Nyala/ Amsterdam - One of the worst maternal and child health emergencies in the world is unfolding in South Darfur, Sudan, according to a report released by Médecins Sans Frontières (MSF). Pregnant, birthing, and postpartum women, as well as children, are dying from preventable conditions as their health needs far exceed what MSF can respond to.

Driven to oblivion: the toll of conflict and neglect on the health of mothers and children in South Darfur reveals the number of maternal deaths in just two MSF-supported hospitals in South Darfur between January and August to be more than seven per cent of the total number of maternal deaths in all MSF facilities worldwide in 2023. A screening of children for malnutrition also found rates well beyond emergency thresholds.

For these crises to be addressed, the United Nations (UN) must act decisively to prevent further loss of life in Darfur. The UN must accelerate the return of UN staff and agencies to Darfur and leverage all available resources and political influence to ensure that aid reaches those in need. Only a coordinated international response, supported by robust funding and unyielding pressure on the warring parties, can avert mass starvation and alleviate the suffering of millions.

“This is a crisis unlike any other I have seen in my career,” says Dr Gillian Burkhardt, MSF sexual and reproductive health activity manager speaking in Nyala, South Darfur. “Multiple health emergencies are happening simultaneously with almost no international response from the UN and others. Newborn babies, pregnant women, and new mothers are dying in shocking numbers. And so many of these deaths are due to preventable conditions, but almost everything has broken down.”

From January to August in South Darfur, there were 46 maternal deaths in Nyala Teaching and Kas Rural hospitals, where MSF teams provide obstetric care and other services. The scarcity of functioning health facilities and unaffordable transportation costs mean many women arrive at hospital in critical condition. Around 78 per cent of these 46 deaths occurred in the first 24 hours following admission.

Sepsis was the most common cause of maternal death in all MSF-supported facilities in South Darfur. The dearth of functioning health facilities forces women to give birth in unsanitary environments that lack basic items such as soap, clean delivery mats, and sterilised instruments. Without these basic items women are getting infections. And with antibiotics in low supply, they can arrive at a hospital only to be met with no treatment option available.

“A pregnant patient from a rural area waited two days to collect the money needed to get care,” says Maria Fix, MSF medical team leader in South Darfur. “When she travelled to a health centre, they had no drugs, so she went back home.”

“After three days, her condition deteriorated but again she had to wait five hours for transportation. She was already in a coma when she reached us,” says Fix. “She died from a preventable infection.”

The crisis in South Darfur extends to children, with thousands on the brink of death and starvation, while others are dying of preventable conditions. From January to June 2024, 48 newborns died from sepsis in in Nyala Teaching and Kas Rural hospitals, meaning one in five newborns with sepsis did not survive.

In August, 30,000 children under two-years-old were screened for malnutrition in South Darfur. Of these, 32.5% were found to be acutely malnourished, well beyond the World Health Organization’s emergency threshold of 15%. Furthermore, 8.1% of children screened were severely acutely malnourished.

Nyala, the capital of South Darfur, was a hub for humanitarian organisations before the war. But since its outbreak, most organisations have not returned. The UN still has no international staff in the city, where MSF is one of the only international organisations present. Between January and August, MSF teams in South Darfur provided 12,600 ante- and post-natal consultations and assisted in 4,330 normal and complicated deliveries.

Across Sudan, interrelated crises are compounding to cause immense suffering, with little help available, as Dr Burkhardt, who worked in North Darfur prior to her assignment in South Darfur, explains.

“The disparity between the huge needs for healthcare, food, and basic services, and the consistently lacking international response is disgraceful,” she says. “We call on donors, the UN, and international organisations to urgently increase funding for, as well as scale up and supply, maternal health and nutrition programmes.”

“We know that Sudan is a challenging place to work but waiting for challenges to disappear by themselves is getting nowhere,” says Dr Burkhardt. “For many mothers and children, it's already too late. Risks must be managed, and solutions found before more lives are lost.”

Conflict is also driving the maternal and child health crisis as people are displaced and subject to violence. Supply shortages are aggravated by the warring parties which, along with their affiliated armed groups, continue to block or restrict access to lifesaving aid.

The crisis risks trapping families in protracted cycles of malnutrition, sickness, and deteriorating health that span generations.

A patient caretaker describes how maternal mortality and malnutrition are interrelated for their family.

“The mother of the twins died from severe bleeding, leaving behind eight other children,” they say. “My husband and I try to take care of them... we don’t earn enough to feed them. Now we’re 13 in the house. We’re struggling, eating porridge and sauce with a bit of salt, little or no oil, and green leaves.”