On the evening of the first day of Eid al-Fitr, Friday, March 20, a Sudanese Armed Forces (SAF) drone strike hit the emergency department of Ad-Deain Referral Hospital in East Darfur, an area under Rapid Support Forces (RSF) control, leaving scores dead and several injured, and rendering the facility completely out of service. A medical source told Atar the hospital is the only referral centre serving the state, as well as parts of neighbouring Kordofan.
In a statement reviewed by Atar, the Health Ministry affiliated with the civilian administration and aligned with the RSF in East Darfur reported an initial death toll of 39, including 12 children in the paediatric ward, six women in the women’s ward, and 21 men, alongside 78 critically injured patients across all groups. In a subsequent update, the ministry said total casualties, dead and wounded, had risen to 153. By Tuesday, March 24, a ministry source told Atar that the death toll had climbed to 97, with additional bodies recovered from the rubble.
In a post on X, World Health Organization Director-General Tedros Adhanom Ghebreyesus said the organization had verified the attack on Ad-Deain Teaching Hospital in the capital of East Darfur, reporting at least 64 deaths, including 13 children, two nurses, one doctor, and several patients.
Local sources in Ad-Deain reported more strikes the following day, Saturday, when drones targeted the state government secretariat building. The attack, which occurred around 9:30pm, coincided with a meeting of RSF commanders convened to assess the hospital strike’s aftermath. The strike marked the third wave of aerial attacks, following earlier bombardments of the hospital and a nearby police station, according to a witness who spoke to Atar.
Details of the attack
A witness to the bombardment inside the hospital told Atar the facility was struck twice by a drone. The first projectile hit the building at around 9pm, followed by a second strike roughly 20 minutes later. The witness said medical staff had been evacuated after the initial impact. He denied reports that a police station was targeted that day, stressing that both strikes hit the hospital exclusively. The emergency department was destroyed in the attack, rendering it completely inoperable.
A source told Atar that the hospital’s emergency department functioned as the central hub of the facility, housing all units along with short-stay wards for 24-hour observation, from which patients were referred to other departments. It also contained the blood bank, minor operating theaters and emergency rooms. The dialysis unit has been knocked out of service, while other sections got damaged due to a collapsed roof and shattered doors and windows. Among the victims were newborns receiving treatment and infants dependent on oxygen, many of whom could not survive even a brief interruption in care.
The source added that Ad-Deain is the only teaching hospital in East Darfur, serving not only the state but also patients from neighbouring Kordofan. The facility is now entirely shut down. On the same day, March 20, a passenger vehicle traveling toward Adila was also struck, killing 20 people on board, according to the source.
Witnesses told Atar that the death toll is expected to rise as bodies were still being recovered from beneath the rubble of the damaged hospital as of Thursday morning.
Finger Pointing
The RSF and the pro-RSF Taasees alliance accused the SAF of carrying out the drone strike. The military, however, denied targeting the hospital, saying it adheres to international rules of engagement and questioned the credibility of the allegations given that the RSF controls the area. Ad-Deain Hospital has been targeted before. It was hit in an airstrike on August 20, 2024, while the city’s main market was bombed as recently as March 8. In both cases, accusations were similarly directed at the SAF, as the city remains under RSF control.
Emergency Lawyers condemned the strike on Ad-Deain Teaching Hospital in East Darfur. In a statement reviewed by Atar, the group accused the SAF of carrying out the attack, which it described as a “massacre” that left dozens of civilians dead and others injured. The group called for an independent and transparent investigation to identify those responsible and bring them to justice, while urging stronger safeguards for medical facilities and health care workers in accordance with international law.
At the height of visiting hours
The strike occurred at a time when the facility was crowded with visitors.
Resident of Ad-Deain (unnamed)
A resident of Ad-Deain, who lives near the hospital, said the strike occurred at a time when the facility was crowded with visitors who had come to see their hospitalized relatives. It was the first day of Eid al-Fitr, and the evening hours are traditionally reserved for such visits, which made the impact even more severe.
The source added that most of the victims were from the nearby areas of Adila and Abu Karinka, who had come to check on family members and acquaintances receiving treatment at the hospital. According to the resident, the drone began its assault on the hospital at around 9:30pm before returning at approximately 10:15pm to strike the nearby police station.
We could clearly hear the drones as they circled over the city and dropped their payload.
Unnamed witness
A witness told Atar that among the victims was a displaced woman who had fled the war in Khartoum. Unable to afford housing, she had been sleeping with her children near the hospital’s perimeter fence. The witness confirmed that the woman and her three children were killed in the strike.
Another witness said that, unusually, no anti-aircraft fire was heard during the attack. “We could clearly hear the drones as they circled over the city and dropped their payload,” he said, “But there were no sounds of air defenses attempting to intercept them.”
Health Conditions in the Aftermath
A source at the state Health Ministry, operating under the civilian administration aligned with RSF, said authorities have moved to redistribute medical services across 11 health centres in neighbourhoods throughout Al-Daein. These facilities began operating on a 24-hour system as of Monday, March 23. A medical source told Atar that hospital staff were evacuated immediately after the strike.
According to the ministry source, surviving medical personnel from the teaching hospital have been reassigned to centres in areas such as Al-Qubba, Al-Zariba and Al-Tadamun to provide primary health care. Efforts are underway to equip these centres with life-saving supplies provided by the World Health Organization, partially offsetting the loss of emergency, maternity and obstetric services. UNICEF, along with local organizations, is also running mobile clinics in displacement sites across Ad-Deain, delivering care to children and treating cases of malnutrition.
