Darfur, Sudan: Reproduced suffering

© Martyn Broughton/MSF
The MSF clinics do not expect to change much of this. They are struggling to deal with the extra demands of the war that is still rumbling on in Darfur. A quarter of the women who come to the clinics have sexually transmitted diseases. Celia is sure that this has increased because of the violence.
Selwa arrived on a donkey cart, exhausted from the journey and the three days at home trying to give birth. Her baby was dead. Just an arm had emerged before everything stopped. The MSF women's health clinic in Riyad camp, West Darfur was once again faced with the limits of emergency care in a conflict zone where tradition produces its own hazards for women. Selwa got there just in time. The gynaecologist, Dr Celia Kohn, was able to remove the baby and save the mother from septicaemia. But Celia is sure that, across Darfur, many thousands like her are dying because they cannot get medical help and because the social mores are stacked against them. "The position of women here is worse than anywhere else I know and I have been doing this work in some of the most difficult places; Afghanistan, Sierra Leone, the Algerian desert," Celia said. MSF's clinics in two displaced people's camps in El Geneina were opened October last year as part of the response to the huge medical needs created by the violent emptying of villages across Darfur. But the problems they found were really just a sharpened form of those from which Darfuri women have always suffered.
  • 90% of women have had genital cutting and stitching performed when they were girls and so have a much greater risk of infection at every stage of the reproductive cycle.
  • Producing children is the thing that defines the worth of a wife. Women who cannot are liable to divorce.
  • Multiple pregnancies hugely increase the risk of transverse or obstructed deliveries, as the muscles of the uterus become looser.
  • There is a chronic deficiency of iodine and folic acid in the diet, which can become critical in pregnancy, leading to anaemia.
  • Knowledge about birth control or about maternity care is minimal. © Martyn Broughton/MSF Click for large view Three generations of women from the same family manage the daily chores in their hut in Kalma camp for internally displaced people. MSF's clinics in two displaced people's camps in El Geneina were opened October last year as part of the response to the huge medical needs created by the violent emptying of villages across Darfur.
    Fatima is not quite meeting the doctor's eyes as she describes her symptoms. A pain in the lower abdomen but she is not sure what it is. Celia's examination makes her very sure what it is and the real story quickly emerges. The woman is 26 and has two children already but she has not been able to get pregnant since the last birth four years ago. Her husband stopped having sex with her last year. The reason for all this is that she has a massively prolapsed uterus from a very badly managed delivery. She needs surgery to get the uterus back up the birth canal. Celia will refer her to the town hospital but even with the operation, she should not have another child and her marriage is still fragile. "Many of my women are anxious about this", says Celia. "Sometimes I can help. Sometimes I even see a husband who seems to care about his wife. I had a 14 year old wife come with her husband to ask about getting pregnant. I thought there was a chance that giving doxycyclin for chlamydia and some extra iodine might help. Something worked and this is now a bit of a legend in the market." There are 1,500 consultations a month in the clinics but far too many mothers stay at home to give birth. Training for traditional birth attendants is underway because they have so far been part of the problem. The standard treatment for a haemmoraged delivery is a hot soup made from honey. Even finding female staff for the clinic who can read and write is a real problem. Only 4% of women finish primary school to the age of 12. The MSF clinics do not expect to change much of this. They are struggling to deal with the extra demands of the war that is still rumbling on in Darfur. A quarter of the women who come to the clinics have sexually transmitted diseases. Celia is sure that this has increased because of the violence. There are no estimates for the prevalence of HIV infection in Darfur but the displacement of people to Congo, Chad and elsewhere will certainly multiply the risks for what had been a relatively isolated population. Women's health is getting even more vulnerable. As the clinic is closing for the day, a small reminder of some of the old and new things that make life so fragile. A very small reminder. She is an orphan suckling at a neighbour's breast. Her mother died as she was born, some 16 days ago. The baby is competing for milk with the neighbour's own child. As a refugee from the countryside, the woman is completely dependent on food aid. She comes to the MSF clinic to get extra rations to manage the two babies. Celia is impressed but not optimistic about the longer term. "She is not their blood and extra mouths are very hard to fill. Mothers here are under so much pressure. Men and the war have much to answer for," she said.