Two weeks of armed confrontations in the town of Kauda, South Kordofan, have left at least 61 people dead and dozens more wounded, the Sudan Doctors Network said on Wednesday, the latest surge of violence in Sudan’s sprawling civil war. The medical monitoring group, which tracks casualties in the conflict, said the fighting erupted earlier this month between forces aligned with rebel commander Abdel Aziz al-Hilu and members of the Otoro tribe, a minority community in the Nuba Mountains.

Al-Hilu’s faction, the Sudan People’s Liberation Movement-North, has operated for years in South Kordofan and recently aligned itself with the Rapid Support Forces, the paramilitary group that is battling the Sudanese military. The SPLM-N has joined a local government the RSF set up in areas it controls.

Mohamed Elsheikh, spokesperson for the doctors group, told the Associated Press that poor communications had made it difficult to verify the full toll. “It is likely higher as the clashes continue,” he said.

The network said that, according to testimonies its team in South Kordofan gathered from survivors, “five women and nine children were among those killed.” Fighters reportedly burned homes and shops, looted properties, and “indiscriminately targeted” civilians. The group warned that areas around Kauda have seen “systematic burning” and attacks on civilians, with no safe corridors for evacuating the wounded or delivering aid.

The SPLM-N did not immediately respond to a request for comment.

In Dilling, another town in South Kordofan, artillery shelling by the RSF on Tuesday killed seven people and wounded 17, according to a local hospital director. Omran Teia, head of Umm Bakhita Hospital, told AP that civilians were targeted by the paramilitary group and the SPLM-N.

Sudan’s war, now in its fourth year, has produced a devastating humanitarian toll. At least 59,000 people have been killed, some 13 million displaced, and more than 30 million are in need of assistance. The United Nations and rights groups have accused both warring sides of atrocities, including ethnic cleansing, extrajudicial killings and sexual violence. Aid groups say the true toll could be much higher because access to areas of active fighting remains severely limited.

The paramilitary RSF and its allies control the western Darfur region and parts of the Kordofan region, both rich in oil and gold, while the military holds the north, east and central regions, including Red Sea ports and oil infrastructure.