(Bloomberg) -- Almost 500,000 people fled from West Darfur in Sudan to eastern Chad to escape violence in 2023 and now face a dire humanitarian crisis with limited food, water and health care, Doctors Without Borders/Medecins Sans Frontieres said. 

A retrospective mortality survey of more than 3,000 refugees now in Chad’s Ouaddai province found that deaths in the region increased dramatically among communities that were targeted by attacks since the eruption of war in Sudan in April last year, the organization said in an emailed statement Tuesday. 

Accounts from people who fled “paint a picture of an unbearable spiral of violence, with looting, burning of homes, beatings, sexual violence and massacres,” it said. 

Read more: Paramilitary Forces Defy US With Attack on Sudan Aid Hub 

The civil war in the North African country has left more than 9,000 people dead and forced about 5.8 million others to flee their homes. The United Nations is warning of a humanitarian catastrophe, with 25 million people — more than half of the resource-rich country’s population — in need of aid.

In Ourang camp, which houses almost 44,000 Sudanese refugees, more than 1 in 10 people reported that a member of their household had been killed between April and August, MSF found. 

Across the camps in Chad, households reported that men had been killed at the highest rates, with firearms as the most common cause of death, the organization said. 

“A further 4% to 5% of the men under 44 years of age had gone missing,” MSF reported. 

In the camps surveyed by MSF, malnutrition rates were also “alarmingly high,” and diarrhea was the most common cause of death for children under five, it found.

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