Years of obstruction of aid to the Nuba Mountains region of Sudan by the Sudanese government and armed opposition is endangering women and girls' lives, Human Rights Watch (HRW) has warned.
The six-year-long conflict in the Southern Kordofan and Blue Nile states, also referred to as the Third Sudanese Civil War, pits the Sudanese government and the rebel Sudan People's Liberation Army-North (SPLA–N). Both parties have obstructed impartial humanitarian aid to the area.
Sudanese government airstrikes in and around several health facilities in mid-2014 have shut down two major facilities which provide emergency obstetric care and contraception.
There are currently only five doctors for as many as 900,000 people. It can take up to two days for many people to reach the only two functioning hospitals in Heiban county, which are often made entirely inaccessible by active front lines. There are no ambulances.
These restrictions have had far-reaching effects on most women and girls living in the rebel-held Nuba Mountains, who lack access to reproductive health care such as contraception, prenatal care, skilled health providers during delivery, and emergency obstetric care.
"When women and girls face complications during labour, they sometimes only reach care after many hours of travel by motorcycle, carried between two men, or transported on beds," HRW found. Amid largely unavailable family planning, local authorities also warned that cases of sexually transmitted infections, such as syphilis, Hepatitis B and gonorrhoea, are on the rise.
"Women and girls in the Nuba Mountains are suffering and dying from years without access to life-saving humanitarian aid," Skye Wheeler, a women's rights emergencies researcher at HRW, said.
There is little information available regarding maternal mortality, which HRW believes is "high". The most recent statistic – from 2006 – showed Southern Kordofan's maternal mortality rate was 503 per 100,000 live births, compared with 91 in conflict-free Northern state.
Local officials told HRW some 350 women died in 2016, most of them suspected of being pregnant. Health workers have said most women who die in pregnancy and childbirth, do so at home, far from help.
The Sudanese government has eased access restrictions in some parts of the country – a condition to the United States government agreeing to lift economic sanctions earlier this year. However, neither warring parties have agreed on conditions for allowing aid into rebel-held areas in Southern Kordofan and Blue Nile states.
"The Sudanese government and armed opposition need to put the people first, and should immediately smooth the way for impartial and independent aid agencies to reach the area," Wheeler said, urging the UN and others to consider individual sanctions against commanders or leaders responsible for blatant obstruction of aid, in violation of international humanitarian law.
The long-neglected crisis has pushed more than 200,000 people into refugee camps in neighbouring South Sudan and displaced hundreds of thousands more within Sudan.