Between Khartoum and El Fasher: Pregnant women pay the price of war in Sudan

In her eighth month of pregnancy, Saada left her home and everything she knew behind, fleeing the intense fighting engulfing Khartoum, the Sudanese capital. “The war has intensified,” she kept repeating. “I must protect my child… I’m leaving my town after losing everything.”

Although traveling in her condition was dangerous, she felt she had no choice. “Insecurity, constant gunfire, and the looting and destruction of health facilities” meant she hadn’t seen a doctor for weeks.

It was a grueling five-day journey, and in early March, she arrived in Port Sudan, the capital of Red Sea State.

Saada arrived at Port Sudan Teaching Hospital, where she went into labor. Her pregnancy was difficult, and she experienced complications during delivery, but the medical staff helped her deliver via cesarean section.

A desperate need for health services: Port Sudan Teaching Hospital is the only maternity hospital in the state, serving approximately 1.6 million people. The hospital receives support from the United Nations Population Fund (UNFPA), the United Nations Sexual and Reproductive Health Agency (UNHCR), and partners in Red Sea State, who provide it with medical equipment. Supplies and staff training are needed to ensure that displaced pregnant women and girls arriving in Port Sudan from across the country can give birth safely.

“Our team is fully dedicated to supporting the women and girls arriving from Khartoum, but we urgently need more supplies, including fuel, life-saving equipment, and medicines,” said Dr. Randa Osman, the hospital’s general manager.

At least 46 health facilities across Sudan have been attacked, and nearly two-thirds are no longer functioning. In Khartoum, less than half of healthcare services are operational, meaning vital supplies—including those for emergency deliveries and post-rape care—are dangerously low. Meanwhile, medical personnel are unable to reach their destinations due to roadblocks and ongoing fighting.

Women in the Crosshairs

Since the conflict between the Sudanese Armed Forces and the Rapid Support Forces began on April 15, 2.5 million people have been forced to flee their homes in search of safety. Around 2 million of these are internally displaced. Even before the conflict, more than 3.7 million people were internally displaced, and few had access to healthcare. Essential supplies.

There are more than 260,000 pregnant women in Sudan right now, and some 90,000 are expected to give birth in the next three months.

All these women and girls need immediate access to basic reproductive health services, as do more than 4 million women and girls trapped in the conflict, who are increasingly at risk of sexual assault and exploitation. But as the bloodshed continues, more health centers are being forcibly closed.

The latest Sudan Humanitarian Response Plan aims to assist 24.7 million people, including 11 million in dire need of health services, and an estimated 2.6 million women and girls of reproductive age, many of whom will be unable to access the life-saving services they need.

The Fall of El Fasher.

Just weeks before her city fell to a Sudanese paramilitary group, Tasabih, then seven months pregnant, walked nearly 40 kilometers (25 miles) along unsafe roads with her baby until she found safe transport to a shelter elsewhere in the country.

She said Tasabih, from her tent in the overcrowded displaced persons camp in the town of Al-Dabba in northern Sudan, said: "When I arrived here, I had lost a lot of blood." “I was admitted to the intensive care unit where I spent a few days and received a blood transfusion.”

Tasabih arrived at the camp fleeing El Fasher in West Darfur two months before the paramilitary Rapid Support Forces, which have been fighting the Sudanese army for more than two years, seized control of the city.

Tasneem Al-Amin, from the Sudan Doctors Network, a group of doctors specializing in monitoring the war, said that more than 140 pregnant women have arrived at the Debba camps since the fall of El Fasher last month. She explained that many of these women are suffering from serious complications, particularly bleeding, which can sometimes lead to miscarriage.

Tasabih carried her three-year-old daughter on her back and walked part of her 14-day journey without her husband, who had gone missing shortly before her escape. She rested in two nearby villages along the way until she found transportation to Debba, a town about 1,300 kilometers (840 miles) northeast of El Fasher.

“I was extremely exhausted during the journey.” “I was carrying one child on my back and another in my womb. We had nothing to eat or drink,” said Tasabih, who was wearing a Sudanese thobe, a traditional garment worn by Sudanese women. Tasabih is one of many pregnant Sudanese women struggling to carry their pregnancies to term and give birth to healthy babies in a country where 80% of medical facilities have collapsed in war-torn areas, according to UN agencies.

Last week, Anna Mutafati, the UN Women’s regional director for East and Southern Africa, told reporters that Sudanese women are being forced to give birth in the streets.

Earlier this year, Doctors Without Borders reported that pregnant women in Darfur were undertaking “a grueling journey” on foot along unsafe roads to seek medical care at the few remaining health facilities, resulting in childbirth complications, miscarriages, or death.

“When I was in El Fasher, I couldn’t reach any medical facilities,” Tasabih said. "I didn't see any doctors until I arrived here in Ad-Dabbah."

Tasabih fled El Fasher shortly after her house was hit by a shell fired by the Rapid Support Forces, killing her relative.

"We barely managed to leave the city," she said. "On the way, we witnessed horrific scenes; it was a massacre."

Last month, the Rapid Support Forces (RSF) stormed El Fasher after more than 500 days of siege. Aid agencies and witnesses reported that the paramilitary group raided civilian homes, killing civilians and committing sexual assaults.

The RSF also stormed the Saudi Maternity Hospital, the last functioning health facility in El Fasher, reportedly killing 460 patients and their companions. The attack left more than 6,000 pregnant women without access to essential medical care, according to the United Nations. The attack forced tens of thousands to flee their homes, embarking on a perilous journey in hopes of reaching displacement camps.

Taysir Abdel Qader, eight months pregnant, recently arrived in Tawila, a town about 60 kilometers west of El Fasher. She told the International Committee of the Red Cross that she and her children have no one to support them, as her husband went missing after a shell hit their home in El Fasher.

“I arrived in my final months of pregnancy, and I have nothing to help me after giving birth—nothing to help me through the postpartum period,” said Taysir, whose index finger and thumb were partially amputated in the shelling.

She added that the Rapid Support Forces confiscated people’s belongings and threw them into the street, forcing them to flee naked.

“They didn’t let us take anything—not even sheets or blankets,” she added.

Taysir is one of more than 100 pregnant women who recently fled to Tawila, according to the Sudanese Doctors Network.

Pregnant and breastfeeding women are also suffering from malnutrition in a country where food insecurity rates are still rising.

The overall rate of acute malnutrition among 66 pregnant or breastfeeding women examined upon their arrival in Tawila by Doctors Without Borders between October 27 and November 3 was 60 percent, according to Tim Schenk, communications officer for the international medical relief organization.

Across Sudan, nearly 74% of women do not meet the minimum dietary diversity requirements, limiting their nutrient intake and consequently impacting maternal and child health. Women are reportedly foraging for wild leaves to boil and consume, exposing themselves to additional risks of violence, including abduction and sexual assault, according to the United Nations.

The war between the Rapid Support Forces and the army began in 2013, when tensions erupted between the former allies who were supposed to oversee a democratic transition following the 2019 uprising. The fighting has killed at least 40,000 people, according to the World Health Organization, and displaced 12 million. Aid organizations say the true death toll is likely much higher.