JUBA, South Sudan (AP) — Everyone and everything is a target in South Sudan's civil war, as attacks against health facilities and aid workers increase, a new report says.

At least 50 medical institutions were attacked in 2016 and 2017, says the report released Monday by the New York-based Watchlist on Children and Armed Conflict. In at least 750 incidents over the same period humanitarian access was denied by various armed groups, including government troops.

Both government and opposition forces have deliberately destroyed, burned, looted and occupied hospitals and clinics and detained, abducted and killed medical personnel and aid workers as a tactic of war, according to the report, based on more than 90 interviews and focusing on the Greater Upper Nile, Bahr el Ghazal and Equatoria regions.

"I have never seen anything like what I saw in South Sudan. Parties to the conflict are attacking health care and regularly denying humanitarian access in tandem. The result has been man-made public health crises such as cholera and famine and the most vulnerable, children, are the most impacted," Christine Monaghan, a research officer with the Watchlist, told The Associated Press.

She called it a "sharp rise" from previous years, putting South Sudan in the company of places like Syria, Yemen and Afghanistan. One study by Human Rights Watch documented 48 attacks on health services over a 17-year period, from 1997-2014. South Sudan's civil war began in December 2013.

The effects of the five-year conflict are far-reaching. The fighting has killed untold tens of thousands, displaced millions and plunged parts of the country into famine. The East African country's already fragile health care system has been devastated.

In one attack in July, six armed men broke into the Doctors Without Borders compound in the town of Pibor, threatening humanitarians, stealing phones and computers and injuring two staff members, the new report says.

By the end of last year at least 20 percent of South Sudan's 1,900 medical facilities had been shut down due to the fighting, leaving 70 percent of civilians without access to adequate health care, according to the United Nations.

Doctors across the country say people are dying as a result.

Armed men looted health facilities in Wau County "taking drugs, equipment, the generator, even the roof, the windows and the doors. Of course no services are being delivered," Dr. Edmund Sebit, senior medical officer at the teaching hospital in Wau city, told the AP during a visit last year.

Some people in the county were forced to walk for hours, even days, for care, some dying on the way, he said.

In the Equatoria town of Lainya in November the AP visited the primary medical center, now closed. Smashed glass, broken furniture, scattered papers and damaged equipment were strewn across the floor. Locals said "men in uniform" attacked the center when fighting spread to the region in 2016.

Both the government and the opposition have denied attacking medical facilities or using them as military bases.

"It's not SPLA's policy to attack or destroy social amenities," army spokesman Lul Ruai Koang told AP.

Opposition spokesman Lam Paul Gabriel said health facilities are always left for community use.

However, rights groups say the attacks and denial of humanitarian access have continued for years.

"Since this war started we have seen both sides attack health workers, clinics and hospitals in total disregard of the protections accorded to them under international humanitarian law," said Jehanne Henry, senior researcher for Human Rights Watch.