Under a huge baobab tree in Sudan’s Nuba mountains, I met Sebila, a 27-year-old mother of three. In March last year, her village had been attacked by Sudanese ground troops and bombed by government war planes. The assault forced Sebila and many other villagers to flee deeper into rebel-held territory.
She was just back in the village for the day with her children, two toddlers in tow and carrying a baby, to dig up sorghum she had buried. Sebila said food here is scarcer than it has been for years, because of poor rains and conflict fighting. “It’s exhausting, trying to feed them all [my family],” Sebila said of her children.
Aid obstruction in the rebel-held territories of Sudan’s South Kordofan and Blue Nile has been in force for nearly six years, and has had a devastating impact on the communities here. For Sebila – and all the women living across these territories – it has meant no access to contraception. “Every year, I give birth,” she told me. “It would be better if I could space it [out].” But Sebila cannot space her babies out, or have any control of her body. Like all women living in rebel-held territory here, she has zero access to contraception.
It has also meant a severe lack of maternal healthcare. There is no local midwife, and Sebila lives five hours’ drive from a hospital, in a region where cars are a rare luxury. Women told me of waiting hours for transport while in obstructed labour, or being held propped up, bleeding and falling in and out of consciousness, between two men on the back of a motorcycle to reach a hospital. Multiple and closely-spaced births can carry serious health risks for both mother and infant, and can be life-threatening without proper treatment.
Yet there is no coordinated international aid effort under way in the Nuba mountains. Funds are in place, but both the government and the rebel group are preventing supplies getting in. The conflict has left already-stretched health services in the region in a pitiful state. Most facilities are little more than a table with some basic medicines, and there are only five doctors and one blood bank for perhaps close to a million people.
Despite many rounds of peace talks since fighting began in 2011, the Sudanese government and the Sudan People’s Liberation Army-North have failed to agree on how to allow aid – needs-based and impartially delivered – into the affected areas. Instead they are still arguing about whether aid can come through a third country, or, as the government insists, only from inside Sudan. Some aid groups have found ways to provide occasional help, unauthorised by the government but supported by the rebels, but this is no substitute for the large-scale effort needed.
This has very serious consequences for reproductive health. None of the women I met in the Nuba mountains had any access to family planning. One clinic provides a three-month injectable contraception, but local rebel regulations require women to get their husband’s permission first. Despite evidence that gonorrhoea and syphilis are on the rise and hepatitis B common, condoms are scarce. Most of the women I met had never seen a condom, let alone any other form of contraception.
It is also feared that the number of women and girls dying in childbirth in the rebel-held areas of Southern Kordofan – already much higher than other states in Sudan – is rising yet further. And two major aid efforts, including a UN polio vaccination campaign for children, have failed.
Sudan has a long history of aid obstruction going back to the start of the conflict: denying travel permits; rejecting visas; blocking work permits; and expelling aid workers. Meanwhile, citing mistrust of the government, the rebels have still not agreed to an offer by the US to provide aid via Khartoum, and have instead called for yet more negotiations.
Although aid saves lives, and warring parties in conflict have an obligation to allow the delivery of humanitarian assistance to civilians, preventing it from reaching people is rarely punished. The UN security council briefly threatened punitive action against Sudan in 2012, but never acted. The health crisis unfolding in the Nuba mountains should prompt a change of tack. The UN security council, the African Union and the EU should investigate and consider travel bans and asset freezes on rebel and government leaders found to have deliberately blocked such deliveries.
International aid is often a lifeline to civilians trapped in conflict. And it would help women like Sebila to access contraception, avoid risky childbirth, and feed their children.