Obstetrician Grace Kodindo is known across the world for her fight to stop women dying unnecessarily in pregnancy and childbirth. The 2005 BBC film ‘Dead Mums Don’t Cry’ filmed her work in Chad, on the Sahara’s edge.

She’s been working for some time with the Ministry of Health and NGOs to improve health care for people affected by war in Democratic Republic of Congo (DRC). Now she’s trying to find out what reproductive health services are available in North Kivu, a war-torn region in the east of the country.

Grace and Yvonne Salama.

Grace aims to meet people affected by the fighting. She’s in for a shock. She’s seen what neglect can do to women – but not yet active combat. Nineteen-year-old Yvonne Salama was attacked by soldiers as she made her way to her parents’ field.

"They dragged me to the forest and raped me. I hid myself away because I didn’t want anyone to know. Only when I found I was pregnant did my parents send me to the clinic."

In the Rwanguba Health Zone, things are not yet back to normal, but the damaged health centres and clinics are starting to function. Dr Serge Ilunga is a brave man. He stayed at his post amid the worst of the war.

"The main health impact of the war is rape and sexual violence," he says. "Many women fled into the bush. So they didn’t give birth in hospitals. Many mothers died along with their babies."

In conflict zones women in labour are unlikely to make it to a qualified doctor – much less a hospital. So they have to rely on a Clean Delivery Kit provided by the agencies, which consists of a sterile plastic sheet, soap, gloves, some tape and a razor. For a woman giving birth while on the run – far from any available health care – it can reduce the chances of infection for her and her baby. And for some, it can make the difference between life and death.

Grace visits a camp for people displaced by the fighting.

The hospital where Dr Ilunga works also stocks another life saver: ‘PEP kits’. 'PEP' is post-exposure prophylaxis' and the kits contain antibiotics for prevention of sexually transmitted infections, antiretroviral drugs (ARVs) for prevention of HIV infection, and the emergency (post-coital) pill against unwanted pregnancies.

Grace sets off to look at conditions further off the beaten track. All along the way, signs of the fighting that’s taken the lives of five and a half million people within a decade. The Congolese army has fought its way against half a dozen or more rebel militias. Only recently has the UN brokered a fragile peace with 17,000 blue helmets on the ground.

Grace is keen to meet people who’ve returned since the fighting subsided. Their stories are a poignant reminder of why reproductive health care is such a critical need in conflict zones. She meets two couples: both gave birth while fleeing the conflict.

One of the big camps for refugees from the fighting.

Esther gave birth while she was on the run – without the emergency delivery kit. Her baby died soon after. Claudine Maombi was luckier - her husband was able to hang on to their clean delivery kit as they fled. He delivered the baby himself – and the child survived.

"It’s very rare that a husband delivers his wife. Especially in Africa. This is my first time to hear about that," says Grace. "They had a clean delivery kit which helps prevent tetanus which is one of the most common causes of neo-natal death, or even maternal deaths from tetanus."

Grace meets another family - a couple with 12 children, who fled during the fighting and have now come back. "Now both the husband and wife want to limit their children now – but don’t know where and how. So this is a typical case of unmet need for family planning."

Mass rape has become a weapon of war in the Congo. Martha Mawazo’s world was turned upside down as she fled the conflict. Her husband and their four children were with her.

As a result of the rape, Marthe was left pregnant, infected with gonorrhoea, and alone with four children with no roof over their heads. Some villagers lent her the use of an old house.

Says Grace: "The story of this poor woman with her four children, and the fifth on the way, can just conclude the whole tragedy that people in this area of conflict are going through. Now she finds herself with a sexually transmitted infection, and a pregnancy, with no means to live on. It’s really unjust for one person to go through this whole tragedy."

Faced with the sheer scale of sexual violence against women, the clinics here offer therapy, or psychosocial programmes, to help repair broken lives, where women can learn to sew which can also help them earn a living.

The makeshift health centre in Katsiru serves nearly 18,000 people. The clinic has no clean delivery kits, almost no condoms and only one type of contraceptive pill, Ovrette, which is often given to women who are breastfeeding.

With so many displaced people, the clinic is struggling to cope. Women in labour have to share a room with people with all kinds of diseases.

Grace with survivors of rape and their children.

Nearby, Grace meets a group of women whose children are all the product of sexual violence. Twenty five year old Oriva Zamkunda was left pregnant after a group of soldiers raped her. She explains: "When my husband found out, he threw me out of the house. I ran away."

When she gave birth, there were complications, but she was fortunately sent to a hospital for a caesarian.

Grace comments: "Twenty per cent of the population are living in the camps, but the large majority are living outside the camps. They have no access at all to services that can help save their lives. So this woman is really one of the luckiest. How many of you were abandoned by your husbands as a result of being raped? Out of the 60 victims of rape that are here today, 58 of them have been abandoned by their husbands. Only two are still with their husbands."

Back in Katsiru, a woman has given birth. Any complications would have meant a four-hour trek on a stretcher to a clinic.

Simple and inexpensive drugs, such as magnesium sulphate for convulsions or antibiotics to treat infections, as well as simple supplies – like needs and syringes – would allow the health centre to treat some of the complications without needing to refer women with complications to a hospital.

Soldiers being sentenced for rape at a roadside court martial.

By chance, Grace comes across a roadside court martial. A group of soldiers and their officers stand accused of raping and terrorising civilians. The symbolism does not escape some local women. They’ve been waiting all day to witness the scene. Women in the world’s conflict zones need medical help. And they also need justice.

Says Grace: "This is a real sign of hope. By far the biggest casualties of this conflict are civilians – not the fighters. And the women and children suffer the most – their need is the greatest. Reproductive health care must be seen as a frontline priority – not something to think about only after the fighting is over."

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