A few days after the outbreak of fighting in Sudan, Amna Al-Ahmad received an urgent call for help from a pregnant woman who told her she was preparing to die.
Amna Al-Ahmad, 42, a midwife, says she ran through the gunfire that swept through her neighborhood of Omdurman, just north of the capital, Khartoum, to reach the woman’s home. Arriving at midnight, she quickly realized that the baby was stuck in the mother’s cervix. But there was no ambulance or taxi to take them to the hospital.
“We had to choose between death on the ground and death in the streets,” she said in a phone interview, remembering the sound of shelling punctuating the woman’s moans.
She told me that the pain had driven her soul from her body.
Amna Al-Ahmad, midwife
After several hours, Ahmad helped the woman onto a motorbike and to a nearby clinic, where she was able to deliver her daughter.
The raging war in Sudan has forced pregnant women across the country to dodge artillery and shuttle between checkpoints to reach the dwindling number of hospitals and maternity wards still open. The United Nations estimates that tens of thousands more women have been displaced or are stuck at home, with their babies delivered by midwives, family members or without anyone’s help.
The conflict, now in its second month, pits the Sudanese army, led by General Abdel Fattah al-Burhan, against rapid support paramilitary forces, led by General Mohammed Hamdan Dagalo. On Saturday, the two sides agreed to a seven-day ceasefire which came into effect on Monday evening, although sporadic gunfire and explosions could be heard in parts of the capital and adjacent towns on Tuesday.
Towards a humanitarian catastrophe
Doctors and aid workers say the situation in Sudan, one of Africa’s largest countries, is rapidly heading towards a humanitarian catastrophe. Sudan already had one of the highest maternal mortality rates in the world before the fighting started.
More than 1.1 million Sudanese women are believed to be pregnant. Of those in urgent need of humanitarian assistance, more than 29,000 are expected to give birth in the next month, according to the UN Population Fund. At least 4300 of them would be in danger of death and would need emergency obstetric care, including caesarean sections.
“The parents went through hell to join us, it’s like they were on a suicide mission,” said the Dr Mohamed Fath Alrahman, 33, pediatrician and general manager of Al-Nada Hospital in Omdurman, who oversaw the maternity ward.
PHOTO OMER JAY, PROVIDED BY THE ASSOCIATION OF AMERICAN PHYSICIANS OF SUDAN
Al-Nada Hospital, Omdurman
It is one of the few facilities in Greater Khartoum still performing deliveries, and its wards have been overwhelmed with expectant mothers.
“The cars that arrive at our hospital are covered in bullet holes,” he said in a telephone interview. “These women are anxious, stressed, and many of them are in late labor. »
He said he had just taken out a woman who had arrived with a breech birth after spending hours at a checkpoint for paramilitary forces, who were questioning her husband.
“Unfortunately she didn’t arrive in time and the baby didn’t survive,” Mr Fath added.
The number of babies born prematurely in his hospital has risen by almost a third since the fighting began on April 15. With a reduced staff, he estimates that his service delivered more than 600 newborns in the past month, 20 times more than usual. During the first weeks of the conflict, they performed up to 50 Caesarean sections a day, often with two newborn babies sharing an incubator.
PHOTO OMER JAY, PROVIDED BY THE ASSOCIATION OF AMERICAN PHYSICIANS OF SUDAN
A pediatric nurse had to resuscitate a newborn at Al-Nada Hospital last month.
Mr. Fath says he was able to keep the hospital’s work afloat thanks to international funding from the Sudan American Physicians Association. The organization has funded all Caesarean sections since the start of the conflict and allowed Mr. Fath to offer his remaining staff higher salaries to prevent him from fleeing.
A vulnerable health system
Even before the current conflict, Sudan had a fragile health system, with inadequate infrastructure and equipment, a shortage of qualified health professionals and a limited supply chain. According to the United Nations, the maternal mortality rate in Sudan was around 270 deaths per 100,000 live births, compared to 21 per 100,000 in the United States.
In Khartoum state, which has a population of about 10 million, almost 60% of health facilities are now closed and only 20% are fully operational, according to the United Nations. In El Geneina, the capital of West Darfur region, all health facilities are closed.
The hospitals themselves became the scene of intense fighting. According to the non-profit organization Save the Children, armed groups evicted eight patients who were receiving treatment at a health center in Khartoum in order to use it as a base. Many doctors and nurses who remained in the country were threatened and arrested.
Looting is also commonplace; many hospitals, pharmacies and warehouses were ransacked. Patients with chronic conditions like cancer, heart disease or diabetes have been unable to get medicine for weeks, while dozens of dialysis centers have closed, according to the Sudanese doctors’ union.
But few sectors of Sudan’s health system have been as badly affected as maternal care networks. As soon as the fighting began, midwives across the country began to receive calls for help from pregnant women.
“These women have become an increasingly vital lifeline for those stuck at home,” said Rania Hassan, head of UNFPA’s reproductive health team in Sudan, which helped support a network of at least 400 community midwives in the country.
Their work is particularly important in and around Khartoum, where the fighting has been heaviest and where many women prefer to give birth in health centres, she added.