Miscarriage or Delivery complications: Pregnant Women’s Fate in Darfur
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With only a few health facilities still functioning in Darfur, pregnant women face harrowing journeys to seek care. Insecurity, checkpoints, and unaffordable or unavailable transportation force them to undertake day-long treks by foot or donkey, often resulting in delivery complications, miscarriage or death. Médecins Sans Frontières operates in ten out of Sudan’s 18 states and has been witnessing the grave toll that the war has taken on women and their health in Darfur and across the country.
In West and Central Darfur, many women who live in remote areas from urban centres give birth at home, relying on traditional methods. The scarcity of health care facilities, the distance they have to travel, the insecurity on the road and the price of transportation, often result in women seeking healthcare only after they face complications, putting both their lives and the lives of their newborns at great risk.
According to the World Health Organization (WHO), more than 70% of health facilities in conflict-affected areas like Darfur are barely operational or completely closed, leaving millions without access to critical care amid one of the worst humanitarian crises in recent history.
“One mother gave birth at home, and couldn’t remove the placenta, then she was bleeding, so they rushed her to the hospital”, recalls Wendemagegn Tefera Benty, Project Medical Referent (PMR) at Zalingei hospital in Central Darfur. “The family had to carry her and after one day of walking, when they reached, she had already passed away because of the bleeding”.
The ongoing war in Sudan has a profound impact on the health of pregnant women and their babies, particularly in terms of preterm deliveries. It left people unemployed and disrupted access to food and clean water. As a result, many pregnant women arrive at hospitals malnourished, which directly affects the health of their babies, often leading to preterm birth and malnourishment. After these babies are born, they are frequently admitted to observation units to ensure their survival and well-being.
"The biggest difficulty is how to manage to bring food to my children. I was working a lot when I was pregnant and that is maybe why my baby was born weak. Access to healthcare was also difficult but MSF helped", said a 35-year-old maternity patient at Murnei hospital, in West Darfur.
The MSF-supported Zalingei hospital is the only referral hospital available for secondary healthcare activities for an estimated 500,000 people. There is no other health facility managing deliveries in the area. In the operation theatre at Zalingei, MSF teams perform over 40 emergency caesarean section operations per month.
Thirty-five-year-old Afaf Omar Yahya experienced severe abdominal pain in her home as her pregnancy was about to come to term. Due to the lack of transportation in Darfur, she had no choice but to travel for hours on a donkey to reach Zalingei hospital. Upon her arrival, the doctor informed her she had suffered a miscarriage, and she needed to undergo an emergency caesarean section. “Losing the baby was the greatest heartbreak for me”, Afaf said while recovering at the maternity ward.
“Most of the complications we receive are caused by post-home delivery and anaemia during pregnancy” said Virginie Mukamiza, Midwife Activity Manager at Zalingei hospital.
Les femmes enceintes consultent en cas de saignements post-partum ou de septicémie. «La plupart des établissements de santé au Darfour ne sont plus que des bâtiments vides. Il n'y a ni personnel, ni médicaments, rien du tout. Avant la guerre, les populations avaient au moins accès à des centres de soins primaires près de chez elles. Aujourd'hui, elles doivent se tourner vers de grands hôpitaux éloignés », explique Osanatu Sento Bangura, responsable de l'activité sage-femme à l'hôpital de Murnei, soutenu par MSF, au Darfour occidental. Nombre de ces situations pourraient être évitées grâce à des consultations prénatales et à des systèmes d'orientation adéquats depuis les établissements de soins primaires, mais la plupart d'entre eux sont hors service depuis le début de la guerre ou dépendent de l'aide humanitaire, largement indisponible, pour assurer leurs services.
Pregnant women seek medical care when they have post-partum bleeding or sepsis. “Most health facilities in Darfur are now mere empty buildings. There’s no staff, no medications, nothing at all. Before the war, people had access at least to primary health care centres near their homes. Now they have to rely on big hospitals that are far away”, Osanatu Sento Bangura, MSF Midwife Activity Manager at MSF-supported Murnei hospital in West Darfur. Many of these situations could be prevented with antenatal consultations and adequate referral systems from primary care facilities, but most of them have been either out of service since the onset of the war or rely on humanitarian aid, which is widely unavailable, to deliver services.
Sameera Abkir
"My name is Sameera Abkir and I'm 25 years old. I live in Ab Doui, far from here. I don't know exactly how far, but it's in that direction. I gave birth at home. It wasn't easy. After giving birth, I had a high fever. My brother went to the pharmacy to get some injections and gave them to me. But my hand started to hurt. I didn't know what was wrong."
Twelve days after giving birth at home, Sameera went to the Romalia mobile clinic in a remote area of West Darfur to be examined with her baby. Upon arrival, she had a high fever and infected wounds on her arm. She was in pain and could not hold her baby properly. After several examinations, the MSF teams at the clinic discovered the infection in her arm. They quickly disinfected and dressed the wound, then prescribed treatment.
"I came to the hospital because I needed a birth certificate for my baby. But I also hoped to be given medicine for my hand. The pain was getting worse. I didn't come alone; my husband accompanied me. We traveled by cart because the hospital is far away, too far to walk. The journey was difficult, but I had no choice."
Halima Ishaq Osman
"My name is Halima Ishaq Osman, I'm 38 years old. This is my fifth pregnancy, and I feel sick all the time. The pain never goes away. This is the first time I've come to this clinic. I live in Ammoshush, which is very far from here. The journey took me an hour on a donkey, and it was difficult."
At home, we don't have adequate transportation. I only have one donkey, and the distance is too great to travel easily. That's why, in the past, I gave birth at home. I've never been to the hospital. I don't know what will happen this time, but I'm worried. Since the start of the war, our situation hasn't changed, but we're still suffering. It's almost impossible to reach the hospital quickly. Without transportation, we use a traditional horse-drawn carriage, which makes the journey slow and difficult.
Sometimes people go far to find us transportation, or we look for a tuk-tuk to take a patient to the hospital. But too often, it's not fast enough. Some don't arrive on time. My grandmother was one of them; she died on the way to the hospital. I just hope things will be different for me."
The war’s far-reaching effects threaten to trap women and girls in a never-ending cycle of malnutrition, declining health, and maternal death.
MSF reiterates our call to drastically scale-up the provision of life saving humanitarian aid and access to healthcare in Darfur. Warring parties must grant unhindered access for aid delivery and ease the obstacles that are preventing the civilian population of reaching healthcare. The full engagement of donors must be ensured to increase a sustained funding to boost the humanitarian response.
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