November 15, Nairobi — Since October 20, fighting in Gezira state has driven more than 343,000 from their homes in Gezira state, the International Organization for Migration said on Thursday. The vast majority have fled to Gedaref, Kassala and River Nile states.

Over 15,100 were already internally displaced persons (IDPs) experiencing their second displacement.

The influx of displaced families has created an urgent demand for medical supplies, as well as isolation centers to deal with the escalating cholera outbreak. The disease is reportedly rapidly spreading among the displaced who do not have access to clean drinking water and are forced to drink contaminated water.

This comes after reports that nearly 500 people have died in recent days in Gezira’s capital city Hilaliya. The city’s death toll has reached unprecedented levels with entire families killed. The Rapid Support Forces (RSF) has also been accused of poisoning food that they sent into the city. On Tuesday, the Gezira Conference, a civilian organization, said that over 1230 citizens have been killed by the RSF in the last three weeks.

Gezira has been under siege since late October. The RSF launched attacks on villages in eastern, northern, and western Gezira after Abu Aqla Keikil, the RSF commander in Gezira state, switched allegiance to the Sudanese army on October 20.

On Monday, Human Rights Watch (HRW) said that the RSF has killed, injured, raped and unlawfully detained scores of civilians during attacks across Gezira in “heinous crimes.”

Earlier this week, the U.S. Special Envoy to Sudan Tom Perriello said that the reports on RSF poisoning hundreds of Sudanese in Gezira “shock the conscience.” He called on RSF leadership to provide answers.

“To poison food in a country already suffering from famine is an especially heinous act,” Perriello said.