It has been 11 months of war in Sudan as the country’s army fights with the paramilitary group, RSF.
The Doctors Without Borders (MSF) reports that almost half a million people have fled to the West Darfur region to neighbouring Chad where the organization provides medical care near the border.
Women and girls have described being raped, beaten, detained, and forced to witness the killings of loved ones by groups of armed men.
Many have suffered hidden wounds, physically and psychologically, and now live in almost total destitution among a vast refugee population in makeshift camps.
Between July and December 2023, some 135 of the patients who presented to an MSF medical facility in eastern Chad disclosed that they were survivors of rape.
All are women or girls, between 14 and 40 years old, and most were attacked before their arrival in Chad.
The attackers were armed in 90 per cent of cases.
“In Sudan, they killed without hesitation, even children, I saw it with my own eyes,” said one refugee who sought safety in the border town of Adré.
“They raped women, also in groups. I focus on God to help me,” a victim told the organization.
According to MSF, nearly a quarter report having suffered at least one sexual assault.
More than 40 per cent were raped by multiple attackers.
Some explained how multiple men participated, making threats, holding the victim down, or standing guard during the rape.
Half of the survivors were at home when they were attacked, MSF said.
Thirty-three reported additional acts of violence during their rape, either against themselves or against a member of their family.
"Fathers who tried to protect their daughters were often injured, mothers were threatened with death, and victims were beaten before and afterward," MSF stated in statement.
Other women were assaulted during their daily activities, such as gathering firewood, or as they tried to escape the conflict.
A total of 13 patients have described being kidnapped.
These detentions ranged from one night to several months, with some forced to perform domestic chores, or tied up during the day and raped at night.
"One in ten survivors reported a theft associated with the attack. Some reported abusive full-body searches, including of women’s genitals, to steal money or valuables. Attacks sometimes target vulnerable people, including pregnant people or those with disabilities," MSF statement explained.
For many survivors, the trauma is compounded by other traumatic events and by grief for people they lost.
One woman explained that her neighbours' house had been set on fire, killing ten people inside.
Others speak of seeing and smelling corpses near their homes and on the roads.
"When they are seen by our medical staff, patients report loss of sleep and appetite, generalised pain, and anxiety, particularly when they have not heard from a family member," MSF said in its report.
"Many fear becoming pregnant following the attack, and indeed 30 percent have had a positive pregnancy test."
The high mortality rate during the conflict in West Darfur has left many women as the sole breadwinners of their families.
Cases of acute malnutrition mainly among young children are being reported.
Large-scale food distributions are needed, but the World Food Programme is suffering globally from a lack of funding.
Even then, food is not enough. People who have found refuge in Chad urgently need access to supplies and services, including clean water, toilets, hygiene materials (including menstrual hygiene items), and a sense of security.