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“There is no more MSF activities since a couple of days now in Zamzam because the security was unbearable for our team," said Marion Ramstein, MSF’s project coordinator for North Darfur.

That leaves few organizations on the ground to help in the remote area, Ramstein said, calling it “a heartbreaking decision. We know that we left the population with no other support."

plunged into civil war in April 2023 when fighting erupted between the military and the RSF. has killed at least 20,000 people, forced more than 14 million from their homes and created famine in some areas.

MSF has said two of its ambulances in December and January were shot at while carrying patients from Zamzam camp to the regional hub of El Fasher.

Ramstein said that in one shooting, a woman accompanying her sister was killed, prompting the group to suspend its ambulance movements between the camp and El Fasher in January.

MSF will return to Zamzam, but teams currently can’t work in a high-risk environment, Ramstein said.

Zamzam is in famine. A report by the Integrated Food Security Phase Classification, an international collection of experts tracking hunger, found last year that the camp and some other parts of North Darfur known as IPC Phase 5.

Ramstein said MSF had received many cases of young children in Zamzam suffering from anemia. In September, during a vaccination campaign there and found that 34% had acute malnutrition.

Zamzam camp has seen displaced families arrive from the areas of Abu Zerega, Shagra, and Saluma. They have told MSF teams of abuses in villages and on roads in that include killings, sexual violence, looting and beatings.