A drone attack on an open market south of Sudan’s capital Khartoum killed at least 43 people, activists and medical workers have said, as the military and a powerful paramilitary group battle for control of the country.

More than 55 others were injured in the attack in Khartoum’s May neighbourhood, where paramilitary forces battling the military were heavily deployed, the Sudan Doctors’ Union said in a statement. The causalities were taken to the Bashair University Hospital for treatment.

The Resistance Committees, an activist group that helps organise humanitarian assistance, posted footage on social media showing bodies wrapped in white sheets in an open yard at the hospital.

Sudan has been rocked by violence since mid-April, when tensions between the country’s military, led by General Abdel Fattah Burhan, and the paramilitary Rapid Support Forces, commanded by General Mohamed Hamdan Dagalo, burst into open fighting.

The RSF blamed the military’s air force for Sunday’s attack, although it was not immediately possible to independently verify the claim.

Indiscriminate shelling and airstrikes by both factions are not uncommon in Sudan’s war, which has reduced the Greater Khartoum area to a battleground.

The conflict has since spread to several parts of the country. In the Greater Khartoum area, which includes the cities of Khartoum, Omdurman and Bahri, RSF troops have commandeered civilian homes and turned them into operational bases. The military responded by bombing residential areas, human rights groups and activists say.

In the western Darfur region — the scene of a genocidal campaign in the early 2000s — the conflict has morphed into ethnic violence, with the RSF and allied Arab militias attacking ethnic African groups, according to human rights groups and the United Nations.

Fierce clashes ensued over the weekend in al-Fasher, the provincial capital of North Darfur province, following an attack on a military facility by the RSF, local media reported.

Clementine Nkweta-Salami, the UN humanitarian co-ordinator in Sudan, expressed concerns on Sunday about the clashes in al-Fasher. Writing on X, formerly known as Twitter, the UN official called for warring factions to stop fighting “so that humanitarians can bring in food, medicine and shelter items to those who need them most”.

The war has killed more than 4,000 people, according to August figures from the United Nations. But the real toll is almost certainly much higher, doctors and activists say.

The number of internally displaced people has nearly doubled since mid-April to reach at least 7.1 million people, according to the UN refugee agency. Another 1.1 million are refugees in neighbouring countries.

Chad received about 465,000 refugees, mostly from West Darfur province where the RSF and its Arab militias launched scorched-earth attacks on non-Arab tribes in the provincial capital of Geneina and its surrounding areas, according to the UN and human rights groups.