Khartoum, 4 December 2023 — As the war in Sudan enters its eight month with no end in sight, widespread conflict-related sexual and gender-based violence (SGBV) has continued unabated, including reports of mass rapes, sexual exploitation and sexual harassment which demonstrate how sexual violence is being used as a tool of war to subjugate, terrorise and punish women and girls. Since the war between Sudan’s Rapid Support Forces and the Sudanese Armed Forces erupted on April 15th, reports of ethnically targeted sexual and gender-based violence have escalated across Sudan, leading to a surge in unplanned pregnancies and sexually transmitted infections. The International Criminal Court (ICC) in The Hague said in July it is investigating the hostilities in Darfur, including reports of killings, rapes and crimes against children. Rape has often been used as a weapon of war over the years in Sudan, human rights groups have said. Sexual violence is prohibited in conflict, and the accounts of rape could constitute war crimes and crimes against humanity. The prevailing conflict and social unrest in various regions of Sudan have created an environment rife for SGBV, leaving countless individuals exposed to the gravest violations of their most intimate rights. Deeply disturbing accounts of gang rapes, sexual assault, harassment, and other forms of sexual, physical and psychological violence have emerged, highlighting the urgent need for comprehensive sexual and reproductive healthcare for survivors. IPPF’s local member association in Sudan, the Sudan Family Planning Association (SFPA) has been providing these services across Sudan since the outbreak of the war, including counselling, medical assistance, and referrals for survivors of SGBV. Despite unprovoked attacks on six SFPA facilities which have so far killed one youth volunteer and injured numerous clients and staff, as well as interrupted the delivery of some health services, SFPA has continued to work in conflict-affected areas through their large network of community based distributors and mobile clinics. Dr Seham Jaber, the director of Digital Health Interventions and Services at SFPA said:  “We have noticed escalating rates of sexual and gender-based violence in Sudan since the outbreak of the war in April. Violence against women and girls is occurring at the hands of militants, as well as an increase in domestic and intimate partner violence, including rape. Young girls and boys are living in overcrowded shelters are reporting to us cases of sexual harassment and abuse." Confidentiality, sensitivity and compassion are crucial to SFPA’s work, because many survivors of sexual violence don’t seek medical treatment due to the fear of social stigma and reprisals. SFPA's website and hotline have seen a considerable increase in traffic for reports of SGBV from the community since the start of the war. In response, SFPA is also running community awareness and education campaigns on SGBV, and is enlisting the support of local Imams to promote gender equality, and foster a culture of respect and consent. For media inquiries or to speak to one of our staff in Sudan, please contact [email protected]  About the Sudan Family Planning Association The Sudan Family Planning Association (SFPA) was established in 1965 by pioneers in obstetrics and gynecology in response to increases in maternal, neonatal and infant mortality and morbidity. Sudan is a country in great need of frontline sexual and reproductive health (SRH) services. In 2022, SFPA provided 26 million services through 24 clinics, 261 associated clinics, and 37 mobile clinics. Since the start of the war on 15 April 2023; the Association teams have been successful in providing 14,706,000 services through 24 SFPA facilities , mobile clinics, mobile teams ,CBDs and partners clinics . SFPA was able to assist 1,145 deliveries under bombardment and provided 167,000 treatments of HIV&AIDS “HIV screening and care for PLHIV” through its static clinics. Mobile clinics are used to offer integrated SRH services including HIV/STI services and condom distribution, STI testing and management, HIV testing and treatment for HIV opportunistic infections, referrals for ARV treatment including PMTCT and awareness sessions both at mobile clinics and at the community level by community health promoters and community base distributors (CBDs). About the International Planned Parenthood Federation  IPPF, through its 149 Member Associations and collaborative partners, delivers high-quality sexual and reproductive healthcare and helps advance sexual and reproductive rights, especially for marginalized people with diverse needs that are currently unmet. IPPF's Member Associations and partners are locally owned, independent organisations, which means the support and care they provide are informed by local expertise and context. IPPF advocates for a world where people have the information they need to make informed decisions about their sexual and reproductive health and their bodies. We stand up and fight for sexual and reproductive rights and against those who seek to deny people their human right to bodily autonomy and sexual and reproductive freedom. We deliver care rooted in rights, respect, and dignity for all - no matter what.

