“We were deciding between death on the floor or death in the streets,” said a Sudanese midwife speaking to The New York Times. She was at home with a mother who had an obstructed labor, there were no ambulances or taxis available and even if there were, many hospitals, including maternity hospitals, have been shut down because of fighting in and around Khartoum, the capital of Sudan. After several more hours of labor, they were able to find a motorcycle that could take them to a nearby clinic. Both mother and baby survived.

That was sadly not the case for a woman who spent hours at a checkpoint while her husband was interrogated by paramilitary forces. The mother survived but her baby, who was delivered breech, did not. Even before the current fighting, Sudan’s maternal mortality rate was more than 10 times that of the United States, at 270 per 100,000 vs. 21 per 100,000.

Now, expectant mothers are struggling to find care. According to The New York Times, some 60% of health care facilities are now closed, while only 20% are fully operational. Sudan’s largest maternity hospital was forced to evacuate patients and staff in April, but left behind those on ventilators and in incubators. At least nine babies died.

In one of the few hospitals still delivering babies around Khartoum, Dr. Mohamed Fath Alrahmann said that in the past month, they had more than 600 babies — 20 times the usual number. Some moms came in cars riddled with bullet holes. Meanwhile, community midwives in the area delivered about 200 babies last month — up significantly from the usual five or six. Their services are more in demand than ever.

Related
Opinion: 400 people killed. Biohazardous samples seized. Has Sudan reached its worst-case scenario?
What’s happening in Sudan?

As in all wars and other disasters, pregnant mothers and babies are among the most vulnerable.

I’ve never been to Sudan, or inside Sudanese orphanages, but I have been to multiple orphanages in African countries and have some idea what many are like. Most I’ve been in are understaffed and under-supplied, but the staff, the nannies as they are often called, do their best to care for their tiny charges. I’ve seen many orphanage workers strap a tiny baby to her back, while she feeds or changes other babies.

What happens, though, when the nannies are gone? Sudan is finding out, with at least 60 infants, toddlers and older children dead in the six weeks since fighting flared up again in Khartoum. Twenty-six died over two days last weekend. Babies are literally starving to death in the largest state-run orphanage because there simply aren’t enough people to feed them. It makes me want to get on a plane.

First reported by Reuters and then by The Associated Press, the orphanage known as Mygoma typically has around 400 children under age 5, many of them babies under 12 months old. In a country with an already high infant mortality rate, the orphanage struggles even when there’s not constant shelling. War has exacerbated the problems. Besides a lack of nannies, there is also no power, meaning there’s no cooling in a sweltering May when temperatures have reached 110 degrees outside. Babies are dying from the heat. There’s no ability to sterilize bottles or diapers. Babies are also dying from illness.

Related
Fighting continues in Sudan, more Americans are evacuated

One doctor who stayed around the clock in the earliest days of the conflict said when she was finally able to rest, she went to sleep not knowing how many dead babies she would find when she awoke. An orphanage nurse told Reuters that the repeated scenes of babies lying dead in their cribs was “terrifying” and “very painful.”

They can’t even bury the babies in the cemetery west of the orphanage, as it has become too dangerous. Last week, they buried two babies and six civilians in a city square close by. As of Monday, The Associated Press reported 341 children remaining at the orphanage: 165 infants 6 months and younger, 48 from 7 to 12 months and 128 between 12 months and 13 years old.

Nazim Sirag, who heads the local nonprofit organization “Hadhreen,” is spearheading efforts to get food, formula, medicine and volunteers into the orphanage. UNICEF and the International Committee of the Red Cross helped Sirag with his efforts. Last weekend, Sirag’s activism spurred repairs on some equipment, electrical lines and the backup generator.

Sirag and remaining staff are pleading for the children to be moved out of Khartoum to someplace safer. Or, says Heba Abdalla, a former orphanage resident and now a nurse there, “you don’t know what will happen tomorrow.”

Except we do.

Holly Richardson is the editor of Utah Policy.