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Pregnant Women Are Dying at Rapid Rates in Darfur, but Where’s the UN?, a Major Aid Group Asks

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An MSF-run clinic in Zamzam camp for displaced people, near El Fasher, in Darfur, Sudan, offering therapeutic feeding services, January 2024. As fighting in the civil war intensifies in the region, the global medical group says it is seeing a “gender dimension” to the conflict. It also suggests that the UN could be trying harder to get aid into the region. MSF

Far too many pregnant women are dying of preventable causes since the beginning of the yearlong civil war in Sudan, says a major global doctors group. Even before the recent escalation of violence in the country, it had one of the highest maternal death rates in the world. Now, in the hotly contested region of Darfur, care for pregnant women is virtually gone, pushing mortality rates further upward.

Oliver Behn, the director of operations and advocacy for Médecins Sans Frontières (MSF, or Doctors Without Borders), said in a recent interview with PassBlue that the 13-month-long war — what he calls a “largely neglected and forgotten conflict” by other governments and media — has worsened maternal and infant death rates, especially in Darfur. There, health care providers struggle with limited resources to meet the needs of the approximately six million people in the embattled area. Darfur was the site of a genocide in 2004.

MSF says it is the only global organization providing medical care in El Fasher, the capital of North Darfur, where the fighting is currently concentrated in the war between the Sudan Armed Forces Gen. Abdel Fattah al-Burhan and the Rapid Support Forces’ Gen. Mohamed Hamdan “Hemedti” Dagalo.

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Behn, who has been working in the MSF post for five years, criticized the United Nations and other international humanitarian groups for abandoning North Darfur State, just as intensified fighting got underway, leaving people without basic help. More than 20 international NGOs previously operated in the region, he added. Moreover, the UN says that only 12 percent of the $2.7 billion required to alleviate the humanitarian disaster in Sudan has been raised, warning that famine is imminent across the beleaguered state.

The RSF, the opposition militia led by Dagalo, has been at war with the Burhan-led Sudanese Armed Forces since April 2023, as outside mediation attempts by Saudi Arabia, the United States and the African Union, among others, have failed. (The US recently named Tom Perriello, as a new mediator.)

El Fasher is the last stronghold of the Sudanese military forces in the capital of North Darfur State. The UN human rights office said at least 58 people have been killed in the city since last week.

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Despite some progress between 2020 and 2022, Sudan’s maternal death rate remained high even before the conflict. The World Health Organization notes that Sudan has consistently suffered from “extremely” low access to essential medicines, health care services and antenatal care. The situation worsened last year when hospitals, including MSF facilities, were looted. The El Fasher Women’s and Maternity Hospital was destroyed by shelling on May 19, according to local media.

In the PassBlue interview, Behn spoke specifically about the unfolding humanitarian disaster in Darfur and called the UN and other humanitarian organizations to action. The interview, conducted by Zoom in May, has been condensed and edited for clarity. — DAMILOLA BANJO

PassBlue: The news coming out of Sudan is devastating, and the MSF is in El Fasher, the capital of Darfur, where the most intense fighting is happening. What are you seeing?

Behn: The numbers speak for themselves: 25 million people are depending on humanitarian assistance, about eight million people are displaced. What we have seen is the disregard for civilian protections and infrastructure, and it is having a heavy impact on the population. There is violence against the health system. We see a gender dimension in the conflict. The other thing we are seeing in Sudan is that it is a largely neglected and forgotten crisis by the international community and the media, which has led to a very late, insufficient response by the humanitarian system.

PassBlue: How are the MSF doctors meeting these incredibly demanding needs?

Behn: Many older doctors have left the country, leaving the hospitals with junior doctors or doctors in training. So we’re missing a certain level of knowledge and experience. I’ve talked to a young doctor who finished her two months’ training before the war started. She’s now the most-senior doctor for the pediatric wards, with a huge number of patients, carrying that burden without resources and experience. The [local arm of the Sudan] Ministry of Health is not providing them with supplies, not providing them with funds to pay staff. There are no medical supplies or vaccines. The other challenge is that while the Ministry of Health is not getting supplies anymore from the central government, it is also not getting them from the UN agencies.

This is one of the most disappointing responses from UN agencies that I’ve seen in my career. The UN, despite us sharing information for a long time with them, hasn’t been able to provide sufficient supplies to Darfur. It is because the government of Sudan has basically closed some of the border crossings, allowing only one crossing: in the north, from Chad, so the cutoffs end a supply route from western, eastern, central and southern Darfur. But we are using different border crossings, and we are showing that it is possible. I would expect the UN to start to prepare and stockpile properly in Chad to respond to and set up coordination mechanisms called humanitarian hubs. Many international NGOs depend on the UN logistics to deliver. If that is not happening at speed and scale, we will see an avoidable and devastating humanitarian catastrophe.

PassBlue: Let’s talk about the gender aspect of the war. How is it affecting women?

Behn: There are two aspects of the conflict that affect women particularly. One is the violence that comes from the conflict per se, but also the violence that is happening in areas where there is no active fighting anymore. There are many unregulated groups; there’s the RSF present but also a huge number of militia groups that are either local or regional, acting with complete impunity. That has led to a destroyed health system. The hospitals are destroyed, primary health care is destroyed and prevention is destroyed. So what does it mean for women and adolescent girls? Antenatal care and maternity care practically do not exist. So antenatal care during pregnancy, support during deliveries and post-delivery services, do not exist.

We have opened two hospitals with the Ministry of Health, where we run pediatrics and maternity. What we are seeing is that women come very late with very complicated deliveries. In total, we have supported about 1,600 Cesarean sections. However, the lateness of this delayed presentation and the high complications have three sources: early detection of problems is not happening; two, there is no support during pregnancy. This means bed nets for malaria prevention and supplementary medical support through iron are not happening. And three, in cases of obstructed labor, there are no ambulance systems or referral systems. In the hospital where we are working, between February and April, there were about 70 maternity deaths, which is a huge number compared with normal rates. We have a 20 percent mortality rate in the two pediatric wards. They are coming in too late and too sick, and the deaths happen in the first 24 hours. Normally it would be at 5 percent, which would be concerning.

PassBlue: Please give us more details on the cases of women and children.

Behn: The main thing we are seeing with women is obstructed labor. The other thing is that we are starting to see malnourished breastfeeding and pregnant women. That is very unusual. The mother is feeding her children at the expense of her own health. But it also means that if you’re malnourished during pregnancy, the newborn has a higher risk of death. It also means that the child is more susceptible to infectious diseases, which means that the risks during pregnancy are much higher. There is a problem with access to chronic medication, whether TB treatment, HIV, STD follow-ups, or diabetes. Everything has broken down.

PassBlue: What are the solutions to the lack of supplies and other basic help from the UN?

Behn: Sudan is a crisis that has been well forgotten and neglected. We also see how political agendas, whether in the country regional or globally, are affecting that response and how important it is for humanitarian assistance and humanitarian actors to be impartial and independent to deliver in these very difficult circumstances. The donor governments also need to delink funding and their mechanisms from the actual events.


We welcome your comments on this article.  What are your thoughts on the Darfur crisis?

Damilola Banjo is a reporter for PassBlue. She has a master’s of science degree from the Columbia University Graduate School of Journalism and a B.A. in communications and language arts from the University of Ibadan, Nigeria. She has worked as a producer for NPR’s WAFE station in Charlotte, N.C.; for the BBC as an investigative journalist; and as a staff investigative reporter for Sahara Reporters Media.

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Pregnant Women Are Dying at Rapid Rates in Darfur, but Where’s the UN?, a Major Aid Group Asks
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