Duaa Tariq, a Sudanese activist still in the capital Khartoum, told Al Jazeera about the perceptible change as the lack of adequate nutrition sets in, saying that many people can only eat one meal a day. “People’s faces are becoming very pale and the hunger is striking,” she said. “And there is no news of aid [coming]. INGO [international non-governmental organisation] support is also very low and it has killed the spirit of our volunteers.”

Along with rising hunger, Doctors Without Borders, also known by its French acronym MSF, warns that Sudan’s medical sector is on the verge of complete collapse. MSF provides five hospitals across Khartoum with either medical supplies or international specialists, or both.

Abandoning local volunteers

The war between the Sudanese army and the paramilitary Rapid Support Forces has fractured the country and put at least 24 million people – more than half the population – in dire need of assistance, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA).

Nearly six million people have been uprooted from their homes and are now internally displaced or have fled the country.

As soon as the fighting began in April, Sudan’s resistance committees – a network of neighbourhood groups at the heart of the pro-democracy movement –  established makeshift clinics.

These “emergency rooms” are staffed by volunteers who administer first aid, find medications and transport the wounded and sick to the few hospitals still operating in the capital Khartoum.

The volunteers at first relied on friends and relatives in the diaspora to fund their activities, as well as money from international relief groups. But as funding dries, up some local activists are fleeing Khartoum – where fighting intensified in recent weeks – after losing hope that aid groups will support their efforts.

“Only a third of the overall humanitarian appeal has been funded and we’re in the final weeks of the year,” NRC’s Carter said about aid funding.

“Many resources are already exhausted … front-line responders and operational organisations simply don’t have resources,” he added.

Choking aid supplies

Many of Sudan’s displaced fled to army-controlled cities in the east where some aid is available, but those living under the RSF have been abandoned, three aid workers told Al Jazeera.

All three blamed the army, which has consolidated control over the aid response from its de facto administrative capital in Port Sudan on the Red Sea and is further restricting access to RSF areas, the impediments putting countless lives at risk.

“Most of the aid is reaching people in army-controlled areas in the east of Sudan and very little is permitted [into RSF-controlled areas],” said William Carter, the country director for the Norwegian Refugee Council in Sudan. “What does get across is just a drop in the ocean.”

For example, MSF said in a news release on October 18 that they had to suspend support for surgical operations at Bashair Teaching Hospital in south Khartoum after the army stopped the delivery of surgical equipment.

Hundreds of patients needing trauma surgery are out of luck, and pregnant women needing c-sections have been referred to the Turkish hospital, which only has supplies to last two to three weeks, warned Michel Hofman, MSF operations coordinator.

Army spokesperson Nabil Abdullah did not respond to questions from Al Jazeera about whether the military was restricting aid deliveries.

No alternative

The restriction of aid into areas under the RSF is pushing civilians to rely on the group for handouts despite its role in creating the humanitarian crisis in the first place, said Tariq, the volunteer in Khartoum.

“[The RSF] are advancing everywhere [in the city] and they are now also feeding people and fixing power [stations],” she told Al Jazeera. “They even give people money.”

Since the start of the war, the RSF has indiscriminately killed civilians and looted homes, banks and businesses. They have even turned hospitals into military outposts.

Most civilians from Khartoum detest the group for their actions. But the RSF appears to be trying to restore some of its credibility by giving people aid, according to Kholood Khair, a Sudanese expert and the founding director of the Confluence Advisory think tank.

“I think the RSF are creating the conditions [where people must rely on them] and the group is absolutely relying [on this strategy] as a pathway to [earn] back some kind of legitimacy again,” she told Al Jazeera.

On October 15, the RSF posted a video on X showing its fighters opening a hospital and distributing medical aid in Omdurman, which is part of greater Khartoum. Three days later, the US accused the RSF of shelling residential neighbourhoods in the area, as well as elsewhere in the country.

Despite their abuses, Tariq expects more people in Khartoum to accept aid from the group.

“After a traumatic six months, people forgot how [the war with the RSF] started,” she said. “People are now just trying to survive.”