BIRAO, CAR   At sunrise in Birao, a remote town in northeastern Central African Republic, Fayda Hussein began the long walk to the district hospital.

Pregnant with her seventh child, the 32-year-old mother left her village of Lamena 2 around 6 am, and walked for nearly an hour under the morning heat to reach one of the only functioning maternity services in the region. 

By the time she arrived, exhausted and unwell, only two medical staff were on duty. Yet the waiting room was already full, with almost twenty other soon-to-be-mothers.

“She says things have become worse,” a translator explained during her consultation. “There are fewer medical personnel now.” 

For years, women like Fayda depended on humanitarian-supported healthcare services at Birao District Hospital, where UNFPA helped provide medicines, maternity care and support for pregnant women and children. But after funding cuts linked to the broader humanitarian response, health workers say services are deteriorating just as needs continue to grow.

Fayda has seen the difference herself. She gave birth to four of her six children at the hospital and two at home when her family could not afford the journey or access care in time. In the past, she said, there were more organizations supporting the hospital.

“Before, there were NGOs taking care of the hospital, like IMC,” the translator said, referring to International Medical Corps. “But after the crisis in Sudan, and after funding cuts, some organizations left.” 

A hospital under pressure from the Sudan crisis

The conflict in neighbouring Sudan has sent thousands of refugees across the border into the Vakaga region, placing enormous strain on already fragile services in Birao. At the district hospital, health workers say consultations surged as refugees arrived at the nearby Korsi refugee site, increasing pressure on maternity wards, paediatric services and medicine supplies. 

Clara Francine Abesende, a midwife who worked in Birao for nearly a decade, recalls how patient numbers more than doubled.

“Before, we saw around 50 to 60 pregnant women a day,” she said. “After the refugees arrived, we could receive 150 to 200 women daily.” 

We met Clara not in Birao, but hundreds of kilometers away in Bangui, where she had arrived after leaving the hospital she had served since 2016. Clara said the funding cuts came so suddenly that many staff barely had time to say goodbye to their patients or colleagues. “It was very painful,” she said. “The children born in my hands are now eight or nine years old. I wanted to continue accompanying them, but I had to leave.

As needs grew, medicines began running out faster. “Antibiotics finished quickly. Malaria cases increased. There were more stillbirths and maternal deaths,” Clara said. 

Now, with humanitarian funding shrinking, women like Fayda are increasingly worried about what will happen when they go into labour.

“She is afraid there will not be enough medicine,” the translator explained. “Sometimes after consultations, she searches the neighbourhoods and markets trying to find prescribed medicines, but there is nothing.” 

Fayda says this pregnancy has already been harder than the others. She suffered from malaria, fever and repeated vomiting during her pregnancy.  “She worries there won’t be enough staff to care for her,” the translator added. 

Keeping maternal care alive in one of CAR’s most isolated regions

Health workers say those fears are justified.

At Birao District Hospital, several maternity and paediatric staff positions funded through humanitarian projects are expected to disappear following the funding cuts. Community health workers who helped connect women and refugees to care have also lost their jobs. 

Despite the challenges, UNFPA and its partners continue supporting reproductive health and maternal care services in one of the country’s most isolated and fragile regions. Midwives and community outreach workers remain critical in helping women access prenatal consultations, safe deliveries, emergency referrals and care for survivors of gender-based violence.

Clara says many women arrive late for prenatal consultations because villages are far away and insecurity still limits movement outside Birao. Mobile clinics previously travelled to remote communities to provide care, but attacks and insecurity along roads forced many of those outreach missions to stop. 

Some women never make it to the hospital at all. “There were cases where women died on the road because they could not arrive in time for a cesarean section,” Clara said.  Inside Birao hospital, Fayda waits quietly for her consultation, one hand resting on her stomach.

After six children, childbirth is not new to her. But this time feels different. “Now she is worried,” the translator said softly. “She does not know if there will be medicines, or enough staff, when the baby comes.”