The below is a joint press release between Amnesty International, the International Planned Parenthood Federation, MSI Reproductive Choices, the International Federation of Gynecology and Obstetrics (FIGO), International Confederation of Midwives and Ipas. People who are defending the right to abortion and providing essential services are being stigmatized, intimidated, attacked and subjected to unjust prosecutions, making their work increasingly difficult and dangerous to carry out, said Amnesty International in a new report out today. The report, An Unstoppable Movement: A global call to recognize and protect those who defend the right to safe abortions, reveals how many healthcare workers, activists, advocates and accompaniers around the world face abuse, arrest, prosecution and imprisonment for supporting the right of women, girls and people to access abortions. Such an environment is prevalent including in countries where abortion is partially allowed by law. It is having a chilling, silencing and stigmatizing effect on all those defending access to abortion, as they live in constant fear of being attacked and prosecuted for providing abortion care, whether it is legal or not. It is also creating major barriers for women, girls and people who need abortion care – particularly those who are most marginalised. “The right to abortion is not an opinion. It is a matter of international standards and international legal norms. It is a right underpinned by many human rights, including the rights to physical and mental integrity, the right to health and the right not to be unlawfully and arbitrarily killed through the withdrawal of safe services. It is essential for the dignity of all women and girls, and of everyone who can become pregnant. Those who defend and enable exercise of that right deserve our respect and protection. Yet, many States around the world persist with policies of over-regulation and criminalization that generate hostile, even perilous environments for those who defend the right to abortion,” said Agnès Callamard, Amnesty International’s Secretary General. “Anti-abortion rhetoric, policies and laws stamp a target on the backs of health workers and advocates. Stigmatized, abused, discriminated against, criminalized, imprisoned, even killed - the rights of those who defend the right to abortion are under attack. But their human rights to work without fear, to provide essential services without threat, to exercise their professional skills without discrimination, must be respected and protected.” Isolated and unsupported While progressive abortion law reform continues, anti-abortion regressions impede access with the promotion of disinformation and toxic narratives - smear campaigns that hijack public discourse and agitate against the right to abortion and against those who defend it. “For many sexual and reproductive health providers this harassment and abuse has come to feel like just part of the job, but we cannot allow this to become the new normal,” said Sarah Shaw, MSI Reproductive Choices’ Head of Advocacy. “Enough is enough. It’s time to recognise abortion providers as human rights defenders and stand up for those who put their lives on the line to make choice possible.” Throughout the report, based on more than 40 interviews with abortion rights defenders from all over the world and with the support of global healthcare and grassroots organizations, people defending the right to abortion, particularly healthcare workers, explained how they often feel isolated and unsupported. Their work is not recognised, and they are left fearing the threat of criminalization, harassment, stigmatization, verbal threats and violence, as well as ostracization and burnout in the workplace. Some health workers have seen their personal details leaked online, while others are unsure whether they’ll make it home safely. For example: Venezuelan teacher and human rights defender Vannesa Rosales was criminalized for helping a woman and her 13-year-old daughter get access to abortion. In Poland, Justyna Wydrzyńska, a member of Abortion Without Borders and the Abortion Dream Team, was convicted for helping a woman access abortion pills earlier this year - a safe way of terminating a pregnancy. In Ghana, an advocate for sexual and reproductive rights said service providers have experienced physical violence and public shaming by members of the public, for educating people about contraception. “Violence against frontline sexual and reproductive health care providers is something that continues to happen unabated; it's about time the voices, experiences and concerns of our frontline defenders are heard,” said Alvaro Bermejo, International Planned Parenthood Federation’s Director General. “As anti-abortion authorities around the world continue to deploy stigma, fear and hate-speech against those seeking and those providing services, we, as institutional champions of sexual and reproductive health and rights, commit to matching the courage of our frontline defenders.”

