As an emergency coordinator for Doctors Without Borders, Ada Yee has lent a helping hand in some of the world’s most dangerous conflict zones: Syria, Yemen, the Democratic Republic of Congo, Haiti.

Then she came to Darfur, Western Sudan in April to help civilians who’ve been caught up in a brutal civil war between the Sudanese Armed Forces and the Paramilitary Rapid Support Forces.

The fighting has destroyed entire cities and crippled the infrastructure. At least 10 million people have had to flee their homes to escape the violence, according to newly released data from the U.N.'s International Organization for Migration.

Yee, who is Canadian, has worked with MSF for nearly a decade and says she’s never seen anything like it.

“It seems like there's just sort of this uncaring notion that human life will be sacrificed as a part of all the collateral damage,” Yee says. “For me, that is one of the most unreasonable and definitely difficult parts to deal with.”

After her nearly 4-month tour of duty in Darfur, she is now in Chad and reflecting on what she experienced. Darfur, she says, was a “humanitarian desert.”

What does that phrase mean?

First, there is the indiscriminate brutality against civilians

This week a report by MSF titled “A war on people” detailed shocking levels of violence against civilians all over Sudan, with testimonies from victims and medical data collected from the group's in-country operations from April 2023 to May 2024.

The report states that bombing and shelling of civilian areas killed thousands of people, including women and children. Civilians were consistently attacked and killed by armed groups in their own homes, at checkpoints, along displacement routes and even in hospitals and clinics.

“My house was set on fire during the fighting. I came to live with my brother in Forabaranga after that. Last week, they set fire to my brother’s house too, so we had to leave,” a Sudanese refugee in Chad told MSF for their report (MSF is the French acronym for Doctors Without Borders).

Those indiscriminate attacks are continuing in Darfur where the conflict has escalated since May, according to Yee.

The toll on health care has been enormous: from shortages of doctors to hospitals barely able to function

When Yee first arrived in the city of Nyala in Darfur state, RSF paramilitary forces had overtaken it after months of fighting and there was a quiet spell. Civilians began returning to the city of 1 million.

But the streets were littered with unexploded ordnance. Yee knew of about a dozen cases of children who accidentally triggered mines or shells as they played. She says several kids were killed and others severely injured. Some of them lost limbs.

It was Yee’s job to figure out how to get help to those children with severe injuries, but the civil war had destroyed so much of the city that her task was nearly impossible. The city had no electricity and no running water available, the MSF report notes. What’s more, hospitals had been bombed, medical supplies looted and many of the medical staff had been displaced along with their families.

MSF was hoping to set up an emergency facility but, Yee says, “at the time, we didn't have our ER ready yet, we had medical staff but no operating theater and there was maybe one surgeon left in a private hospital,” says Yee. “So, to find the right trauma surgeon, to find the right care for these people just didn't exist at that time.”

The challenges remain. Aid workers are hampered by fuel and electricity shortages, the lack of medical supplies and staff, the destruction of many hospitals and facilities.

“There is a [kidney] dialysis center, but there's no electricity to run it," says Yee. "There are massive amounts of cases of sexual violence, but there are no services, and that's something that we're trying to work on,” Yee says. “It is incredibly depressing to be in an environment where, even as MSF, we have our limitations.” 

The sexual violence she refers to is described in the MSF report: It's “a characteristic feature” of the war, the report states, noting that women and girls were raped in their homes and along displacement routes. Of 135 survivors of sexual violence who were interviewed by MSF, 40% said they were assaulted by multiple attackers.

An absence of aid organizations

Typically, a crisis zone attracts many aid groups. They work together, they coordinate a response.

In Darfur, Yee was struck by the fact that other than MSF, there was virtually no other humanitarian presence. The U.N. pulled out its political mission from Sudan due to pressure from the government. The U.N.’s local office does still provide aid but it’s far from Darfur.

The dangers have forced other international aid groups to evacuate their international staff, leaving only local staff.

At the MSF office, says Yee, “every day, there's somebody knocking on the door asking for support. It's really hard to deal with that because we can't be everywhere. We can't do everything,” Yee says. Despite pledges from the U.N. and the U.S., among others, Yee notes: “This is where the rest of the international community needs to come in, funders, donors, the U.N. system. That is something that we rely on.”

The Sudanese government is putting up roadblocks against humanitarian services

Why would the government hinder help to its citizens? Yee explains that her group has to engage with all actors and authorities.

“In Darfur, we engage with RSF, but the government of Sudan doesn’t recognize that and says ‘well, you're dealing with terrorists now, so your organization will be deemed also a terrorist.’”

Yee says she had to spend a significant part of her days in Darfur filling out paperwork to get critical supplies and other support.

“The level of permissions that is needed is unreasonable. It shouldn't have to be the case, right? We're in an emergency situation. People are dying. We need to get drugs from A to B. I shouldn't have to ask for permission from multiple, multiple, multiple actors to be able to do that.”

NPR reached out to the Sudanese Foreign Ministry for comment but did not receive a response in time for publication.

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