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Victims describe how they have been targeted while carrying out everyday activities.
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Calling rape a "defining feature" of the conflict, it says sexual assault is overwhelmingly carried out by armed men and is often accompanied by acts of brutality and humiliation.
But MSF says rape persists as an "insidious" part of life for communities in the western region of Darfur that are no longer on the front line.
The report is the most comprehensive account yet on sexual violence in Sudan's nearly three-year war.
Warning: This article contains details of sexual violence that some people may find distressing
It is based on testimonies from 3,396 victims who sought treatment in MSF-supported facilities across North and South Darfur between January 2024 and November 2025.
The warring parties - Sudan's army and the paramilitary Rapid Support Forces (RSF) - are both accused of sexual violence. But Darfur is the stronghold of the RSF and the vast majority of perpetrators identified by survivors were their fighters.
Many of the cases in the report took place in the conflict hotspot of North Darfur last year, following the RSF takeovers of the displaced persons camps of Zamzam and Abu Shouk, and of the city of el-Fasher in October, which MSF calls "one of the most shocking iterations, unfolding the most unimaginable brutality".
The charity says more than 90% of victims it treated were assaulted while travelling from these areas to safety in the town of Tawila.
The attacks often involved multiple rapists and included other forms of extreme violence and intimidation such as beatings or the murder of relatives.
"They took us to an open area," said one woman quoted in the report.
"The first man raped me twice, the second once, the third four times and the fourth once," she said.
"Apart from the rapes, they beat us with sticks and p
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