15 November 2023 - With the forced closure of Gaza’s largest hospital, Al Quds, due to the lack of fuel and incessant Israeli bombardment, and the recent storming of al-Shifa Hospital by Israeli forces, midwives are a lifeline for the estimated 180 women who are giving birth each day.  As of 13 November, all but one of the hospitals in Gaza City and northern Gaza are reportedly out of service due to lack of power, medical consumables, oxygen, food and water, compounded by bombardments and fighting in their vicinities, according to OCHA. 26 year old Narmeen Al Shafee is a midwife currently living in Deir al-Balah in central Gaza, who has previously worked with the Palestinian Family Planning and Protection Association (PFPPA) outreach team. She describes the case of a 29-year-old pregnant woman who fled along with her family from Sheikh Radwan to Deir al-Balah to seek refuge in a school shelter near her home. The women was in her ninth month of pregnancy and not long after being displaced from her home she underwent a cesarean section. Midwife Al Shafee said: “After giving birth, and for her own safety, the shelters did not want to accommodate her due to the widespread infectious diseases and [the] high risk of infection since she had a cesarean section. Her husband was calling out in the streets for someone to receive his wife and three children. My parents welcomed them into our home to take care of her. I would change her bandages daily and monitor her and her child. After ten days, I removed the stitches. Thank God, her condition is now stable, and there are no problems.” In a separate case, Al Shafee describes caring for her 23-year-old cousin who was pregnant for the first time and lost her husband early in the war. “Her delivery date was approaching, and she gave birth at Nasser Hospital in Khan Younis [in southern Gaza]. Her child faced complications during birth, and due to the bombings she sought refuge with us. I took care of her and her child until their situation stabilized. Now, I am helping her with breastfeeding, as she is finding it difficult.” Aminah*, another midwife who has also previously worked with the PFPPA outreach team, said: “I’ve been in contact with two pregnant women multiple times, providing weekly consultations. One woman experienced severe cramps, and after offering advice, she was referred to the hospital. She needed lung maturation injections for the fetus, along with rest and nutritional supplements and iron. Another woman, 29 weeks pregnant, suffered dizziness and vomiting and she took Ancozine [an antiemetic] for nausea during the visit. I also found out that she was taking iron and provided her with information on the correct way to take iron tablets in order for her to benefit from them as needed. I am also providing information to women in my area and around me hoping that it will help them if and when needed.” According to data from the UNFPA, there are an estimated 50,000 pregnant women in Gaza, with 15% expected to encounter complications. In many instances women are only admitted to hospital when they are fully dilated, with some forced to deliver their babies in cars, in the streets, and in overcrowded shelters where the risk of infection and the spread of disease is high. There are reports of c-sections bring performed without anesthesia, and there is currently no type of post natal care available in Gaza.  Levels of early labor and miscarriages are expected to increase with the trauma and conditions being faced.  Al Ahli Hospital, in Gaza City, which currently accommodates over 500 patients, is reportedly the sole medical facility able to receive patients, amid increasing shortages and challenges. In Shifa hospital, 32 patients, including three premature babies, have reportedly died since 11 November, following the power cut and amid dire conditions. Without a full and immediate ceasefire, and the unimpeded delivery of humanitarian aid across all parts of Gaza, maternal and neonatal deaths will continue to rise. For media enquiries, or to speak to our staff member in Palestine, please contact [email protected] Click here to donate to IPPF's emergency appeal for Palestine. About PFPPA Established in Jerusalem in 1964, the Palestinian Family Planning and Protection Association (PFPPA) is locally registered as an independent, non-profit and non-governmental association with headquarters in Jerusalem. PFPPA has service delivery points located in the West Bank Areas of Ramallah, Bethlehem, Hebron and Halhoul, in addition to one in the Gaza Strip, which has yet to be relocated after it was destroyed following an Israeli airstrike on 8 October. Furthermore, and in cooperation with local partners, PFPPA is also responsible for 3 safe spaces to provide Gender Based Violence (GBV) related services in the Jerusalem area. About the International Planned Parenthood Federation IPPF, through its 149 Member Associations and collaborative partners, delivers high-quality sexual and reproductive healthcare and helps advance sexual and reproductive rights, especially for marginalized people with diverse needs that are currently unmet. IPPF's Member Associations and partners are locally owned, independent organisations, which means the support and care they provide are informed by local expertise and context. IPPF advocates for a world where people have the information they need to make informed decisions about their sexual and reproductive health and their bodies. We stand up and fight for sexual and reproductive rights and against those who seek to deny people their human right to bodily autonomy and sexual and reproductive freedom. We deliver care rooted in rights, respect, and dignity for all - no matter what. Banner image: Midwife Narmeen Al Shafee provides care to a newborn baby in Deir al-Balah, in central Gaza. 

