All hospitals in the Sudanese capital, Khartoum, except a few, have closed due to the conflict there. Those left open often lack power, making childbirth even more stressful than usual for women and the healthcare workers trying to help them, especially if surgery is needed.
“We rely on mobile phone lights to perform a caesarean section,” obstetrician Dr Howaida Ahmed al-Hassan said in a video shared with the BBC.
She recorded the footage while operating on an expectant mother.
Her gloved hands can be seen exerting pressure on the patient’s chest and stomach during the C-section.
The doctors present – all women – surround Dr Hassan and hold up their phones to illuminate the area where an incision has been made.
Dr Hassan was one of the few obstetricians who remained at Alban Jadeed Hospital, in the north of the Sudanese capital, Khartoum, for three consecutive weeks after heavy fighting broke out between military factions in April.
In the video she sent to the BBC, she showed wards with nurses helping mothers give birth in extremely difficult conditions.
“The situation is really bad. We have been in the hospital for days and days. We have completely lost track of time. We don’t know if it is day or night,” Dr Hassan said. .
“There are minimal medical staff in the hospital, and in many cases the electricity is out and we don’t have gasoline to run the generators for caesarean sections.”
“High Risk Births”
She said the maternity ward at her hospital was filled with women in dire need of emergency obstetric care, many of whom required a caesarean section.
“We took big risks by performing these caesarean sections in poorly lit operating rooms. We don’t have enough resources.
“We work in the absence of consultants and specialists in general anesthesia. We had to discharge the women only 10 hours after each cesarean delivery.”
In April, the United Nations Population Fund estimated that 219,000 pregnant women were at risk, as heavy fighting raged around Khartoum, interspersed with fragile and failed ceasefires.
As the fighting began, he said around 24,000 would give birth “in the coming weeks”.
Bashayer al-Fadil was one such woman. She underwent a caesarean section just days after clashes erupted in Khartoum.
During a video call with the BBC, she could be seen cradling her one-week-old baby girl, Omayma.
She said she was lucky to find a hospital still open and was admitted amid sporadic gunfire.
“Explosions could be heard in the streets,” Ms Fadil said.
Most of the hospitals in her area were not functioning, so she was only able to give birth in a hospital thanks to her network of contacts.
According to the World Health Organization (WHO), only one in six hospitals in Khartoum is operating at full capacity.
“I was trying to find a hospital that would admit me for a caesarean section and I was lucky enough to find the hospital with the help of my doctor and my friends.”
On the day of the birth, Ms Fadil said she and her husband had to walk through gunfire which swept through their neighborhood until they arrived safely at the hospital.
“I gave birth in difficult circumstances. Even the simplest things, like water, were not available.”
The new mother could not obtain a birth certificate for her baby, nor give him the essential vaccines, as the violence continues to rage.
Ms. Fadil’s experience is not isolated. She said dozens of her pregnant friends had difficulty getting to the hospital and many had miscarried.
The Omdurman maternity hospital, one of the largest of its kind in Sudan, closed its doors a few days after the start of the clashes.
Dr Kameel Kamal, a consultant gynecologist there, told the BBC that most maternity wards in Sudan were now out of service. As a result, thousands of pregnant women faced dangerous complications, he said.
“Although there are no official statistics, we believe that a large number of pregnant women are forced to cry [in pain] in their homes.
“I’m sure there are many deaths at home, hemorrhages, miscarriages, ectopic pregnancies, breech births, stillbirths and many cases [of patients] who cannot access treatment,” he said.
Dr Kamal warned that the fighting was taking a “disastrous toll” on pregnant women in Sudan.
Even before the conflict began, Sudan had one of the highest maternal death rates in the world, according to the WHO.
“We create lives, they kill us”
Midwives still play a vital role, with some continuing to make home visits.
Midwife Mawaheb, who did not give her surname, told the BBC she had helped around seven women to have safe natural deliveries since the fighting began.
“When I get a phone call asking if I can help a woman in labour, I immediately head to that woman’s house without hesitation.
“In most cases, the labor goes well. If there is a problem or a complication, I send the woman to the nearest functioning hospital,” she said.
Despite the growing odds at the hospital, obstetrician Dr Hassan said medical staff were trying to keep their spirits up and celebrate the babies’ safe delivery.
“We create lives, they kill us. We help two souls stay alive – a mother and a baby,” she said.
The United Nations Population Fund in Sudan has posted on his Twitter account a contact list for trained midwives who are able to provide antenatal care to pregnant women and help those in labor deliver safely.