She Said: Women’s lives, women’s voices
You’ve heard it before. Women and girls pay a heavy price during humanitarian crises. She Said is an ongoing collection of reporting in which women offer glimpses of their lives, speaking with TNH from situations of conflict and displacement, and other global emergencies.
After more than 17 months of grinding conflict, millions of Sudanese women are struggling to access lifesaving sexual and reproductive health services as the warring parties continue to target hospitals and health workers, and to block the flow of aid.
Health workers and activists told The New Humanitarian that rape survivors cannot get abortion medication and post-exposure prophylaxis to prevent HIV infection, while pregnant women are having to give birth unattended or with unsterilised instruments.
“There are no gloves. An alternative is nylon bags, and wounds are stitched with clothing thread after boiling it in water and salt,” Sudanese rights activist Amira Osman said, describing the situation in hospitals across Sudan.
Sudan’s war began in April 2023 and pits the country’s army against the powerful paramilitary Rapid Support Forces (RSF). It has produced the world’s largest hunger and displacement crises, uprooting over 10.5 million people.
Women and girls have been especially badly impacted, with rights groups and UN experts documenting widespread sexual violence being used as a tool of war. Both fighting groups have committed abuses, though most violations implicate the RSF.
Survivors are struggling to access services because of the fighting, and because health centres have been targeted by the warring parties and are suffering from a lack of staff, funding, and electricity cuts.
Female-headed households, widows, adolescent girls, and pregnant and lactating women are also acutely affected by food shortages across the country, with famine officially declared in some parts of the western Darfur region.
According to UNFPA, the UN’s sexual and reproductive health agency, around 1.2 million pregnant and breastfeeding women are facing acute malnutrition, with most unable to obtain healthcare.
“After giving birth, the suffering of obtaining food doubled due to breastfeeding,” said a 17-year-old who recently gave birth in a shelter in Kassala, in eastern Sudan, and who asked not to be named. “I also did not get the baby's needs for clothes and other things, and no vitamins were available.”
International aid groups have struggled to respond – to both the needs of women and girls and the broader humanitarian disaster – because of the insecurity, and because the army and the RSF regularly block them from delivering relief to areas controlled by one another.
Several local women’s groups told The New Humanitarian they are trying to plug gaps by delivering services for women and girls through grassroots organisations, by documenting cases of sexual violence, and by advocating for justice.
However, resources for local groups are stretched thin, said Hiyam al-Yasa, who volunteers for one of the neighbourhood-based mutual aid groups – known as emergency response rooms – that have been set up across Sudan.
“We have a shortage of resources and we don't have enough support,” said al-Yasa, who is based in Sennar, a war-hit state in southeastern Sudan. “The [local] society is not encouraging the victims of the war to speak up, and the victims of rape are not receiving enough support.”
A war against women’s bodies
Sexual violence by army troops, rebels, and militias was widespread even before the war, though women’s rights groups described dealing with an overwhelming number of cases over the past year in interviews with The New Humanitarian.
Several recent reports have documented how armed men – especially members of the RSF – have committed rapes and gang rapes against women and girls, some of whom have been kidnapped and forced into marriage and sexual slavery.
Hala al-Karib, regional director of the Strategic Initiative for Women in the Horn of Africa (SIHA), which has been monitoring and reporting on the situation since the outset of the conflict, said sexual violence is being used as a strategy of war.
“Women’s bodies and civilian bodies are extensively subjected to violations,” said al-Karib, whose organisation has appealed to the International Criminal Court to investigate and prosecute members of the RSF for sexual and gender-based violence.
Sulima Ishaq, the director of a government unit that works to combat and track violence against women and children, said rights groups are barely scratching the surface in terms of the cases they have documented.
“What we have been reporting does not represent more than 2% of what is happening in reality,” Ishaq said. “That means there are a lot of people who have been sexually assaulted with no kind of intervention.”
Ishaq said many women and girls who have been raped cannot get treatment. Earlier this month, she said a 15-year-old rape survivor from Sennar died before members of her family were able to find her medical care.
“She was bleeding, but the family couldn't get her to the health centres because of the security situation and the lack of safe roads,” Ishaq said. “When they finally got her to the hospital, she had blacked out. It took only a few hours and then she passed away.”
Many survivors of sexual violence often suffer in silence due to feeling shame within their communities, and because of a lack of support services, local activists and volunteers said.
“These crimes are kept secret in Sudan, especially in poor areas, for fear of societal stigma, which reduces the possibility of accountability,” al-Yasa said, adding: “The most horrific concerns we have [are] for the fate of the children resulting from [rape].”
‘We don’t have any emergency supplies’
The lack of functioning hospitals and medical supplies is also impacting other essential health services for women and girls.
Al-Yasa said there are no medications for abortions in Sennar, and insufficient equipment for women giving birth. She said some women have died as a result of childbirth complications.
According to a UNFPA report in May, more than 7,000 new mothers and 220,000 severely malnourished children have been at risk of death without access to maternal health services and nutritional support.
