To mark International Day of the Midwife as Médecins Sans Frontières, we’re shining a light on the role of midwives as frontline emergency responders.
Midwives are essential to prevent and resolve obstetric emergencies, but also indispensable in responding to humanitarian emergencies. They are central to not only providing lifesaving care but also to be “with woman” as the name ‘midwife’ signifies, accompanying women’s and adolescent girls in their diverse, and often amplified, health needs.
When midwives are embedded in health systems, they could prevent more than four in five of all maternal deaths, stillbirths and neonatal deaths, according to the World Health Organization. But these often preventable deaths are not experienced evenly around the world. Nearly two in three maternal deaths—those due to complications of pregnancy or childbirth, up to 42 days after the pregnancy ended—and the ramifications of that loss are borne in countries affected by conflict or considered fragile.
Integrating midwifery from the onset
The ongoing civil war in Sudan has destroyed infrastructure, caused indiscriminate loss of life, decimated livelihoods and displaced nearly 14 million people. As a result, people are often left trying to survive in the face of escalating health risks. But women will always need safe pregnancy care and delivery care—it cannot be an afterthought in the humanitarian response.
Blessing Odagwe is a midwifery activity manager coordinating outreach activities from the MSF-supported Nyala Teaching Hospital in South Darfur. She and her team travel hours by road to support health centre midwives and the remote communities that rely on them, although insecurity in the Nyala area remains a major challenge to maintaining their routine.
A key focus of their outreach is capacity-building, often through on-the-job training. “If we don’t have skilled birth attendants in the community, there will be an increase in maternal and newborn death,” says Blessing, who first worked with MSF in Nigeria. “So I train [local midwives] in normal delivery, postpartum haemorrhage, postnatal complications both for mother and baby, how to identify danger signs in mothers and babies, and making prompt referral for those cases that we cannot manage in the primary healthcare centres.”
When a woman “arrived during the course of our training in labour. I used that as a scenario to train the midwife,” recalls Blessing. “At the end of the day, the mother named the child after me, saying, ‘your presence made a difference’. For me, that is not a personal recognition, but a reflection on the impact MSF is making in the community by creating a positive outcome for many families.”
Many midwives who work with MSF are also part of the affected community.
MSF’s team in Tawila in North Darfur includes Zoubeida, originally from Zamzam. Displaced first to El-Fasher, she undertook an exhausting and painful trek to reach Tawila, destination of more than half a million people newly displaced in 2025.
After finding support for essentials such as food and water, she joined MSF as a midwife and now provides rare care to pregnant women and newborns in the middle of one of Tawila’s displacement camps.
Women-led and women-centred
Midwifery is a women-centred healthcare profession and service—exclusively so in Afghanistan, where sexual and reproductive health services for women can only be provided by women. Yet the future of those services and women’s health is threatened due to women being banned from education beyond primary school. Afghanistan ranks among the top 10 countries worldwide for maternal mortality and the top five for neonatal mortality, according to the most recent estimates for 2023.
Maryam Saidy joined MSF as a medical translator in Khost maternity hospital in the country’s east in 2012. Inspired by seeing midwives at work and the impact of their care, she retrained as one herself. Employed as a midwife outreach supervisor at first, she is now the hospital’s midwife activity manager, supervising a team of 150 midwives, midwife supervisors and midwife aides.
“I’m responsible to check that the patients and the midwives, the staff who are working under me are in a safe environment, and that the patients are receiving quality of care and their own rights,” says Maryam.
In Khost, MSF’s hospital focuses on treating patients with obstetric complications “who come here in a very critical situation,” says Maryam. “They come already in active labour and most of them have severe bleeding. When the mother comes in, it is the midwife who is the first person to answer this mother’s call for help. We take her direct to ICU, we pass IV lines, we call the ‘gynaes’ (obstetrician-gynaecologists), the anaesthesia team and we try our best to save this mother as soon as possible, because the whole family is worried about this mother and the newborn.”
A holistic approach in supporting women’s health
Care for sexual and gender-based violence and provision of safe abortion care are inseparable from responding to women’s health needs in emergencies and conflict. They are lifesaving healthcare, evidence-based and grounded in humanitarian principles, and midwives are at the forefront of enabling a respectful person-centred approach to both.
Sexual violence is frequently used as a weapon of war, a form of torture, or a tool of intimidation and control. Stripped of the security of the life they’ve left behind, women and girls face the risk of violence on their displacement journey and where they seek refuge as well.
Between January 2024 and November 2025, MSF treated more than 3,396 survivors of sexual violence in South and North Darfur alone. More than 90 per cent of those survivors in North Darfur were assaulted while traveling between towns to reach safety. Women in South Darfur reported being assaulted while collecting firewood, water or searching for food, while working in fields or travelling to farmland.
MSF research in fragile and conflict‑affected settings shows that abortion-related complications can be five to seven times more severe than in stable settings. The contributing factors are always the same: delays in care, stigma, lack of contraception and safe abortion services.
It is often midwives who drive the launching and sustaining of these areas of care, unflinchingly advocating for the women and girls they have seen as patients, and the wider community.
Midwives’ call to action
Despite their important role, and the evidence of their impact, there are simply not enough midwives available where they are needed most. Not surprisingly, midwives themselves are quick to identify the benefits that more midwives would bring.
For Maryam in Khost, two midwife activity managers would mean one could be doing all the office work and management: “the rosters, the gap-filling…the training plan, capacity building…the feedback”. The other would be “working in the hospital near to the patients and to the staff, present with them in the complicated and critical cases which they are managing.”
For Ygline Saint Clair, a midwife providing sexual violence care in Cite Soleil, Haiti, another Ygline would mean a shorter waiting time for survivors, and more opportunity to raise awareness about seeking early care.
Kate points out there are decision-making gaps. To ensure that women’s and girls’ health needs are prioritised in any emergency response, we need more midwives involved in setting up emergency health programs.
