The war in Sudan, which began in April 2023, has created one of the world’s largest displacement crises, forcing more than 10 million people to flee their homes. The warring sides, the Sudanese Armed Forces and the Rapid Support Forces, are inflicting horrendous violence on people across the country. Hospitals have been attacked, markets bombed, and houses razed to the ground, leading to a catastrophic toll on the health of the Sudanese people.

I am an obstetrician-gynecologist from New Mexico currently on assignment with Doctors Without Borders in Sudan. The state where I am currently working, South Darfur, hosts approximately 1.8 million people displaced by the war, often in camps with unsanitary and overcrowded conditions.

The ongoing violence and displacement in Sudan have led to disastrous consequences for women and children in particular. The conflict has exacerbated already high maternal and neonatal mortality rates. Doctors Without Borders has documented 114 maternal deaths in medical facilities and communities in South Darfur in the first eight months of 2024 alone. High case fatality rates for both maternal and neonatal sepsis, as well as for pre-eclampsia, highlight the preventable nature of these deaths.

Impact of conflict

The ongoing conflict and deliberate obstruction by warring parties are exacerbating the crisis, severely restricting access to lifesaving aid. Mass displacement of the population has forced pregnant women to flee to overcrowded camps with inadequate maternal health care. Most women are delivering outside health facilities, at home or in displacement camps, leading to unsanitary deliveries and increased risk of postpartum infections.

Child malnutrition

Malnutrition has reached emergency levels in South Darfur. A screening in August of 30,000 children between the ages of 6 and 23 months found that more than one-third were acutely malnourished. Thousands of children urgently need food, including therapeutic food. The crisis is trapping families in cycles of malnutrition and deteriorating health, with maternal health also affecting child health.

Health care infrastructure and access constraints

The conflict has severely damaged health care facilities, such as the Nyala Hospital for Women and Obstetrics, which was looted and remains largely in disrepair. Referral systems are dysfunctional, and supplies are scarce, impacting women’s access to care. High numbers of late presentations for emergency obstetric care are reported, with 78 percent of maternal deaths occurring within 24 hours of admission. Many die within the first hour of arrival to facilities as they arrive in such critical states.

Sexual violence and unsafe abortions

Unsafe abortions leading to sepsis and maternal deaths are occurring due to high levels of sexual violence and sexual violence-related pregnancies. The lack of services for sexual violence survivors, including safe abortion care, forces women to resort to dangerous methods to terminate their pregnancies, contributing to maternal mortality. Women also limit their movements due to the risk of sexual violence, particularly during farming months, further restricting access to health care.

Medical supply shortages

There are critical shortages of essential medical supplies, such as oxytocin and antibiotics, exacerbating the health care crisis. The roads from neighboring Chad, which provide the lifeline for supplies for most of Darfur and other regions of Sudan, have been nearly impassable due to recent flooding, making it very difficult to bring in much-needed supplies.

Calls to action

The situation in South Darfur is a snapshot of what is occurring across the war-torn country of Sudan. A coordinated humanitarian response with adequate funding and access is urgently needed to address the crisis and prevent further deaths and suffering among mothers and children. Here are key actions that need to be taken:

1. Unrestricted humanitarian access: Open all access routes for humanitarian supplies and rehabilitate critical infrastructure.
2. Focus on maternal and reproductive health: Urgently scale up maternity and sexual and reproductive health programs, addressing barriers to care.
3. Expand child nutrition services: Increase child malnutrition programs and provide food and cash assistance to vulnerable families.
4. Return of UN agencies: Re-establish a UN presence in areas such as South Darfur to coordinate and raise visibility of the crisis.

The maternal and child health crisis in South Darfur is a dire situation that requires immediate international attention and action, or more lives will be lost. The alarming maternal and neonatal mortality rates, coupled with the severe impact of conflict and displacement, highlight the urgent need for a coordinated humanitarian response. We must act now to support the vulnerable populations in South Darfur and prevent further deaths and suffering among mothers and children.

Gillian Burkhardt is an obstetrician-gynecology physician.