Sudan’s war spilled into the city of Dilling in South Kordofan on Saturday, when paramilitaries and allied rebels launched an offensive that left at least 14 people dead, including five children, medical monitors said. The Sudan Doctors Network said the assault involved shelling of residential areas and that at least 23 other people were wounded. The military, which recently ended an RSF siege on the city earlier this year, said it fended off the attack.

The Doctors Network said the attack began after the Rapid Support Forces and their allies — including the Sudan People’s Liberation Movement–North — moved on Dilling’s capital area. It described dire conditions in the city that have followed years of siege, saying the RSF cut off supplies and frequently bombed the area while Dilling experienced what it described as famine-like conditions.

The medical group’s casualty figures included five children among the dead and said the attack wounded at least 23 other people, including seven additional children. It warned that the latest violence could set the stage for a “catastrophic scenario” that resembles the situation in Darfur’s el-Fasher, where the RSF invaded in October.

In el-Fasher, the U.N.-commissioned experts cited by the Doctors Network said the attack bore “hallmarks of genocide.” The Doctors Network said more than 6,000 people were killed over three days in el-Fasher, describing the violence as “a wave of intense violence … shocking in its scale and brutality,” citing a report from the U.N. Human Rights Office.

The war began in April 2023 after a power struggle between Sudan’s military and the RSF escalated into open fighting in Khartoum, according to the medical group’s summary of the conflict’s broader trajectory. The U.N. has estimated that the war has killed more than 40,000 people, while aid groups have said the true toll could be many times higher.

As the fighting has shifted more recently toward Darfur and the Kordofan region, the medical group said deadly attacks there have been reported daily, “mostly by drones.” It said that as of mid-March, more than 500 civilians were killed in drone strikes, according to the U.N. Human Rights Office.

The medical group also said atrocities in the war have included mass killings and gang rape, and that the International Criminal Court has been investigating crimes that could amount to war crimes and crimes against humanity.