Dr Mustafa Ali Abdulrahman Ibo and his colleagues bravely perform surgery under increasing bombardment in the last remaining hospital in el-Fasher, a city that has been under siege for the last nine months in Sudan's western Darfur region.

Over the last month the hospital has recorded 28 deaths and more than 50 injuries among its staff and patients because of intense shelling. This is the highest number of casualties recorded in a month since the siege began.

"Recent continuous attacks targeting Saudi Hospital have intensified dramatically, it has become part of our daily lives," Dr Ibo, a Darfuri who has lived in el-Fasher since 2011, told the BBC.

He said the most frightening day had been when a team of medics were performing an emergency caesarean as the shelling began - a near-death experience for them all.

''The first one hit the hospital's perimeter wall… [then] another shell hit the maternity operating room, the debris damaged the electrical generator, cutting off the power and plunging us into complete darkness,'' he said.

The surgical team had no option but to use the torches on their phones to finish the two-hour operation.

Part of the building had collapsed and the room was full of dust with shrapnel scattered all over the place.

Dr Khatab Mohammed, who had been leading the surgery, described the dangers.

"The situation was dire, the environment was no longer sterile," the 29-year-old medic told the BBC.

"After ensuring our safety and the patient's safety from shrapnel, we cleaned her and changed our surgical gowns since our clothes were full of dust and we continued the surgery," he said, adding that the patient could have died from complications.

After successfully delivering the baby, the doctors moved mother and new-born to another room to recover and then gathered to take a group photo.

It was a testament to their survival, but Dr Mohammed added: "I thought it might be our last photo, believing that another shell would hit the same spot and we would all die."

They went on to perform two more life-saving emergency operations that day.

These doctors - most of whom are graduates of the University of el-Fasher - have stayed put since Sudan's civil war erupted in April 2023.

The conflict has pitted the army against the paramilitary Rapid Support Forces (RSF) and has caused the world's biggest humanitarian crisis, forcing more than 12 million people from their homes.

The two rivals had been allies - coming to power together in a coup - but fell out over an internationally backed plan to move towards civilian rule.

A year into the conflict, the siege of el-Fasher began. It is the only city still under army control in Darfur, where the RSF has been accused of carrying out ethnic cleansing against non-Arab communities.

The RSF began attacking el-Fasher from three sides and cut off supply routes. In a report issued last month, the UN Human Rights Office said the fighting had left more that 780 civilians dead and more than 1,140 injured - many of them casualties of crossfire.

The fighting has forced all other hospitals in el-Fasher to shut.

South Hospital, which was supported by medical charity Médecins Sans Frontières (MSF), was the main health facility in the city dealing with war casualties.

It was near the frontline and was stormed in June by RSF fighters, who also looted medicine and equipment and assaulted staff.

Saudi Hospital, which is run by the Ministry of Health and funded by non-governmental organisations, the UN and MSF, specialises in obstetrics and gynaecology but is now providing all medical services - it is the only place in North Darfur state with surgical capacity.

Amid shortages of medical supplies, equipment and personnel, Saudi Hospital is facing ''a heart-breaking situation that violates all humanitarian and international laws and values'', its medical director, 28-year-old Mudathir Ibrahim Suleiman, told the BBC.

He recalled how terrifying it was during recent bombings: "Pregnant women, children and staff were in shock and paralysis, some people were injured and had to be pulled out the rubble.

"All the current conditions push us to consider stopping our work, but women and children have no other place to save their lives except this hospital," he said.

"The staff at the hospital are doing the impossible to save lives."

All normal aspects of life have completely disappeared from el-Fasher, especially in the northern and eastern parts. The university, for example, operates via online learning, with exam centres established in safer cities like Kassala in eastern Sudan.

With widespread hunger and insecurity, the city has also emptied. About half the population have sought refuge in the nearby Zamzam camp, where an estimated 500,000 people now live in famine conditions.

Saudi Hospital also serves the camp, with MSF running ambulances to bring in emergency cases.

But these have also recently started coming under attack, including an incident earlier this month when a gunman shot at a "clearly marked ambulance with the MSF logo and flag".

"We are horrified by this deadly attack on a humanitarian crew carrying out life-saving medical work where it's desperately needed," MSF's Michel Olivier Lacharité said in a statement.

Dr Ibo admitted it was his colleagues - there are 35 doctors and 60 nurses at Saudi Hospital - who kept him going.

''We lose people every day, and offices and rooms are destroyed, but thanks to the determination of the young staff, we continue to persevere.

''We draw our resilience from the people of el-Fasher - we are its children and graduates of the University of el-Fasher."

Aid agencies are warning that one of the worst maternal and child health emergencies is unfolding in Darfur, where some areas are also being targeted in air strikes by the military.

The World Health Organization (WHO) has called for a halt to attacks on health facilities and adherence to international humanitarian laws.

"The sanctity of health must be respected even in war," WHO Sudan communications officer Loza Mesfin Tesfaye told the BBC.

Dr Mohammed, who is originally from Sudan's White Nile State but came to el-Fasher to study medicine in 2014, also pays homage to his team, who have ignored many opportunities to flee.

"Our souls refused to abandon the people of this city - especially given the catastrophic conditions we witness daily."

All the medics, who communicated via chats and voice notes on WhatsApp, sounded focused.

''We are determined to continue saving lives, from wherever we can, even underground or under the shade of a tree, we pray for the war to end and for peace to prevail," said Dr Ibo.

Additional reporting by Sudanese journalist Mohammed Zakaria

This story contains details, including a video, that some people may find distressing.

As Mzwandile Mkwayi was lowered into the South African mine in a red metal cage attached to a hoist above ground, the first thing that struck him was the smell.

"Let me tell you something," he tells the BBC, "those bodies really smelled bad".

When he got home later that day, he told his wife he could not eat the meat she had cooked.

"It's because when I spoke to the miners, they told me some of them had to eat other [people] inside the mine because there was no way they could find food. And they were also eating cockroaches," he said on a phone call from his home.

Allegations that the miners resorted to eating human flesh in order to survive were also made by other miners who were rescued in December, in statements submitted to the high court.

Mkwayi, a former convict, known locally as Shasha, lives in the township of Khuma that was close to the disused mine in Stilfontein. The 36-year-old, who had served seven years in prison for robbery, volunteered to go down to help with the rescue effort.

"I'm being rehabilitated by the correctional services and I volunteered because people in our community were seeking help for their children and brothers.

"The rescue company said they didn't have anyone who wanted to go down. So my friend Mandla and I agreed to volunteer so we could help our brothers to resurface and bring up the dead bodies."

But even though he wanted to help, the 25-minute journey down the 2km (1.2 mile)-deep shaft filled him with terror.

The crane would occasionally stop and start, leaving him dangling in the darkness. Once he got down into the mine, he was shocked by what he saw.

"There were lots of bodies, over 70 bodies, and around 200 or so people that were dehydrated.

"I felt very weak when I saw them, it was a painful thing to see. But Mandla and I decided we needed to be strong and not show them how we felt so we could motivate them."

The miners who had been waiting for help for months, gave them a hero's welcome.

"They were very, very happy," he says.

The miners had been stuck there following a nationwide police operation to end illicit mining at disused sites that had closed, as the industry – once the backbone of the country's economy – was shrinking.

It was no longer profitable for mining multinationals to operate in many places, but the promise of still finding gold deposits was a magnet for many desperate people – particularly undocumented migrants.

Thousands of shafts were abandoned.

In November, police stepped up efforts at the Buffelsfontein mine in Stilfontein, surrounding the entrance to the shaft and refusing to let food and water go down.

Before the rescue operation began on Monday, the local community had tried to take matters into their own hands by lowering a rope down the shaft to try and pull out some of the men.

They also sent down messages and told the miners that help was coming.

"So when we got there, they were already waiting for the crane. Now when they see us, they see us as their presidents, as their messiahs: the people that came from outside into the hole to help them to resurface."

The police say the illegal miners were always able to come out on their own but were refusing to do so because they feared arrest. But Mkwayi disagrees: "It's a lie that people didn't want to come out. Those people were desperate for help, they were dying."

While at the mine site on Tuesday, the BBC saw dozens of the rescued men.

They appeared emaciated, their bones visible through their clothes. Some could barely walk and had to be helped by medical staff.

In statements submitted to the high court, the illegal miners describe in graphic details the slow and painful death of their peers. They say many died of starvation.

"From September through October 2024, the absence of even basic sustenance was absolute, and survival became a daily battle against starvation," one miner was recorded as saying.

Mkwayi says the men he rescued were so frail that the rescue cage that is only meant to carry seven healthy adults could take 13 of them.

"They were very dehydrated and had lost weight so we managed to fit more into the cage, because they wouldn't have survived another two days down in the hole. They would be dead if we didn't get them out as soon as possible."

The volunteers were also in charge of bringing up dead bodies.

"The rescue services gave us bags and told us to put the bodies in them and bring them up in the cage which we did with the help of some of the miners."

The rescue operation was initially meant to last at least a week, but after just three days, the volunteers said no-one was left underground.

The authorities sent a camera down the shaft to do a final sweep. They say the mine will now be permanently sealed.

But the experience has deeply impacted Mkwayi.

At one point during the call he asks for a question to be repeated, explaining that his hearing has been affected since going down into the mine, presumably by the pressure.

But the hardest impact has been from what he witnessed.

"I have to tell you, I am traumatised. I will never forget the sight of these people for the rest of my life."

For activists and trade unions helping the community, the death of the 87 people in the mine amounts to a "massacre" perpetrated by the authorities.

The use of the emotive word has drawn comparisons with the shooting dead by police of 34 striking miners in Marikana, some 150km (93 miles) away from Stilfontein, in 2012.

But this time no triggers were pulled. Instead it seems many of the men starved to death.

The authorities reject the idea they were responsible.

The government initiated the crackdown on illicit mining in December 2023 through Operation Vala Umgodi (meaning "close the hole" in isiZulu).

The abandoned mines had been taken over by gangs, often led by former employees, which sold what was found on the black market.

People were co-opted into this illicit trade, either by force or voluntarily, and made to spend months underground digging for minerals. The government says illegal mining cost South Africa's economy $3.2bn (£2.6bn) in 2024 alone.

As part of the police operation, entry points at various disused mines were blocked, along with food and water supplies, in a bid to flush out the illegal miners, known locally as zama zamas (which translates as "take a chance").

While Vala Umgodi was largely successful in other provinces, the old Buffelsfontein gold mine presented a unique challenge.

Prior to the police operation, most of the miners were only able to get underground through a makeshift pulley system operated by people at the surface.

But they then abandoned the top of the mineshaft when security officials arrived in large numbers in August, leaving those in the mine stranded.

Community members then stepped in to help, pulling a few people up using ropes, but this was a long, arduous process.

Other difficult and dangerous exits were available and in all nearly 2,000 resurfaced - most were arrested and remain in police custody.

Why others did not come out is not clear – they may have been too weak or were being threatened by gang members in the mine - but they were left in desperate circumstances.

Out of the 87 who died, only two have been identified, police said on Thursday, explaining that the fact that many were undocumented migrants made the process harder.

"We hold the view that government has blood on its hands," Magnificent Mndebele from the Mining Affected Communities United in Action group (Macua), told the BBC.

He argued that the miners were given no warning about what was about to happen before the police operation began.

Over the past two months, Macua has been at the forefront of the various court battles initiated to compel the government to first allow supplies and then undertake a rescue operation.

Its blaming of the government echoes earlier statements from families who had said that the authorities had killed their loved ones.

They had taken a hard line since the operation intensified. In November, one minister, Khumbudzo Ntshavheni, made the now infamous statement during a press briefing that they were going to "smoke them out".

The state refused to allow food to be sent down or anyone to help retrieve the miners, only caving in after several successful court applications.

In November, small portions of instant maize and water made it down the shaft, but in a court statement, one of the miners said it was not enough for the hundreds of men down below, many of whom were too weak to even chew and swallow them.

More food was delivered in December, but again it could not sustain the men.

Given that the operation to bring up the men and bodies lasted just three days, what is hard for Mr Mndebele to understand is why this could not have been done sooner, when it was clear there was an issue.

"We're disappointed by our government, frankly put, because this help has come too late."

While the government is yet to formally respond to these accusations, police have vowed to continue with the wider operations to clear the country's disused mines until May this year.

Speaking to journalists in Stilfontein on Tuesday, Mining Minister Gwede Mantashe was unapologetic. He said the government would intensify the fight against illegal mining, which he labelled a crime and an "attack on the economy".

On Thursday, Police Minister Senzo Mchunu was a little more conciliatory.

"I do understand and accept that this is an emotional issue. Everyone wants to judge… but it would help all of us as South Africans to wait until pathologists have done and completed their job," he said.

The police have defended their actions, saying providing the miners with food would have "allowed criminality to thrive".

Illegal miners have been accused of fostering criminality in the communities where they operate.

A number of stories have been published in local media linking the zama zamas to various rapes and murders.

But for Mkwayi, who put his own safety on the line to help the miners, the men in the Stilfontein mine were just trying to make a living.

"People went down 2km with a rope and risked their lives to put food on the table for their families."

He said he wants the government to give licences to artisanal miners who are forced to go into disused mines due to South Africa's high unemployment rate.

"If your children are hungry, you won't think twice about going down there because you have to feed them. You'll risk your life to put food on the table."