A view of vehicles damaged in clashes between the Sudanese Armed Forces and the paramilitary Rapid Support Forces (RSF) in Khartoum, Sudan, April 18, 2023. OMER ERDEM/ANADOLU AGENCY/GETTY

The vicious battle between two Sudanese military commanders for control over the country continued for a fifth day Wednesday, with the fighting raging on despite a planned 24-hour ceasefire. The clash between the generals in charge of the country's armed forces and a massive paramilitary force had claimed at least 270 lives by Wednesday, according to the U.N.'s World Health Organization, and a medical group in Sudan said the majority were civilians.

The Sudan Doctors' Syndicate, a domestic organization which monitors casualties, said Tuesday that at least 174 civilians had been killed and hundreds more wounded, but the real toll from the fighting is likely to be considerably higher as bodies still lay on the streets in major cities where intense fighting continued.

The 24-hour humanitarian truce agreed to by both sides of the conflict never really took hold. Heavy gunfire peppered the capital city of Khartoum almost immediately after it was supposed to have gone into effect Tuesday evening.

Over the last five days the city that's home to more than six million people has been turned into a battlefield in the power struggle between the rival generals. Their bitter personal dispute has exploded into all-out war.

Half of Khartoum's hospitals were out of action Wednesday as the number of killed and wounded climbed precipitously higher.

Caught in the middle are millions of civilians, including Dallia Mohammed, who said she and other residents in the capital had spent the last few days "just staying indoors to keep our sanity intact" as the sounds of war echoed outside.

The U.S. has urged Americans in Khartoum to shelter in place, and Secretary of State Antony Blinken said Tuesday that a clearly marked U.S. diplomatic convoy had been fired on earlier in the week amid the chaos.

Nobody was harmed in the incident and it wasn't clear which side was responsible, but in calls with both Gen. Abdel Fattah al-Burhan, who heads the Sudanese Armed Forces, and the leader of the paramilitary Rapid Support Forces (RSF), Gen. Mohamed Hamdan Dagalo, Blinken called the action reckless and irresponsible.

"I made it very clear that any attacks, threat, dangers posed to our diplomats were totally unacceptable," he said later.

The State Department has established a Sudan Military Conflict Task Force to oversee management and logistics related to events in Sudan, and it has said that contingency planning for U.S. personnel in the east African nation is underway.

Germany's government, meanwhile, canceled a plan to evacuate about 150 German nationals from Sudan due to the ongoing fighting, a source with knowledge of the planning told CBS News.

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