Sudan: The harrowing reality of giving birth in a war zone

War in Sudan continues to devastate communities, with dire conditions worsening for pregnant women seeking safe childbirth. In the mountain town of Golo, located in western Sudan’s Central Darfur region, expectant mothers face impossible choices as they trek for hours, sometimes days, to reach the sole maternity hospital capable of performing life-saving C-sections. Essential medical supplies, including oxytocin to prevent postpartum hemorrhage, are dwindling, leaving many women and newborns at risk of death. The conflict, which erupted in April 2023 following a breakdown in Sudan’s transition to civilian rule, has intensified between the paramilitary Rapid Support Forces (RSF) and the Sudanese Armed Forces (SAF). This violence has driven hundreds of thousands into displacement camps, with Tawila, a sprawling settlement near Golo, housing over 700,000 people. The journey from Golo to Tawila, spanning approximately 100 kilometers through rugged mountainous terrain, is arduous. Women, often in labor or experiencing severe bleeding, traverse this distance on foot or using rudimentary transport such as donkeys. Those who can afford it may hire a donkey, but many are left with no choice but to endure the perilous path. Fabrizia Falcione, the UNFPA Sudan Country Representative, described the grim reality. “Most women reach it from mountain villages on foot, often walking for hours or being transported on crude wooden stretchers through the mountains, when they’re already in labour or bleeding,” she said. “Those who can afford it hire a donkey, but many women cannot. Many arrive when it is already too late for them and also for their babies.” The hospital in Golo, while vital, struggles under immense pressure. Doctors, midwives, and other staff frequently run short of critical supplies, including anaesthetics, further complicating deliveries. In Tawila, the situation is equally dire. Health facilities lack essential resources, and the absence of oxytocin means that many women who arrive in the camp are beyond the point of intervention. “Women come even from Golo to get a C-section when they know that their situation is desperate,” Ms. Falcione said. “Now, if it took us by four by four, nine hours [by car], you can imagine how long it will take a woman on a donkey… And that is exactly why the medical health providers told us when the women reach here, it's often too late and they cannot do anything and they lose their lives and those of their babies.” The displacement camp sprawls across the desert, its boundaries seemingly endless. As the number of displaced persons grows, so does the strain on existing infrastructure. New families arrive daily, setting up makeshift tents amid the chaos. The image of a child sitting beside a stove in Tawila, having fled El Fasher, encapsulates the broader narrative of loss and resilience. Meanwhile, elsewhere in Sudan, hostilities persist. Reports indicate that RSF forces continue to employ attack drones and siege tactics against the city of El Obeid in North Kordofan. These actions underscore the escalating nature of the conflict, which has turned entire regions into zones of crisis. Ms. Falcione emphasized the urgent need for decentralized healthcare solutions. “We can’t give pregnant women no other option than going across this vast and difficult terrain to reach a hospital to give birth safely,” she stated. “We need to decentralize healthcare, expand mobile services to reach those most difficult to reach.” She also called for greater support for community midwives, who are present throughout the region but often lack adequate training and equipment. “A well-trained and properly equipped midwife can meet 90 per cent of medical needs before, during and after delivery,” she added.