Women deliver babies on the road and under fire as catastrophe grips Sudan’s Aj Jazirah State

AJ JAZIRAH STATE, Sudan - This was Amina's fifth delivery by Caesarean section, but the first performed on the floor of a stranger's home. "I had to start walking again just six hours later, carrying my baby while my wounds were still fresh and painful," she told UNFPA, the United Nations sexual and reproductive health agency.

At nine months pregnant, the 27-year-old mother of five had fled her home in Aj Jazirah State as violence erupted around her. She made it on foot to a neighbouring village, but the pain was too intense to continue any further.

Fortunately, a local doctor had spread word that any woman in labour in the area should go to his home, where he was assisting deliveries even with only the most basic equipment. In just one day he supported 21 childbirths - including Caesarean sections like Amina's.

After her operation she was weak, hungry and in agony. "But the shooting was so terrifying that I found the strength to leave the village," she said.

"Some local men saw me walking and offered me a spot on a cart pulled by a donkey. I stayed on that cart for days until I arrived in Gedaref, where I was immediately taken to the hospital."

At nine months pregnant, Amina (left) fled her home in Aj Jazirah State as violence erupted around her, eventually giving birth on the floor of a stranger's house. Credit: UNFPA Sudan

The Gedaref Maternity Hospital is supported by UNFPA with essential reproductive health supplies, as well as a solar power system so life-saving care can continue if electricity sources are compromised.

"The women helping us here are very kind," said Amina of the health workers. "They spoke with me for hours and provided a bag full of hygiene supplies - they took care of even the smallest details, which meant so much."

She was also grateful to the man who delivered her son. "I don't know what happened to the doctor who saved me and my baby. Some say he managed to escape, others said he was left behind and captured. I hope he is safe."

Childbirth on the run

More than 390,000 people have fled Aj Jazirah State since fighting escalated on 20 October. Most arrived in the neighbouring states of Gedaref and Kassala, where UNFPA and its partners are working to provide emergency assistance. The majority of those displaced walked for days, and many are sleeping in the open - including women, girls, the elderly and the sick.

Midwife Awatef was also forced to flee Aj Jazirah and is now in a displacement camp in Gedaref. "I delivered four women on our way here," she told UNFPA. "I delivered them in the bush, with only very basic sterilization - I had nothing but water and soap."

"One of the women was bitten by a scorpion during labour - it was terrifying and extremely painful for the mother, and it scared me too. We eventually found a car and sent her to the hospital. Thankfully, she is healthy now."

The conditions for close to 5.8 million women and girls uprooted by the crisis in Sudan are perilous - all the more so for the 270,000 who are pregnant. There are reports of women dying from pregnancy and childbirth-related complications due to lack of healthcare, medicine and power outages, while hunger, malnutrition and a cholera outbreak are further endangering their lives.

Alaa Faisal fled her home in Khartoum with her three children and is now sheltering in a camp in Gedaref State. Credit: UNFPA Sudan.

Alaa Faisal fled her home in Khartoum with her three children and is now sheltering in a camp in Gedaref State. "Transport was very expensive, it took us three days to get here," she told UNFPA.

"We only receive one meal per day - many children are suffering from malnutrition, and sadly, some have died. There are many diseases in this place, such as dengue fever. The children desperately need food, and it is very cold."

Mother-of-four Sabreen Abdulrahman left her home in Khartoum and has been displaced multiple times on her way to Gedaref - a journey that would take days to complete, all of it on foot. "I'm nine months pregnant, and I'm afraid of the surgery," she told UNFPA.

"After I give birth, I worry about the cold weather and not having a proper place to put my baby. We don't have a home - we sleep on the floor. A mobile clinic visited us, examined me, and performed an ultrasound. They treated me kindly. I needed pills for jaundice, which they didn't have at the time, but they went to the city and brought them back for me."

UNFPA on the ground

Despite treacherous conditions, UNFPA is continuing to provide services wherever possible. This includes ensuring emergency obstetric and neonatal care and providing essential reproductive health supplies to facilities across Aj Jazirah, Gedaref and Kassala States.

UNFPA is also deploying roving teams of midwives and medical staff across Sudan, particularly in areas of high need and where access to health and protection services is limited. Supplies are ready for distribution for Caesarian sections, blood transfusions, post-abortion care, and for the clinical management of rape and sexually transmitted infections. Other key health centres such as the Kassala, Khashm El Girba and New Half hospital are being supported with supplies, rehabilitation and medical staff training.

With the help of UNFPA's clean delivery kits, midwife Awatef is now providing antenatal and postnatal care for other displaced women and has been recruited as part of a UNFPA-supported mobile health team.

"I have started delivering babies in the camp - just yesterday, I assisted a young woman and she is doing well."

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