Fifty-four states and over one billion inhabitants, of which 70% are under 30 years old. Africa is the second largest continent on Earth, crucial for the future of the West both in terms of global health (the Covid-19 experience has taught us that we are all “connected”) and demographics (the Africa has a rapidly growing population, while the West is plagued by declining birth rates). Since it achieved independence in 1956, Sudan has been one of the areas most suffering due to internal conflicts supported by cultural, religious and economic interests which led, in 2011, to the secession of South Sudan. Being a woman today in Sudan means living in a context of extreme fragility and being exposed to violence from an early age, during one of the most serious humanitarian crises ever.
Violence against women
Giulia Bonavina, gynecologist at the Obstetrics and Gynecology Unit of the San Giuseppe Hospital in Milan, saw first-hand the critical health issues in Sudan and shined a light on this tormented country and the condition of its women (4 million are at risk according to the United Nations Fund). With a letter published last May in the scientific journal The Lancet, the gynecologist has launched an appeal to the entire international scientific community to provide healthcare and human resources to combat the devastating effects of war on Sudanese women and their childrenand ensure the protection of human rights. «The impact with Sudan was very strong, both as a woman and as a gynecologist, and precisely because of what I experienced, I decided that something had to be done and denounce violence against women internationally» says Bonavina.
Cockroaches in the delivery room
Her experience began with a first mission in 2021 when, as a specialist in Gynecology and Obstetrics at the Vita-Salute San Raffaele University, directed by Massimo Candianiwent to the African country for the first time, as part of the collaboration project between her University and the Italian Association for Solidarity among Peoples (Aispo), chaired by Fabio Ciceri. «On that occasion, when there was not yet a civil war, I started working at the old Port Sudan hospital, working in unacceptable situations, with cockroaches roaming the delivery room, women giving birth on the street after hours and hours of walking and they arrived at us in critical conditions, often victims of war rapes. I also started collecting data, which then became a study, on theimpact of genital mutilation on 500 women».
Genital mutilations
«Infibulation is a very widespread tribal practice (affecting 90% of women) in sub-Saharan Africa and my analysis, published in the journal of the American College of Obstetrics and Gynecology, showed its effects at the time of birth: causes increased risk of postpartum hemorrhage, mortality and use of episiotomy (the incision of the perineum, ed) with frequent further healing lesions that cause pain and impact on the quality of life.” Having returned from her second mission, which ended in February 2024 due to a coup d’état, Giulia Bonavina published (on Heliyon) a meta-analysis that considered more than 80 thousand women (in 14 observational studies from different countries) on risks of infibulation for female health and for the survival of newborns.
The new hospital in Port Sudan
«Before returning to Italy I visited the new maternal and child hospital in Port Sudan which welcomes the 12 thousand women a year who go there to give birth in much better conditions. Seeing the new structure and the results of the training work on hygiene procedures and practices was a source of great pride. However, there is still a lot to do regarding the conditions of women. I believe that, in this, research can be a powerful tool to denounce the violation of human rights and that the scientific institution can engage and find solutions. With my letter I wanted to shine a spotlight on the health conditions of women in Port Sudan and on the fight against the barbaric practice of infibulation. We must commit to global reproductive health” concludes the gynecologist.
The letter in «The Lancet»
«Sudan is facing its most serious humanitarian crisis since its independence in 1956 – we read in letter from Giulia Bonavina published on The Lancet -. The history of conflicts in Sudan is long and heterogeneous, ranging from foreign colonization to internal ethnic and religious disputes, including almost 20 military coups interspersed with short periods of democracy. In April 2023, during Ramadan, a new armed conflict began between two factions of the newly established military government, the Sudan Armed Forces under Abdel Fattah al-Burhan and the paramilitary Rapid Support Forces. Since, at least 9,000 people have been killed and over 9 million have been displaced within and outside the country. The fight was concentrated in the Darfur region and in Khartoum, the capital, and al-Burhan moved the seat of government to the city of Port Sudan, on the Red Sea.”
