Since the Sudan civil war erupted in April 2023, at least 17,000 people have been killed, 10.7 million displaced internally, and more than two million rendered refugees in neighbouring countries.
But the spike in the number of women either violated or at risk of sexual violence has become a bigger concern, rights lobbies say.
The latest report by Human Rights Watch, recording incidents between September 2023 and February 2024, accuses the Rapid Support Forces (RSF), the paramilitary group fighting the Sudan Armed Forces, of sexual crimes as it battled for control of Khartoum, Omdurman and Bahri.
The report, Khartoum is Not Safe for Women, is a product of 42 interviews with service providers, including healthcare workers, as well as social workers, counsellors, lawyers, and members of local "emergency response rooms" volunteers on how they responded to those in distress.
RSF members sexually assaulted women and girls in front of their family members, the report says, adding to the trauma experienced by victims and witnesses and potentially compounding stigma and other social consequences for survivors.
"We received a case of a mother and her four daughters who were raped in front of their father and brothers. They were not able to leave their home, as the RSF placed them under some sort of house arrest. These women were raped repeatedly for days. One of the daughters was pregnant when they were able to reach us," said a health worker in Khartoum, quoted in the report.
Civilians who fled the war-torn Sudan camp at the United Nations High Commissioner for Refugees (UNHCR) transit centre in Renk, near the border crossing point in Renk County of Upper Nile State, South Sudan May 1, 2023.
Officially, the RSF reject the allegations.
Spokesperson Lt-Col al-Fateh Qurashi argued that his side had taken "all necessary measures to prevent sexual violence and all other forms of violence that constitute human rights violations."
But if RSF attacked the women, the SAF worsened it by blockading responses to those injured in the war, delaying the needed medical response to victims.
The report says that warring parties have targeted hospitals, medical workers and local responders, and, in the case of the SAF, imposed a de facto blockade on the capital since late 2023, victimising survivors by preventing them from accessing critical care.
Human Rights Watch said rape, torture, early marriages and sex slaves have been observed in the war in Sudan, all of which amount to crimes against humanity.
The US government observed last year that war crimes and crime against humanity had occurred in Sudan and sanctioned key lieutenants from both sides for targeting civilians, especially women and children.
In April this year, Rosemary DiCarlo, UN Under-Secretary-General for Political and Peacebuilding Affairs, said there was evidence of widespread use of sexual violence as a weapon of war, recruitment of children by parties to the conflict and of extensive use of torture and prolonged arbitrary detention by both sides.
On July 28, the UN Population Fund raised concerns about the escalation of cases of gender-based violence and inadequate access to healthcare services, especially sexual and reproductive health. The UN agency said nearly seven million Sudanese people are now at risk of gender-based violence while half of that population, who are women and children, may miss out on critical healthcare.
While Sudan's post-war costs may be weighed in terms of how it resettles the displaced or rebuilds damaged infrastructure, rights watchdogs warn of future mental health problems in survivors of sexual violence, adding a toll on the cost of running the country's healthcare services.
An earlier report by the humanitarian analysis group ACAPS warned that the impact of the conflict would extend beyond the physical, with the mental health of women and girls also being affected.
"There are reported cases of depression and post-traumatic stress disorders, with strong suicidal tendencies observed among GBV survivors, heightening the need for mental health and psychosocial support interventions," ACAPS said in its report,
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