement already. In a joint statement, the mediators said the violations included “reported offensive operations in Khartoum and El-Obeid, air strikes, and use of artillery.”

Cameron Hudson, an Africa analyst at the U.S.-based Center for Strategic and International Studies, said the two sides in the Sudan fighting needed the ceasefire as a pause to rest and resupply themselves. The ceasefire also eased the threat of sanctions against them, and allowed them to portray themselves as concerned about the fate of civilians, Mr. Hudson said on Twitter on Wednesday.

The number of refugees and internally displaced people is continuing to soar. More than a million have abandoned their homes inside Sudan, while a further 320,000 have escaped across borders to neighbouring countries, according to the International Organization for Migration, a UN agency.

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A growing number of women and girls are being exposed to heightened risks of domestic violence, sexual exploitation and abuse as they flee the violence, the IOM said in a report this week. The rising cost of fuel and transportation has further worsened the conditions for the internally displaced, it said.

In the West Darfur city of El Geneina, all 86 gathering sites for internally displaced people have been burned to the ground, forcing more than 85,000 people to seek new shelter, the UN said. And in the city of Zalingei in Central Darfur, RSF-backed militias reportedly attacked the city in recent days, looting and burning hospitals, banks and government offices.

One humanitarian agency, Médecins Sans Frontières, published a list of seven of its offices and warehouses that have been looted since the fighting began, including some in hospitals, often with vehicles and fuel stolen. In one case, medicine was ruined when fridges were unplugged. Medical staff and patients are repeatedly facing the trauma of armed groups breaking into their offices to loot, MSF said.

“The space for humanitarians to work is shrinking on a scale I’ve rarely seen before,” said Jean-Nicolas Armstrong Dangelser, the agency’s emergency co-ordinator for Sudan, in a statement this week.

“People are in a desperate situation and the need for health care is critical, but these attacks make it so much harder for healthcare workers to help. It’s senseless.”