NAIROBI, Kenya (AP) — Sexual violence against women and girls is being used as a weapon of war in Sudan 's fierce conflict between the military and paramilitary Rapid Support Forces, international aid group Doctors Without Borders said in a report Tuesday.

Sudan slid into chaos in April 2023 when a power struggle between the two forces exploded into open fighting in Khartoum and elsewhere. The International Criminal Court is investigating mass killings, gang rapes and other crimes during the conflict as potential war crimes and crimes against humanity.

Doctors Without Borders, known by its French acronym MSF, detailed in its report the accounts of women who were gang raped in the South Darfur and North Darfur regions.

MSF said that at least 3,396 survivors of sexual violence sought treatment at their facilities between January 2024 and November 2025. The group said most of the survivors identified the perpetrators as armed men, with 60% of the cases in South Darfur involving multiple perpetrators.

In the report, one survivor narrated her horrific ordeal. “They took us to an open area. The first man raped me twice, the second once, the third four times,” she is quoted in the report as saying.

MSF Emergency Coordinator Myriam Laroussi, who was in Tawila, North Darfur, supporting teams in late 2025 after the fall of El Fasher, told journalists at the report launch in Nairobi, Kenya, that the numbers captured in the report were just a “tip of the iceberg” and that the scale of the sexual violence is bigger in areas where MSF lacks access.

An MSF midwife, Gloria Endreo, said the team saw an average of 10 to 15 women daily, with most of them coming after the initial 72 hours, which are considered a critical period for treating injuries and trauma, avoiding infections and preventing unwanted pregnancies. Most victims have to walk for days or get a camel ride to Tawila.

“As healthcare practitioners, we consider the 72 hours as a golden period because we provide a lot of care within that period,” Endreo said.

Sexual violence affects not just the victims but the broader community because in some cases the girls were raped in front of their mothers and grandparents, said Andreza Trajano, a sexual health specialist at MSF. Some community members are unable to conduct daily activities like farming for fear of sexual assault, Trajano said.

“Will we continue to just let women’s and girls’ bodies be used as a weapon of war?” she said.

MSF urged the United Nations to have a stronger presence in Sudan to help respond to the needs of communities.

The devastating war has killed more than 40,000 people, according to U.N. figures, but aid groups say that is an undercount and that the true number could be many times higher.

The fighting has recently centered in the Darfur and Kordofan regions, where deadly attacks, mostly by drones, were reported daily. More than 500 civilians were killed in drone strikes this year as of mid-March, the U.N. Human Rights Office said.

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Magdy reported from Cairo, Egypt.