Without the financial resources to access medical services, many women and girls are also forced to prioritise purchasing food over their health needs, aid organisations said.
The situation is similarly bleak for women and girls who have escaped Sudan to neighbouring countries, where international humanitarian groups and local responders are also under-funded and thinly spread.
Zeinab Abdelbakheit Adam, a volunteer doctor helping Sudanese refugees stranded in a forest in Ethiopia’s Amhara region, said she has been treating pregnant women for several months with virtually no medical supplies.
“We have more than 47 pregnant women here and 10 delivered in the camp,” Adam said, communicating via WhatsApp voice notes. “We don’t have any emergency supplies for any emergency, and we cannot provide any painkillers or medication.”
Rafia Idris, a reproductive health officer with SIHA in the Chadian town of Adre – where hundreds of thousands of Darfuris have fled following RSF attacks – said her organisation is also struggling to cater for the number of people in need.
Idris said SIHA set up the centre to provide medical advice for women and girls who have been raped, mothers who have lost their children due to miscarriages, and to provide advice and awareness on sexually transmitted infections and menstruation. In the last year, the clinic has supported over 5,000 people, but Idris said there are countless more in need.
“What threatens their lives is the lack of comprehensive healthcare, the lack of medicine, and the lack of gynaecologists, especially in the Adre area,” Idris said.
Local responders targeted
Many of the local organisations, frontline responders, and women human rights defenders providing sexual and reproductive health services or speaking out against abuse have been deliberately targeted by the warring parties.
“It's not just medical doctors, [the warring parties] also target nurses, midwives, and medical assistants,” said Ishaq, the head of the government unit combating and tracking violence against women and children.
The Sudan Family Planning Association (SFPA) – a leading national NGO focused on supporting marginalised and internally displaced women and girls – has been attacked several times by the RSF, and had their main warehouse in Khartoum looted.
RSF bombardments and assaults have also killed or severely injured SFPA staff and volunteers, and the organisation’s patients have been kidnapped, their whereabouts unknown.
Despite the attacks, the SFPA continues to provide services for the clinical management of rape, diagnosis and treatment of HIV and other STIs, maternity and post-abortion care, said Seham Jaber, who works for the SFPA.
At the outset of the war, Jaber said SFPA created and shared via social media a database that has information about operational midwives and health facilities to help women access safe places to give birth.
Jaber said SFPA also operates a 24/7 call centre for survivors of sexual and gender-based violence, staffed with eight specialist agents. When the centre was destroyed in an attack, agents switched to providing help via WhatsApp.
Al-Yasa said members of the emergency response rooms have also been targeted. “Many volunteers are exposed to arrest, investigations, or other constant harassment from military intelligence [for speaking out about] these crimes,” she said.
According to a report from ACAPS, which provides independent humanitarian analysis, some women working in emergency response rooms in Khartoum have been sexually assaulted by the RSF, with some being killed after resisting.
Emergency response room members said they provide several services for women and girls, including counselling for rape survivors, and the distribution of post-rape kits, period kits, vitamins for pregnant and lactating women, and breastmilk for newborns whose mothers died during childbirth.
However, with little international funding and amid such widespread abuse, al-Yasa said there is only so much that volunteers can do. “There is no awareness about the rights of women,” she said. “We are trying to save who we can.”
International aid groups say they are trying to reach women and girls in need. UNFPA said it has helped thousands with sexual and reproductive services, even as access to medical care, maternal health, and menstrual hygiene supplies is “compromised”.
Most aid groups face major obstacles accessing conflict-affected areas. Their efforts to bring in supplies to places like Khartoum are often scuppered by the army and aligned authorities, which seek to starve RSF-occupied territories of relief.
Despite Sudan being the world’s biggest humanitarian disaster, the UN has also so far raised just over 50% of the $2.7 billion requested to respond to the crisis, which limits what organisations are able to do on the ground.
Centering women’s protection
Akshaya Kumar, the director of crisis advocacy at Human Rights Watch and a lead author of a recent report on conflict-related sexual violence in Sudan, said more money for response organisations won’t be enough to solve the issues they face.
“It's not just about money being channelled to the right people, it's also about challenging the underlying access constraints and the targeting of people who are on the front lines,” Kumar said. “Part of the solution is raising this issue and centering women's protection, or lack thereof, in the broader conversations about how things move forward.”
Al-Karib of SIHA said accountability for violations against women and girls and other civilians should be part of the process of reaching a cessation of hostility agreement between the army and RSF.
“When you emphasise the political process in isolation from accountability at all levels in any peace accord, you will definitely prolong this pain and prolong the humanitarian crisis,” she said.
Al-Karib said her organisation is continuing to share accounts of crimes committed against women and girls to the Sudanese public, and to the international community and different international justice institutions.
“This is what we can do at this point in time,” al-Karib told The New Humanitarian. “I hope the international community is learning that enough is enough.”
Edited by Philip Kleinfeld.
