Artillery shelling and airstrikes claimed at least 56 lives across greater Khartoum on Saturday, according to medical sources and Sudanese activists.

The Sudanese army and paramilitary Rapid Support Forces (RSF) have been locked in a power struggle since April 2023, which escalated this month as the army intensified efforts to seize control of Khartoum and its sister cities, Omdurman and Khartoum North.

RSF shelling reportedly killed 54 people at a crowded market in Omdurman, overwhelming the city's Al-Nao Hospital, a medical source told AFP. "The shells struck the heart of the vegetable market, causing numerous casualties," a survivor recounted.

In Khartoum, two civilians were killed and dozens injured in an airstrike on an RSF-controlled area, according to the local Emergency Response Room (ERR). While RSF has deployed drones in its attacks, the regular army maintains control over airstrikes.

The ERR is one of hundreds of volunteer networks providing emergency care in Sudan. The war, which has claimed tens of thousands of lives, has displaced more than 12 million people and rendered most health facilities inoperable.

A volunteer at Al-Nao Hospital described critical shortages of “shrouds, blood donors, and stretchers for the injured.” The hospital, one of the last functioning facilities in Omdurman, has endured repeated attacks.

Following months of stalemate, the army reclaimed several strategic bases last month, including its pre-war headquarters, forcing RSF forces to the city's outskirts. Witnesses reported that Saturday's shelling originated from western Omdurman, an RSF stronghold.

The bombardment came a day after RSF commander Mohamed Hamdan Daglo vowed to retake the capital. “We expelled them before, and we will do it again,” he said in a rare video address.

Greater Khartoum, a key battleground in the nearly 22-month conflict, has been devastated by the fighting. A study by the London School of Hygiene and Tropical Medicine reported 26,000 deaths in the capital between April 2023 and June 2024.

At least 3.6 million civilians have fled, while those remaining face artillery fire, widespread hunger, and blockades by warring forces. The UN estimates that 106,000 people in Khartoum are facing famine, with 3.2 million at critical hunger levels.

Nationwide, famine has been declared in five regions, mostly in RSF-controlled Darfur, with more areas expected to follow by May.

Before leaving office, the Biden administration sanctioned Sudanese army chief Abdel Fattah al-Burhan for attacks on schools, markets, and hospitals, accusing the army of using starvation as a weapon. The RSF commander was also sanctioned for alleged genocide against non-Arab minority groups in Darfur.