Today marks one month since Hamas launched its attack on civilians that triggered Israel’s declaration of an unprecedented war in the Gaza Strip, and a subsequent humanitarian catastrophe. Since 7 October, some 1,400 Israeli civilians have been killed, 200 hostages taken, and thousands injured, according to the Israeli authorities. In Gaza, over 10,000 people have been killed, the vast majority of whom are women and children. IPPF echoes international demands for an immediate and full ceasefire to prevent further atrocities. The continued bombing and rockets will make it virtually impossible to distribute any aid to civilians. In addition to the immediate need for fuel, water, food, and medicine for civilians in Gaza, the urgency of sexual and reproductive health care needs must not be overlooked. Alvaro Bermejo, IPPF Director General said: “Our colleagues in Gaza are currently sheltering for their lives, yet still delivering sexual and reproductive healthcare in any way they can amid appalling conditions. For 30 days, bombs have been falling across Gaza, leaving behind devastation and destruction unlike anything we have dealt with before as a Federation. In the absence of a full ceasefire, we are gravely concerned for the lives of our colleagues, civilians, and humanitarians who are desperately trying to deliver aid inside Gaza.” Insufficient supplies, resources and equipment for sexual and reproductive health and rights were already a pressing issue in Gaza, which has been under Israeli occupation and blockade for decades. Since 7 October, thousands of Palestinian mothers and children have been killed, marking a recurring stifling of reproductive justice in the region. Pregnant women are miscarrying due to stress and shock, and the availability of medical facilities to birth safely is now virtually non-existent. Women and girls are reporting a severe lack of menstrual hygiene products and contraceptives, and a rise in cases of sexually transmitted diseases and urinary tract infections with little to no medical treatment available. Without a full and immediate ceasefire, we can expect to see this vicious cycle continue, with thousands more maternal and newborn deaths. On top of this, we will see a rise in unintended pregnancies, the spread of sexually transmitted infections including HIV, and a rise in psychological trauma and conflict-related sexual violence, all of which will have long-term, generational impacts. We echo calls by the UN Inter-Agency Standing Committee to establish a robust aid operation in a safe and peaceful context. Gaza needs a coordinated effort that meets the urgent needs of all its people, including the particular sexual and reproductive healthcare needs of women, girls and vulnerable groups. There are no justifications for war crimes or grave violations of international humanitarian law, regardless of who commits them or against whom they are committed. We reaffirm that all people have the right to access emergency sexual and reproductive healthcare, no matter where, and no matter what. IPPF calls for an immediate ceasefire to end the violence, deaths and suffering of civilians in Israel and Palestine. This ceasefire is an essential precursor towards a path to peace with justice.   For media enquiries, or to speak to our staff member in Palestine, please contact [email protected] Click here to donate to IPPF's appeal for Palestine.   About PFPPA Established in Jerusalem in 1964, the Palestinian Family Planning and Protection Association (PFPPA) is locally registered as an independent, non-profit and non-governmental association with headquarters in Jerusalem. PFPPA has service delivery points located in the West Bank Areas of Ramallah, Bethlehem, Hebron and Halhoul, in addition to one in the Gaza Strip, which has yet to be relocated after it was destroyed following an Israeli airstrike on 8 October. Furthermore, and in cooperation with local partners, PFPPA is also responsible for 3 safe spaces to provide Gender Based Violence (GBV) related services in the Jerusalem area.   About the International Planned Parenthood Federation IPPF, through its 149 Member Associations and collaborative partners, delivers high-quality sexual and reproductive healthcare and helps advance sexual and reproductive rights, especially for marginalized people with diverse needs that are currently unmet. IPPF's Member Associations and partners are locally owned, independent organisations, which means the support and care they provide are informed by local expertise and context. IPPF advocates for a world where people have the information they need to make informed decisions about their sexual and reproductive health and their bodies. We stand up and fight for sexual and reproductive rights and against those who seek to deny people their human right to bodily autonomy and sexual and reproductive freedom. We deliver care rooted in rights, respect, and dignity for all - no matter what.  

