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War in this northeastern African country has forced pregnant women to move ‘through hell’ to a dwindling number of hospitals and clinics, or turn to overworked midwives to deliver their babies at home.

Days after fighting broke out in Sudan, Amna Ahmed received an urgent distress call from a pregnant woman who told her she was about to die. Amna Ahmed, a 42-year-old midwife, said that during the gunfire that engulfed her neighborhood in Omdurman, north of the capital, Khartoum, she ran to reach the woman’s house. Arriving in the middle of the night, she quickly realized the baby was stuck in the mother’s birth canal. However, there were no ambulances or taxis to take her to the hospital.

“We were choosing between death on the ground or death in the streets,” the midwife said in a telephone interview, referring to the mingling of the sounds of shelling with the woman’s moans: “The woman told me that the pain had forced her soul to leave her body.”

After several hours, Amna Ahmed helped the woman onto a motorbike and rushed her to a nearby clinic, where she was able to deliver her daughter.

Pregnant women are victims of war

The war in Sudan has forced pregnant women across the country to dodge artillery and walk through checkpoints to reach the dwindling number of hospitals and maternity wards that remain open. The United Nations estimates that tens of thousands more have been displaced, trapped in their homes, or had their babies delivered by midwives, family members, or no one at all.

The conflict is entering its second month, between the Sudanese army, led by Lieutenant General Abdel Fattah al-Burhan, and the paramilitary “Quick Support” forces, led by Lieutenant General Muhammad Hamdan Dagalo. On Saturday, the two sides agreed to a 7-day ceasefire, which took effect on Monday evening, despite the sounds of gunfire and isolated explosions in parts of the capital and its neighboring cities on Tuesday.

Doctors and aid workers say the situation in Sudan, one of the largest African countries, is heading towards a humanitarian catastrophe. Sudan already had one of the highest maternal mortality rates in the world before the fighting broke out.

More than 1.1 million Sudanese women are believed to be pregnant. Among those most in need of humanitarian assistance are 29,000 women who are expected to give birth in the next month, according to the United Nations Population Fund. At least 4,300 women are believed to be at risk of dying and need emergency obstetric care.

Suicide missions to rescue pregnant women

“The parents were driving through hell to reach us, as if they were on suicide missions,” said Dr. Muhammad Fateh al-Rahman (33 years), a pediatrician and general manager of the “Nada Hospital” in Omdurman, who supervises the maternity department. The Nada Hospital is among the few remaining facilities in greater Khartoum where babies are still being born, its halls crammed with pregnant women.

“Cars come to our hospital covered in bullet holes,” Fateh al-Rahman said in a phone interview. These women are very anxious, they are under a lot of stress, and many of them are in advanced labour.”

He said he had just discharged from the hospital a woman who had arrived with a reversed birth, after she had spent hours at a checkpoint controlled by paramilitary forces, who were interrogating her husband. Dr. Fateh al-Rahman added, “Unfortunately, it did not reach us in time, and the child did not survive.”

High number of births

He added that the number of babies born prematurely in the hospital had risen by nearly a third since the fighting began on April 15. With a meager staff, he estimated the maternity ward had delivered more than 600 newborns over the past month, 20 times the usual number. In the first few weeks of the conflict, they were performing up to 50 caesarean sections a day, often with two newborn babies sharing the same incubator.

Fathur Rahman said he was able to keep the hospital running with international funding from the Sudanese American Medical Association. The association has funded every caesarean section since the conflict began, and has allowed Dr. Fateh al-Rahman to offer his remaining staff higher wages to prevent them from fleeing.

His account was corroborated by aid workers from the United Nations, CARE, the International Medical Corps, Doctors Without Borders and Save the Children, who told The New York Times that the crisis affecting pregnant women represented A symbol of the collapse of the public health system across Sudan since the fighting began.

“This is only going to get worse,” said Adif Joseph Ige Siriki, global advisor on sexual and reproductive health at the International Medical Corps, which trains healthcare workers across Sudan.

The poor health of mothers also has consequences for babies born prematurely. “Premature babies are more likely to have lifelong defects, including intellectual disabilities, cerebral palsy, and hearing and vision impairments,” Siriki said.

Even before the current conflict broke out, Sudan had a fragile health system with inadequate infrastructure and equipment, a shortage of skilled health professionals, and a limited supply chain. According to the United Nations, the maternal mortality rate in Sudan is about 270 deaths per 100,000 live births, compared to 21 deaths per 100,000 live births in the United States.

60 percent of hospitals closed

In Khartoum state, home to about 10 million people, about 60 percent of healthcare facilities are now closed, with only 20 percent fully operational, according to the United Nations. In El Geneina, the capital of the West Darfur region, all health facilities have closed.

Hospitals themselves have been turned into theaters of fierce fighting. Armed groups expelled eight patients receiving care from a health center in Khartoum in order to use it as a base, the non-profit Save the Children said. Many doctors and nurses who remained in the country were threatened and arrested.

Looting was rampant, and many hospitals, pharmacies and stores were looted. The Sudanese Doctors Syndicate said that patients suffering from chronic diseases, such as cancer, heart disease or diabetes, had not been able to obtain medicines for weeks, while dozens of dialysis centers closed their doors.

But few areas of Sudan’s health system have been affected as severely as maternity care networks. As soon as the fighting began, midwives across the country began receiving calls for help from expectant mothers.

“These women are increasingly becoming a vital lifeline for those stuck at home,” said Rania Hassan, Team Leader for Reproductive Health at the United Nations in Sudan, which helps support a network of at least 400 community midwives in the country. She added that their work is “particularly important in the area in and around Khartoum, where the fighting has been heavier and where many women prefer to give birth in healthcare facilities.”

Midwives are scattered throughout towns and villages, entering women’s homes to deliver newborns, and often responding to requests from neighborhood chat groups or emergency hotlines.

Ms. Amna Ahmed, who was riding with the pregnant woman on a motorbike, helps coordinate a team of 20 midwives in Omdurman. Together, they have helped deliver nearly 200 babies since the fighting broke out.

Not only do midwives defy violence, she noted, they are often forced to work without access to phones or the Internet, services that have deteriorated greatly due to the clashes.

Amna Ahmed said she gave birth to 8 children during the conflict, but the chaos made it difficult to reach women and obtain medical supplies.

Her story was echoed by other women, such as Ahlam Abdullah Hameed, a 27-year-old midwife who delivered six children in Bahri, north of Khartoum.

“The situation is very difficult,” Hamid said in a phone interview, adding that she moved to help after following a series of requests from pregnant women on a WhatsApp channel in her neighborhood.

While all of her births were successful, she said she began to feel anxious about moving around amid the increasingly unpredictable street fighting at night, when she usually responds to calls.

But she is still willing to take a risk, she says, adding that she feels a strong sense of responsibility to help every time she hears a plea from a woman in critical condition.

Finally, she said, “The women’s prayers for me make me feel sad,” asking, “How can I leave when they are constantly asking for help?”

New York Times service