Famine is tightening its grip on Sudan’s western Darfur region, with two additional towns now confirmed to be suffering from extreme hunger, according to a global food security monitoring body, as the country’s devastating war continues unabated.

The Integrated Food Security Phase Classification (IPC) said on Thursday that famine conditions have been identified in Umm Baru and Kernoi in Darfur. The warning comes months after the group reported famine in el-Fasher, the region’s largest city, which has been under siege for about 18 months and at times overrun by Sudanese paramilitary forces.

Sudan has been engulfed in conflict since April 2023, when a power struggle between the national military and the Rapid Support Forces erupted into full-scale fighting. The war has displaced millions and pushed the country into what the United Nations has described as the world’s worst humanitarian crisis.

The IPC had earlier said famine was also present in Kadugli, a city in South Kordofan province, and warned that at least 20 other areas across Sudan were at high risk of slipping into famine.

The latest IPC report coincided with a deadly attack on Thursday in South Kordofan, where paramilitary forces struck a military hospital in the town of Kouik. At least 22 people were killed, including the hospital’s medical director and three other medical staff, according to the Sudan Doctors’ Network, which monitors the conflict. Eight others were wounded in the attack, though it was not immediately clear how many of the casualties were civilians.

As fighting continues across large parts of the country, humanitarian groups have repeatedly warned that access constraints, insecurity and collapsing health and food systems are accelerating hunger and preventable deaths, particularly in conflict-affected regions such as Darfur and South Kordofan.