‘Death on the Floor of Death in the Streets’: Giving birth in the midst of war in Sudan

Days after fighting broke out in Sudan, Amna Al-Ahmad received an urgent call for help from a pregnant woman who told her she was preparing to die.

Ms. Ahmad, a 42-year-old midwife, said she sprinted through the gunfire that swept through her neighborhood in Omdurman, just north of the capital Khartoum, to reach the woman’s home. When she arrived at midnight, she quickly realized that the baby was stuck in the mother’s birth canal. But there were no ambulances or taxis to take them to a hospital.

“We wavered between death on the floor or death in the street,” she said in a telephone interview, recalling how the sounds of shelling interrupted the woman’s moans. “She told me the pain had driven her soul out of her body.”

After a few hours, Mrs. Ahmad the woman on a motorcycle and rushed to a nearby clinic, where she was able to deliver her daughter.

The war in Sudan has forced pregnant women across the country to evade artillery and commute through checkpoints to reach the dwindling number of hospitals and maternity wards that are still open. Tens of thousands more, the United Nations estimates, are displaced or trapped at home, their babies delivered by midwives or relatives or by no one.

The conflict, now in the second monththe Sudanese army led by General Abdel Fattah al-Burhan has incited against the paramilitary Fast support troops led by Lieutenant General Mohamed Hamdan. On Saturday, the two sides agreed to a seven-day ceasefire that took effect Monday evening, although sporadic gunfire and explosions were heard in parts of the capital and neighboring towns on Tuesday.

Doctors and aid workers say the situation in Sudan, one of Africa’s largest countries, is heading for a humanitarian catastrophe. Sudan already had one of the highest maternal mortality rates in the world before the fighting started.

It is believed that more than 1.1 million Sudanese women are pregnant. More than 29,000 are expected to give birth in the coming month to those in dire need of humanitarian aid, according to the United Nations Population Fund. At least 4,300 are believed to be at risk of death and need emergency obstetric care, including cesarean deliveries.

“Parents drive through hell to get to us — it’s like they’re on suicide missions,” says Dr. Mohamed Fath Alrahman, 33, a pediatrician and general manager of Al-Nada Hospital in Omdurman, who has supervised the maternity ward. . It is one of the few remaining facilities in Khartoum that still delivers babies. The hallways are overwhelmed with pregnant women.

“Cars stop in front of our hospital full of bullet holes,” he said in a telephone interview. “These women are anxious, stressed, and many are in advanced stages of labor.”

He said he had just fired a woman who arrived with a breech birth after spending hours at a checkpoint controlled by the paramilitary forces, who questioned her husband. “Unfortunately she did not reach us in time and the baby did not survive,” Dr Fath added.

The number of premature babies in his hospital had increased by nearly a third since fighting began on April 15, he said. With a skeletal staff, he estimated his department had delivered more than 600 newborns in the past month — 20 times the usual number. In the first weeks of the conflict, they performed as many as 50 caesarean sections a day, often with two newborns sharing an incubator.

Mr Fath said he was able to sustain the hospital’s work thanks to international funding from the Sudanese American Physicians Association. The organization had funded every cesarean section since the beginning of the conflict and allowed Dr. Fath to offer his remaining staff a higher wage to prevent them from fleeing.

His account was supported by aid workers from UNFPA, CARE, International Medical Corps, Doctors Without Borders and Save the Children, who told The New York Times that the crisis affecting pregnant women is symbolic of the collapse of the public health system across Sudan since the battles started.

“This is only getting worse,” said Adive Joseph Ege Seriki, the global consultant for sexual and reproductive health at the International Medical Corps, which trains health workers across Sudan.

The dire health situation of mothers also affects premature babies. “Babies born prematurely are at high risk of developing lifelong abnormalities,” he said, including intellectual disabilities, cerebral palsy, and hearing and visual impairments.

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

In Khartoum, part of a metropolitan area home to more than six million people, about 60 percent of health care facilities are closed and only 20 percent fully operational, according to the UN. In El Geneina, the capital of the West Darfur region, all health facilities are closed.

Hospitals have that themselves become scenes of intense fighting. Armed groups kicked out eight patients receiving care at a health center in Khartoum to use it as a base, the nonprofit organization Save the Children said. Many doctors and nurses who remained in the country have been threatened and arrested.

Looting is also widespread; many hospitals, pharmacies and warehouses have been looted. Patients with chronic diseases such as cancer, heart disease or diabetes have been unable to receive medicines for weeks, while dozens of dialysis centers have been closed, the Sudanese doctors’ union said.

Few parts of the Sudanese health system have been hit as acutely as maternal care networks. As soon as the fighting started, midwives across the country began receiving requests for help from expectant mothers.

“These women have become an increasingly vital lifeline for those trapped at home,” said Rania Hassan, UNFPA’s reproductive health team leader in Sudan, who has supported a network of at least 400 midwives in the country. Their work is especially crucial in the region in and around Khartoum, where the fighting was fiercestand where many women prefer to give birth in care facilities, she said.

Midwives fan out across cities and towns and enter women’s homes to deliver newborns, often in response to requests from nearby chat groups or emergency helplines.

Ms. Ahmad, who rode the motorcycle with the pregnant woman, is helping coordinate a team of 20 midwives in Omdurman. Together they have helped deliver about 200 babies – five or six in an ordinary month – since the fighting began.

Not only do the midwives defy violence, she said, but they are often forced to operate without access to phones or internet connections, which have been made worse by the clashes.

Ms. Ahmad said she gave birth to eight babies during the conflict, but the chaos made it more difficult to reach women and get medical supplies.

Her account was echoed by others, such as Ahlam Abdullah Hamid, a 27-year-old midwife who had delivered six babies in the town of Bahri, just north of Khartoum.

“The situation is so difficult,” she said in a phone interview, adding that she was thrilled to help after a flood of requests from pregnant women posted on her nearby WhatsApp channel.

While all of her deliveries have been successful, she said she was beginning to worry about navigating the increasingly aggravating and unpredictable nighttime street fights when she usually responds to calls.

But she’s still willing to take the risk, she said, adding that she feels a strong sense of responsibility to help every time she hears from a woman in need.

“The calls from the women humiliate me,” she said. “How can I leave if they keep asking for help?”

Hwaida Sad reporting contributed.