Shelter conditions in Gaza for the estimated 1.4 million internally displaced people have become dire, with women and girls reporting a severe lack of menstrual hygiene products, cases of sexually transmitted diseases and urinary tract infections with little to no medical treatment available in the severely overcrowded shelters. Contraception is in very short supply, and according to our local team sheltering and providing services in Gaza, women are sharing contraceptive pills. Women with intrauterine contraceptive devices (IUDs) are experiencing bleeding and infections due to the unhygienic conditions in the camps. There are currently no options for IUD removal in Gaza, posing long term risks to women’s reproductive health, including severe bleeding. On 25 October, the UN said that fuel in Gaza could run out within hours, and that hospitals in the Gaza Strip are taking emergency cases only, which will prevent many women and girls from seeking sexual and reproductive health care. If Israel continues to block humanitarian aid including safe delivery kits from entering Gaza, many of the estimated 50,000 pregnant women[1] in Gaza will have no safe place to give birth, with at least 15% likely to experience complications[2], further compromising already stalled progress in reducing the rates of maternal morbidity and mortality. Wafa Abu-Hasheish, a health worker at PFPPA in Gaza said: “The shelter is suffering from a shortage of water, lack of medical care, and an increase in the incidence of diseases such as influenza, chest infections, skin ulcers, scabies, lice, and diarrheal diseases, and girls and women are reporting menstrual disturbance. There are also cases of sexually transmitted infections and urinary tract infections. Women using contraceptive pills are sharing their supplies with others." The number of internally displaced persons (IDPs) in Gaza is currently estimated at around 1.4 million (more than half the population), with a large part of that population living in overcrowded and under-supplied shelters with food, water, and fuel running out – and basic and life-sustaining services becoming more inaccessible by the hour. The mental and physical health toll on local health workers in Gaza is immense. Abu-Hasheish added: “On a personal level, being the service provider and being present in the shelter has caused me several psychological problems, stress, and fear. I also suffer problems such as neck ache and back muscle tension due to the inability to sleep or sit properly. I have contracted a flu and developed excessive breathing difficulties, but there is a lack of available treatment for displaced people due to the high number of patients and the scarcity of medicines. I had to go home for rest and relaxation, despite the dangers and lack of safety at home. Ammal Awadallah, the Executive Director of the Palestinian Family Planning and Protection Association (PFPPA) said: "If pregnant women are lucky enough to reach a health center or hospital, they are only admitted when they are fully dilated. And they must leave the hospital within three hours after delivery, due to overcrowding in hospital facilities, lack of space and resources. “Women are forced between choosing privacy and a clean space in their own homes, where they still stand, or shelters with dire conditions. It is choosing between the different evils. There is no safe place in Gaza.” For media enquiries, or to speak to our staff member in Palestine, please contact [email protected] Click here to donate to IPPF's appeal for Palestine. About PFPPA Established in Jerusalem in 1964, the Palestinian Family Planning and Protection Association (PFPPA) is locally registered as an independent, non-profit and non-governmental association with headquarters in Jerusalem. PFPPA has service delivery points located in the West Bank Areas of Ramallah, Bethlehem, Hebron and Halhoul, in addition to one in the Gaza Strip, which has yet to be relocated after it was destroyed following an Israeli airstrike on 8 October. Furthermore, and in cooperation with local partners, PFPPA is also responsible for 3 safe spaces to provide Gender Based Violence (GBV) related services in the Jerusalem area. About the International Planned Parenthood Federation IPPF, through its 149 Member Associations and collaborative partners, delivers high-quality sexual and reproductive healthcare and helps advance sexual and reproductive rights, especially for marginalized people with diverse needs that are currently unmet. IPPF's Member Associations and partners are locally owned, independent organisations, which means the support and care they provide are informed by local expertise and context. IPPF advocates for a world where people have the information they need to make informed decisions about their sexual and reproductive health and their bodies. We stand up and fight for sexual and reproductive rights and against those who seek to deny people their human right to bodily autonomy and sexual and reproductive freedom. We deliver care rooted in rights, respect, and dignity for all - no matter what. [1] Source: UNFPA [2] Source: MISP

An estimated 19,000 pregnant women are part of the 1.1 million residents forced to flee from northern Gaza due to Israel’s evacuation order on 13 October, with no safe place to give birth. Women are miscarrying pregnancies due to stress and shock, and the availability of medical facilities to birth safely in Gaza’s already overwhelmed healthcare system is rapidly dwindling. Wafa Abu Hasheish, a healthcare provider with the Palestinian Family Planning and Protection Association (PFPPA), an IPPF Member Association, has been providing medical aid to residents of her neighbourhood in northern Gaza where she has been sheltering since 10 October, three days after Israel declared war on the Gaza Strip. She said: “I have dealt with two suspected cases of miscarriages already, where there was no movement for the foetus and the mother had hypotension, bleeding and back pain. There has been one case where a woman was referred to where I am staying, since they knew I was a health service provider in the neighborhood. The woman was 8 months pregnant and was suffering from severe labor pain and was having a premature birth. We were very fortunate that when she reached me that we were able to refer her to a health center in time to be able to give birth safely." Even if the delivery of limited amounts of aid is allowed into southern Gaza, as was reported on 16 October, it remains unclear exactly how this aid will reach the more than 9,600 injured and the nearly 600,000 internally displaced people in central and southern Gaza[1] who are living in increasingly dire conditions. It has also been reported that the aid will not be distributed into northern Gaza, where 1.1 million residents have been ordered to evacuate ahead of a likely Israeli ground invasion. Ammal Awadallah, Executive Director of PFPPA, said: