Almost two dozen children died of malnutrition-related causes within a month in central Sudan where fierce fighting between the country’s military and a paramilitary group has centered, a medical group said.

The deaths of 23 children in the Kordofan region underscores the deteriorating humanitarian situation in the northeastern African country where famine is spreading after more than 30 months of devastating war.

Sudan plunged into chaos in April 2023 when a power struggle between the military and the paramilitary Rapid Support Forces exploded into open fighting in the capital, Khartoum, and elsewhere in the country.

The devastating war has killed more than 40,000 people, according to UN figures, but aid groups say that is an undercount and the true number could be many times higher.

About 370,000 people had been pushed into famine in Kordofan and the western region of Darfur as of September, with another 3.6 million people one step from famine in the two regions, according to international hunger experts.

The children’s deaths were reported between October 20 and November 20 in the besieged city of Kadugli and the town of Dilling, said the Sudan Doctors Network, a body of professionals that tracks the conflict.

The group said late Friday that the deaths were a “result of severe acute malnutrition and shortages of essential supplies” in the two areas, where a blockade “prevents the entry of food and medicine and puts the lives of thousands of civilians at risk.”

Kadugli, the capital of South Kordofan province, is where famine was declared earlier this month by the Integrated Food Security Phase Classification.

The RSF has besieged Kadugli town for months, with tens of thousands of people trapped as the group tries to seize more territory from the Sudanese military.

Fighting for the control of Kordofan intensified earlier this year after the military forced the RSF out of Khartoum.