Mohamed Osman Adam, the executive director of Ad-Deain locality under the civilian administration aligned with the Rapid Support Forces, said the city is facing “catastrophic” health conditions after the hospital was knocked out of service by the strike. He warned of acute medicine shortages, adding, in press remarks, that authorities are working with local and international humanitarian organizations, as well as emergency health committees, to contain the crisis. Ad-Deain, he noted, hosts displaced people from across Darfur and Kordofan, in addition to refugees from South Sudan, all of whom had relied on the hospital as their sole source of care.
In a statement reviewed by Atar, the East Darfur Dialysis Patients Committee said the hospital had been a lifeline for patients with kidney failure, who now face what it described as a “death sentence” following the destruction of dialysis equipment. The committee urged humanitarian organizations to intervene urgently and provide alternative treatment options before it is too late.
For its part, the United Nations Office for the Coordination of Humanitarian Affairs expressed shock at the attack. The office said such strikes are unacceptable, stressing that civilians and health care workers must be protected, not targeted, and calling on all parties to respect international humanitarian law.
The Sudanese American Physicians Association (SAPA) announced preparations for an emergency medical intervention in Ad-Deain, East Darfur, deploying teams already operating across Darfur in response to the hospital strike. In a statement issued Sunday, March 22 SAPA rejected any attacks on health institutions, calling for their protection and for the safeguarding of civilian lives across Sudan. The group urged all parties to spare civilians, medical facilities and other civilian infrastructure from the ravages of war.
Market Closures and Displacement Waves
Residents of Ad-Deain reported a complete shutdown of markets and shops across the city. One woman said she is feeding her children from dwindling household reserves, warning that their supplies are nearly exhausted. As of Tuesday, markets remained closed, with little or no civilian movement visible in the city.
Another resident said that since the day after the strike, no goods have reached El-Daein’s markets. Traders and truck owners reportedly fear that their vehicles and cargo could be targeted by drones, making any truck in the area a potential strike target at any moment, regardless of its contents.
A local source within the civilian administration aligned with RSF told Atar that they had observed intermittent waves of displacement during and after the bombardmen. Residents of neighbourhoods near critical sites, such as the hospital and administrative centres, have fled toward more stable villages and localities within the state, particularly Asalaya and Abu Jabra. The latter has seen a large influx of families seeking safety away from major urban centres increasingly exposed to aerial attacks. The source added that some families have fled toward traditional agricultural areas surrounding El-Daein, preferring to remain outdoors or under trees rather than stay in homes that could be struck. He also noted that groups of displaced people have been moving along the road connecting El-Daein to Nyala in South Darfur.
A displaced resident who reached the Abu Karinka area east of El-Daein said that, in the past, RSF had prevented citizens from leaving the city en masse. This time, however, they allowed people to evacuate during and after the aerial bombardment. He added that many residents are still preparing to leave and expect large waves of displacement in the coming days, particularly if the city comes under further attacks.
Appendix: Double Strike, Double Crime
On March 24, the Yale Humanitarian Research Lab released a report on the attack targeting El-Daein Teaching Hospital. The lab accused the Sudanese Armed Forces of carrying out the strike, citing the fact that El-Daein is under the control of the RSF and is home to communities of the Rizeigat tribe, who make up an estimated portion of the RSF ranks.
The report detailed that low-resolution satellite images taken between March 20 and 21, along with high-resolution images from March 24, reveal significant damage to the hospital building. The high-resolution images show damage to the roof in two separate locations, a breach in the perimeter wall, and large amounts of debris both in the street opposite the hospital and on parts of the roof. The lab concluded that the pattern of destruction is consistent with aerial strikes and the result of multiple precision hits. The absence of damage to surrounding buildings, including government offices and police stations, indicates that the hospital was deliberately targeted.
Satellite images of Ad-Deain Hospital, taken on January 6 (left) and March 24 (right), reveal the impact of the strikes. They show the roof destroyed, debris and shrapnel penetrating the interior, damage to the perimeter wall, and rubble scattered across the street in front of the hospital. The images were provided by Yale Humanitarian Research Lab.
Based on news reports that the building was struck first and then hit again as people rushed to rescue the wounded, and citing the executive director of East Darfur’s Health Ministry who stated the first strike occurred at 8:48pm and the second at 9pm, the lab described this pattern as a “double strike” or “double raid.” However, it emphasized that such a conclusion cannot be confirmed solely from satellite imagery.
The “Double Tap” Strike: A Controversial Military Tactic
The so-called “Double Tap Strike” is a military tactic of disputed legality. It involves an initial strike or projectile, followed by a pause of five to twenty minutes during which medical personnel or others gather to aid the wounded, and then a second, sometimes third, strike. The tactic is designed to maximize casualties as many of the injured and rescuers are killed in the follow-up attack, which is why its legality is widely questioned. The United States began employing it in 2009, and its use expanded with the growing reliance on drones in modern warfare.
A 2017 article in the Florida Law Review argued that such strikes should be considered a war crime because they do not distinguish between combatants and civilians. They are difficult to justify under military necessity, violating the principles of distinction and proportionality. This constitutes a blatant breach of Article 3 of the 1949 Third Geneva Convention, which governs the treatment of prisoners of war and criminalizes targeting anyone who has surrendered or is hors de combat. The article’s title posed the provocative question: “Double Tap Warfare: Should President Obama Be Investigated for War Crimes?”
According to a source who witnessed the hospital strike, the two projectiles hit the facility 20 minutes apart, suggesting this was likely a double tap strike, an additional accusation layered onto the crime of deliberately targeting the hospital itself.
