Famine has spread to two additional regions in Sudan, including the Darfur city of el-Fasher, a hunger monitoring agency said Monday, as the country’s civil war deepens what is now the world’s worst humanitarian crisis.

The Integrated Food Security Phase Classification, the leading international authority on hunger crises, said famine has been detected in el-Fasher in Darfur and Kadugli town in South Kordofan province. Twenty other areas in Darfur and Kordofan, where fighting has intensified in recent months, are also at risk of famine, according to the IPC.

El-Fasher had been under siege by the paramilitary Rapid Support Forces for 18 months, cutting off much food and other supplies to tens of thousands of people. Last week, RSF fighters seized el-Fasher, reportedly unleashing attacks that killed hundreds, though the scope of violence is unclear as communications are poor.

Kadugli town also has been under RSF siege for months with tens of thousands of people trapped, as the paramilitary group tries to seize more territory from its rival, the Sudanese military.

The war has torn Sudan apart since April 2023. More than 40,000 people have been killed, according to U.N. figures, but aid groups say the true number could be many times higher. The fighting has driven more than 14 million people from their homes and fueled disease outbreaks.