Denied by the system: How lack of documentation blocks health access for the most vulnerable

The war in Sudan has created a humanitarian crisis far beyond the fighting itself. Displaced pregnant women and girls are among the most affected. With clinics shut down, records lost, and health workers also displaced and scattered, they have nowhere to go for routine check-ups or safe delivery support. Pregnancy has become an incredibly dangerous undertaking with serious long‑term consequences for mothers and their newborns.

Access to healthcare has become one of the most urgent humanitarian challenges for displaced women and girls in the midst of Sudan’s war. Pregnant women and girls, some of them very young and therefore especially vulnerable, face extremely fragile conditions, whether they remain inside the country, are displaced internally, or have crossed borders. Health risks intersect with social pressures and the absence of official documentation, leaving thousands without the protection and care they need.

As a result, even basic health services, including safe delivery support, are increasingly difficult to access. The loss of stability, the breakdown of support networks, and limited resources further deepen the crisis. Pregnancy, which should be a period of care and attention, instead becomes a high-risk experience with potentially serious consequences of both women and newborns.

Pregnant and displaced
When conflict erupted in Sudan, thousands of women were uprooted and thrown into uncertainty.

Among internally displaced people in Sudan, reports from UNFPA indicate that approximately 1,092,000 women and girls of reproductive age are among the more than 4.5 million internally displaced persons, of whom around 108,740 are currently pregnant and in need of essential health services such as antenatal care and safe delivery.

Some were already pregnant when they fled their homes, others became pregnant as a result of sexual violence during the chaos of displacement. Many families moved from one Sudanese city to another in search of safety, while others crossed into neighboring countries with no documents: No IDs, no passports, not even marriage certificate.

Without documentation, many cannot register at hospitals or receive regular antenatal care, despite urgent medical needs. Routine check-ups, safe delivery options, and essential medication can mean the difference between life and death for both mother and child.

Without documentation, many cannot register at hospitals or receive regular antenatal care, despite urgent medical needs.

Pregnant women without proper medical care face serious risks. Conditions such as anemia, hypertension, and infections often go undetected, and when the time for delivery arrives, the absence of professional assistance can turn an already difficult moment into a life-threatening emergency.

Different categories, unequal risks
Across these circumstances, different categories of pregnancies emerge. While all pregnant women face barriers, the degree of restriction and the complexity of challenges vary depending on whether they are internally displaced, living in conflict-affected areas, crossing borders, or underage girls without recognition.

As displacement continues, countless women are forced to give birth at home, alone or with the help of untrained neighbors, without sterile equipment or medical supervision. Inside Sudan, the situation is even more challenging. Weakened health services, shortages of medical supplies, and limited availability of care make it extremely difficult for pregnant women to find the support they need. In addition, the lack of documents often forces women to pay high fees for services that would normally be free. Unable to afford these costs, many women spend their entire pregnancy without any medical follow-up.

As displacement continues, countless women are forced to give birth at home, alone or with the help of untrained neighbors, without sterile equipment or medical supervision.

For those who crossed into neighboring countries, the risks are different. Many feel unsafe seeking healthcare due to insecure legal or security status, leading them to rely on home delivery, even though they are aware of the severe medical dangers of giving birth without professional assistance.

Among them are girls under the age of 18 who are still children themselves, yet are forced to face pregnancy and motherhood alone. According to UNICEF’s report Children reported among survivors of rape during Sudan’s violent conflict, 221 rape cases against children were documented in Sudan since the beginning of 2024, with 66% of survivors being girls. Many adolescent survivors were left coping with unwanted pregnancies as a consequence of sexual violence. According to UNFPA’s report Sudan: Rape survivors and pregnant women cut off from life-saving services as funding collapses, around 12.1 million people in Sudan—nearly one in four, most of them women and girls—are now at risk of gender-based violence, often resulting in unintended pregnancies and severe psychological trauma. Social stigma and shame further isolate survivors and prevent many from seeking the support they need.

Their experiences highlight an important reality: access to healthcare is not just about the presence of hospitals or clinics, but also about the ability to safely reach and use services during displacement and instability. Understanding the distinctions between women in these different situations underscores the urgent need for practical solutions that ensure essential maternal care for all.

The forgotten children
For many newborns in Sudan, survival begins at birth. Some are born without fathers or legal documents, making it nearly impossible to obtain a birth certificate, a simple paper that determines whether a child is officially recognized, can access medical care, and follows the vaccination schedule that protects their life.

Vaccinations are vital, yet conflict and weak health services often prevent mothers from completing them. Many displaced families leave behind records, further limiting newborns’ access to care.

"I have been trying since my daughter’s birth to obtain a birth certificate for her but could not. When I went for a vaccination, which I thought was free, it was not, and they asked me to pay a large amount. I had no choice but to give up."

                                    Lebaba, a mother of a two-year-old daughter

For families in neighboring countries, lost documents and unclear vaccination histories create challenges in registering children. Health workers try to help, but missing records cause confusion and children risk missed or repeated doses.

A call for flexible health systems
In communities affected by conflict, NGOs continue to provide life-saving health services for displaced families. Yet, despite their efforts, many mothers and children still face barriers simply because they lack documents. Some neighboring countries have shown generosity in hosting displaced populations, but their health systems were not built to handle large-scale displacement, making access to care often dependent on paperwork rather than actual need. As a result, many families remain deprived of maternal and child healthcare.

Health programs must adapt: Health is a right, not a privilege. Humanitarian agencies, the Sudanese government, and local clinics can make meaningful changes by:

• Providing safe maternal and child healthcare without requiring official documents.
• Including undocumented families in vaccination and outreach campaigns.
• Training health workers to deliver confidential, trauma-informed care for survivors of sexual and gender-based violence (SGBV).
• Strengthening partnerships between NGOs, local communities, and the Sudanese Ministry of Health.

This blog post is written by Rayan Ibrahim. She is a Sudanese nursing graduate and humanitarian caseworker with extensive experience in social and protection programs. She has worked with several non-governmental organizations, including Médecins Sans Frontières (Doctors Without Borders), Save the Children, and St. Andrew’s Refugee Services, supporting displaced and vulnerable communities. Her academic and professional background has shaped her interest in education, social development, and fostering resilience among youth affected by conflict and displacement.