Midwives in Sudan work tirelessly against a collapsing health system

In Sudan, five babies are born every two minutes into a conflict where almost all functioning hospitals have been either partially or completely destroyed.

This year, an expected 1.3 million babies will be born in Sudan, compared to the average yearly rate of 300,000 in Australia.

United Nations Childrens Fund Australia Chief of Staff Alice Hall says healthcare facilities in Sudan are under severe pressure.

"When we think about the kinds of facilities that pregnant mothers are delivering newborn babies in, think about very basic setups, they may not have access to power or water. This means that midwives are unable to provide a clean and safe environment for mothers to give birth, which hugely increases the risk of infection. You know, midwives are telling us that theyre seeing up to twice as many mothers coming to deliver births in the functioning health centres that are there. And so theyre under immense pressure with limited space, and not enough workers to be able to do the jobs that they need to do so. The amount of stress and pressure for midwives is immense, and we know that thats putting mothers and babies lives at risk."

The conflict in Sudan, now in its second year, has seen the wide-scale destruction of health facilities.

Recently, UNICEF received reports that at least six children were killed in attacks targeting what was the last remaining hospital with surgical capacity in the city of El Fasher.

It was a devastating blow to the already vulnerable civilian population.

Alice Hall says that even before the most recent conflict, the healthcare system in Sudan was incredibly weak.

"Over the past 14 months of fighting, weve really seen a decimation of the health system and its ability to provide care. Weve got estimates of about 70% of health facilities no longer able to function. And thats because theyve had damaged infrastructure, staff have had to move away to find safety, but also lack of access to basic supplies to be able to deliver care."

While such widespread conflict impacts every facet of life, women, and pregnant women in particular, are often the hardest hit.

As well as the dangers posed by malnutrition itself, children, pregnant and breastfeeding women who are malnourished face even higher risks of serious illness and death.

The hunger levels experienced by those facing malnutrition weakens the bodys defences and opens the door to a range of diseases.

"When we see high rates of malnutrition among pregnant women, its putting their lives at risks and also their babys lives that risk. Health workers are also having to deal with this as they see children with severe acute malnutrition coming in and requiring treatment. Many health workers may still need training on how to identify malnutrition and how to provide the right treatment or have limited access to the supplies they need to give children in the care that they need so its not only putting childrens lives at risk but also their ability to develop sort of healthy and well for the long term."

Professor of International Relations at the Australian National University Bina DCosta says the risks to children can last generations.

"Children are the most vulnerable, and many times they are left unprotected, there is risk of exploitation, abuse, sexual abuse, trafficking and all sorts of issues which cause different kinds of harm. In terms of also young children and in terms of malnutrition, we also know that it doesnt actually end if theres some way to recover from that. Its a lifetime condition, malnutrition can affect young children when they become adults, it can create also inter-generational trauma and stress on bodies."

She says that the stigma attached to sexual violence often makes it even more difficult for people to address it.

"Pregnancies following sexual abuse and violence, so there has been also serious stigma, and also silence in terms of having support in these cases. We also know that there has been increased risk of trafficking child trafficking and child abduction in cases."

International Criminal Court Prosecutor Karim Khan says his office is deeply concerned about the evidence of expanding attacks on civilians.

"The evidence my office has collected to date seems to show credible, repeated, expanding, continuous allegations of attacks against the civilian population, in particular attacks directly against camps for internally displaced persons. It seems to show the widespread, prevalent use of rape and other forms of sexual violence. It seems to disclose consistently the shelling of civilian areas, the looting of properties and attacks against hospitals. I am particularly concerned by the ethnically motivated nature of these attacks against the Masalit and other communities."

As the conflict rages on for the second year, many healthcare workers have been displaced or injured as attacks on hospitals continue.

Increased sexual violence and acute malnutrition make pregnancy not only more traumatic and challenging for mothers but often requires unique skills and training for healthcare workers.

Alice Hall says the ability to provide that training and support is even more challenging when there are gaps in staff availabilities.

"Many health workers have had to move theyve been displaced, like the rest of the population so were seeing, you know, big gaps in staff able to provide services and its a shifting environment like any conflict, you know, things are changing. And when we see health centres being damaged by the fighting, that also means that health workers may have nowhere safe to operate as well."

UNICEF plays a major role in providing essential supplies and training to midwives in Sudan.

One of the things provided by UNICEF are obstetric and newborn kits created to assist workers deliver babies safely.

Alice Hall says the midwives are also trained in conflict specific tools to deal with complications when high tech solutions arent available.

"But were also teaching health workers, some really simple and highly effective tips which can help keep babies safe even when theres not high technology solutions. If theres no power to operate an incubator tools like kangaroo care, which is skin to skin contact between a mother or a father and the newborn baby is really effective in keeping them warm, and helping them sort of be free of infection. So some of those skills can really help keep babies alive, even when theres no supplies or the things that we might expect to have in a hospital in Australia."

Amira Khameis is just one of the midwives UNICEF has helped provide with equipment and critical supplies.

"I have been working as a midwife for nearly 24 years now. Ever since I was a child I dreamed of becoming a midwife. Our neighbour, Maqbool, was a kind woman who worked as a midwife. Whenever she had work to do, I would follow her secretly and hide, just so I could watch her work. Here I did not have any medical equipment or kits. If a pregnant woman bled, or if there were any health complications I did not have the necessary equipment to deal with it."

She says that despite the circumstances she is grateful to be doing such important work.

"I feel a sense of relief when I am able to save two lives, and I thank God for the opportunity to work in a profession where I can save lives."

Source: https://www.sbs.com.au/news/podcast-episode/midwives-in-sudan-work-tirelessly-against-a-collapsing-health-system/1fftrrw3o