Hundreds of thousands of pregnant women and new moms in Sudan have nowhere to go
Doctors describe ‘nightmare’ as conflict shuts down maternity and neonatal wards
When Dr. Duria Rayis checks her phone, she sees desperate pleas from her colleagues who are trying to care for pregnant patients and newborn babies.
Rayis is an obstetrician in Khartoum, Sudan, where violent clashes between the army and a rival militia have led to the closure of most of the capital city's hospitals. According to UNFPA, the United Nations' sexual and reproductive health agency, this has left hundreds of thousands of pregnant women with nowhere to go.
The few hospitals that remain open are under-staffed, under-resourced and, sometimes, under attack. So health-care providers have taken to social media to try and co-ordinate with each other as best as they can.
As she glances at her Facebook and WhatsApp groups, Rayis sees a message from a colleague urgently looking for blood for a bleeding patient and another trying to find a surgeon who can perform a caesarean section. Someone else is ready to perform a C-section, but has no access to anesthetics.
"Everything is getting worse for everybody — especially for pregnant ladies," Dr. Rayis told As It Happens host Nil Köksal. "It is a nightmare."
Hundreds dead, hundreds of thousands displaced
It's been a little over a month since the fighting in Sudan broke out between the army and the paramilitary Rapid Support Forces, upending an internationally backed plan to transition to a civilian-led democracy after a series of military coups.
Despite multiple ceasefires brokered by neighbouring countries, neither side seems willing to lay down arms.
The sudden violence has turned people's lives upside down. About 200,000 fled the country, including health-care providers, according to the latest figures from Reuters. Another 700,000 have been displaced internally.
Officials have recorded 676 deaths and more than 5,500 injuries, but the real toll is expected to be far higher with many reports of bodies left in the streets and people struggling to bury the dead.
WATCH | Crisis in Sudan:
In Khartoum, more than half of health-care facilities have been forced to close, according to UNFPA. Others are only operating part-time.
The World Health Organization says only 16 per cent of the city's health-care facilities are operating at full capacity.
While this crisis affects all Sudanese people, Dr. Rania Hassan, UNFPA's team lead in Sudan, says pregnant women and newborn infants are among the most vulnerable.
And, as in any crisis, she says women and girls are under-served by the international community.
"They are always left at the end of the priorities for political attention [and] political commitment," Dr. Hassan told CBC. "We have good political commitment in Sudan, but we don't have the financial resources."
UNFPA estimated late last month that there are 219,000 pregnant women in Khartoum alone — 24,000 of whom are on the cusp of giving birth. Because the situation is so chaotic, Hassan says it's hard to say with accuracy what those numbers are now.
"The vulnerability is significant. The birth hour doesn't know war," Hassan said. "When the hour comes, when the woman is in labour, she needs to be treated with the required level of life-saving services."
'We are losing babies'
Rayis works for the Saad Abuale maternity hospital in Khartoum, which she says was forced to close after it came under missile attack. Fortunately, she says nobody was harmed, but the hospital had to transfer or discharge all of its patients.
She later volunteered her services at a hospital in neighbouring Omdurman. But that, too, has since shut its doors.
As a doctor, she says it's very hard to know that so many women and babies are going without care.
"It's like a stab to the heart," she said.
Sudan had a high maternal mortality rate before the fighting broke out, with 295 maternal deaths per 100,000 live births according to the UN, often due to sepsis, hypertension or bleeding. All of those risks are exacerbated by war.
"To be very honest, the [shortage] of resources and medication is something not new to the context of Sudan in general," Hassan said. "However, what is happening these days is really catastrophic."
And it's not just maternal health-care that's lacking. There are also no resources for newborns, as very few hospitals equipped to care for pre-term babies.
"We are losing babies because neonatal units have been closed completely," Rayis said.
Rural hospitals overwhelmed, midwives step up
In rural Sudan, Hassan says most women have always relied on midwives for childbirth, except in emergency situations. Now those midwives are stepping up in the country's urban centres.
"Midwives, they were taking, and still continue to take, a huge burden of obstetric care," Hassan said.
But they, too, face limited supplies, a lack of clean water, fluctuating power and constant danger from gunfire and bombings.
Rayis says patients are making long journeys to rural hospitals, travelling more than 100 kilometres to give birth.
"They don't know what is going to happen in the streets. They don't know that they are going to be bombed or not, that they are not going to be stopped at any station," she said.
"The hospitals outside are not prepared for this number. We know that our colleagues outside have been overworked by the gush of patients coming from Khartoum."
Many health-care workers have fled, or stopped practising altogether, staying home to protect their families, offering what services they can online. Others are risking their own health and their own lives to keep working.
"Some people are staying for five, seven, six days, all in the hospital, not going to their homes," Rayis said.
"What the doctors have been doing ... is above imagination. It is above being marvellous. It is above being human. It is something, I think, from God to our patients."
- This story has been updated to clarify that when Dr. Rania Hassan said women and girls are underserved, she was referring to the global community.May 18, 2023 11:30 AM ET
With files from Reuters. Interview with Dr. Duria Rayis produced by Niza Lyapa Nondo.