The ongoing war in Sudan has pushed children and adults in El Fasher in southwestern part of the country to the limit of survival as access to food, clean water, medicine and healthcare dwindle even as violence continues to escalate.

In a joint statement on Thursday, a group of international non-governmental organizations operating in Sudan including CARE International and Save the Children International said due to lack of food, some boys have joined fighters while some girls married fighters as a means of survival to get food, adding that other children have been eating leaves from trees to survive.

Aid workers from NGOs working in the region said children were witnessing atrocities no child should see, which were impacting their behaviour with many becoming anxious, not sleeping and suffering psychological distress.

The eight workers who were caught up in a five-month siege of El Fasher said the lack of services and escalating violence made life harder by the day, calling for immediate action to protect those at risk.

The statement said about 2.8 million people in and around El Fasher currently have no option to escape or access much needed assistance. Additionally, about 500,000 people are living in Zamzam refugee camp near El Fasher which is experiencing famine.

"The scale of human suffering that we are seeing is hard to put into words, and it's only getting worse. On a daily basis, I see bodies on the road and children fleeing their home without their parents or any belongings," an NGO staff member working in the area said in anonymity, according to the statement.

"There are soldiers fighting in front of our homes and in the market, and there are bombs and airstrikes, the shooting is everywhere."

He said violence against women is terrible, some being kidnapped and raped when going into the market.

"Community members tell us that young girls have been forced to marry fighters, and young women are engaging in sex in exchange for food, water, and cash," the staff member said.

He said they take advantage of the three to four hours when there is no shooting or shelling to do some critical activities such as trucking water to the gathering point to ensure that displaced people have access to clean water.

"We are worried millions of people will die unless the world pays attention and listens to us," he said.

Another worker said the children he works with have lost their parents and homes and that they sleep without eating anything.

"I see children crying… and I've noticed changes in their behaviour — poor sleep, more anxiety, a lack of appetite, depression, and psychological distress," he said.

"The situation around me is difficult, there is a lot of shelling, bombing, and ammunition everywhere. We aren't able to move to the market or go to the mosque. Feeling safe has become a dream."

The NGOs are calling for parties to conflict to protect civilian areas such as displacement shelters, including Zamzam camp, and immediately halt military operations around El Fasher and Zamzam camp that put civilians at risk.

This is in addition to upholding international humanitarian law, which includes the protection of civilians, and end to indiscriminate targeting of civilians, refraining from using starvation or sexual violence as a weapon of war, and preventing mass atrocities;

The conflict that has been ongoing for almost 18 months has displaced 11.3 million people.