After fleeing from the war in Sudan to Egypt, Mohamed Ismail says his ambitions are limited to putting food in the mouths of his five children from a meagre monthly salary of about $100 earned at a paper factory in Giza.

One seven-year-old son sleeps in his arms because of the trauma of hearing explosions before they fled from the outskirts of the Sudanese capital, Khartoum, in January.

Fleeing Sudanese seek refuge in Chad.

A year of war between Sudan's army and the paramilitary Rapid Support Forces (RSF) has driven more than 8.5 million people from their homes, creating the world's largest displacement crisis and uprooting families multiple times as people struggle to escape to neighbouring countries with economic and security problems of their own.

Financial challenges have led some to return to the war-stricken capital.

"Being safe somewhere is the most important thing," said Ismail, 42. "We're not even thinking about education because the economic situation doesn't allow that. As a parent that really impacts you, but we are helpless."

Sudan's war erupted on April 15, 2023, over a planned political transition under which the army, led by Abdel Fattah al-Burhan, and the RSF, led by Mohamed Hamdan Dagalo, known as Hemedti, were competing to protect their interests.

Fighting tore through the capital and unleashed waves of ethnically-driven violence in the western region of Darfur, before spreading to other areas including Gezira state, an important farming region that became an aid hub where many had sought refuge.

When the RSF entered the state's main city Wad Madani in December, looting and occupying neighbourhoods as they had done in the capital, many were uprooted for a second time.

'LOST EVERYTHING'

Ahmed, 50, who had fled with his wife and four children from the capital when the war began, said RSF troops pulled them from a car as they tried to escape Wad Madani in order to seize the vehicle.

They headed east to al-Gedaref, where his 75-year-old mother-in-law died after the arduous, three-day journey. They then paid smugglers to come to Egypt, which suspended visa-free entry for women, children, and men over 50, as Sudanese poured across the border last year.

"Because of Al-Burhan and Hemedti, our lives were completely shattered. We lost everything we owned," said Ahmed, speaking by phone from Cairo. He asked to be identified by his first name to avoid problems with Egyptian authorities.

Within Sudan, more than three million were already homeless from previous conflicts before the current war, mostly in Darfur, where the RSF and its allies have been accused of widespread abuses in violence over the past 12 months that they have blamed on their rivals.

Though parts of the country, Africa's third largest by area, remain relatively unscathed, many displaced rely on charity as conditions worsen and nearly 5 million people face extreme hunger.

Sudan's health system has collapsed, allowing outbreaks of diseases including measles and cholera. Aid agencies say the army restricts access for humanitarian relief, and what little gets through is at risk of looting in RSF-controlled areas.

'EXTRAORDINARY SUFFERING'

Both sides have denied impeding aid efforts. But on the ground, volunteer-run "emergency rooms" linked to the pro-democracy networks from the uprising that toppled autocratic former leader Omar al-Bashir in 2019, have been left to provide minimal food rations and keep some basic services running.

Ismail Kharif, a 37-year-old farmer living in a camp for displaced people near El Fasher, capital of North Darfur, said people there were at risk from fighting and subject to reprisals by both sides if they tried to move, while being cut off from healthcare, regular food supplies, and phone networks.

Across the country in Port Sudan, tens of thousands have sought shelter under army control but wonder what lies ahead.

"You cannot imagine that one day you will be living like this," said Mashaer Ali, a 45-year-old mother of three from the capital, living in a displacement centre in the Red Sea city. "Is this reality?" she said. "It's very, very difficult."

The war has created "one of the worst displacement and humanitarian crises in the world, and one of the most neglected and ignored almost, although its implications, its repercussions and the suffering of the people are quite extraordinary," Filippo Grandi, United Nations High Commissioner for Refugees, said in an interview.

He warned that more Sudanese refugees might head to Europe if aid was not provided.

The displacement crisis continues as intervention by powers including the United Arab Emirates and Iran risks prolonging the conflict and destabilising the region around Sudan.

Hundreds of thousands have crossed in Egypt, Chad and South Sudan, with smaller numbers fleeing to Ethiopia and the Central African Republic.

Recently South Sudan's oil exports, which are piped through Sudan and an important source of income, were suffered stoppages due to the war.

That led to a surge in prices, said Imad Mohieldin, a guitar player known in Sudan as Imad Babo, struggling like others to make a living in South Sudan's capital, Juba.

"My profession and my life is music ... (but) there is no place for music in wartime," he told Reuters by phone. "Now we're searching for hope in the unknown."