The cemeteries of El Fasher are now watched over by Sudanese police guards, posted to stop a surge in rushed burials.
The town’s elderly are reportedly dying at such an alarming rate that the government has now banned funerals without death certificates as it investigates the cause, and has placed the state of North Darfur on lockdown.
Activist networks have been recording dozens of deaths every day over the past fortnight, prompting concerns that an outbreak of Covid-19 might be killing older people in their homes.
Isolated from the capital Khartoum and home to more than 200,000 people displaced by state-backed violence, many fear a health disaster in El Fasher.
Suad Musa said activists in the town have been recording deaths among their own relatives, putting the numbers at more than 60 on some days, but there is no official record because most people are avoiding hospitals as they do not believe they will receive the necessary treatment.
There have been more than 30 cases officially recorded in El Fasher and the joint UN and African Union peacekeeping force has reported seven suspected cases at its base in the town. Musa says now that there has been a sudden increase in illness among the population.
“They have it just one week and they just die. Sometimes just three days. It’s just a few days and they get unable to breathe and then they die. That’s what leads them to think it’s Covid-19 but they did not know,” she said.
A local UN employee, who spoke on condition of anonymity, said many people dismiss the idea of going to hospitals because of a lack of transport and a belief that hospitals cannot do much to help.
They said that many were originally dismissive of the threat of Covid-19, thinking their illness may have been malaria, but the deaths and symptoms are now causing panic.
“People think that if somebody passed away, why should we send them to the hospital? Anyway in El Fasher we don’t do this Covid-19 test, we have to send it to Khartoum and it can take five days to return,” they said. “That’s why there’s a gap between the government figures and what’s happening in the community.”
Earlier this week a new testing centre was announced in Nyala, another Darfuri city more than 100 miles away, but a senior humanitarian official said it does not yet appear to be operational.
Sudan has recorded more than 4,000 cases and 195 deaths but the official said the statistics only reflect the current testing levels which at about 400 results a day are well below the stated official capacity.
The UN worker said investigations into the reported deaths have not yet clarified the scale or cause of the problem but it was possible the deaths were caused either by Covid-19 or by a lack of access to healthcare.
They also pointed out that healthcare in general has suffered because of the pandemic, with many fearful of catching the coronavirus at hospitals and many key services suspended since the outbreak began.
“We’ve seen from other crises like Ebola that the collateral effects are massive, we saw that measles went up, that maternal mortality went up, but the Sudanese government in many areas decided to close services,” they said.
Dr Elnazeer Mohammed Thani, who works at the El Fasher specialised children’s hospital, said North Darfur’s hospitals are ill-equipped, lack protective equipment and are designed to provide only general healthcare at a local level.
“Most of these healthcare facilities lack basic equipment to provide even primary care,” he said. “There is no central oxygen or even oxygen generator in the state. We depend on the supply from Khartoum, which is 1,300km from El Fasher.”
The few available oxygen cylinders take days to be sent for refilling in the capital and the shortage has caused serious concern about whether hospitals will be able to provide the most basic care for Covid-19 patients. There also only three ventilators, according to Thani.
Musa said activists in El Fasher have been trying to raise funds to support the hospitals but are unable to generate the substantial donations necessary.
“It’s a big problem because we know one of the only ways to help them is to give them oxygen to help them breathe,” said Musa. “There is not even simple means of saving people there, that’s why we need help.”
Both she and the UN worker also highlighted the need for food supplies to stop people seeking daily income working on farms or selling produce.
“You cannot stay in the house, you need to eat, you need to drink. No one has food for five or even two days,” said the UN worker. “They think if we are dying from not eating or drinking, then let coronavirus kill us.”