The application of maternal death surveillance and review in acute humanitarian responses

Sexual and reproductive health needs and rights continue to be not only unmet but actively deprioritized in humanitarian settings. This disproportionately exacerbates inequities in maternal and newborn health, leading to increased maternal morbidity and mortality. Poor maternal health outcomes often go unnoticed in emergency settings in which competing priorities mean that monitoring maternal morbidity and mortality is frequently excluded from the initial response. The World Health Organization's MPDSR (Maternal Perinatal Death Surveillance and Review) system is a widely accepted standard for monitoring maternal morbidity and mortality; however, it is not recommended for the acute phase—defined as the first 6 months—of a humanitarian crisis because of feasibility constraints. This highlights the need for adapted approaches for surveillance and response during acute humanitarian crises. As part of its focus on reproductive health in humanitarian settings, Médecins Sans Frontières adapted the MPDSR tool for Tigray, Ethiopia, in 2020 and has since implemented the tool in Sudan after war erupted in April 2023. Although doing so has involved challenges, the results have been instrumental in informing programming, even during complex emergencies. This clinical perspective describes the Médecins Sans Frontières experience implementing a R-MDSR (Rapid Maternal Death Surveillance and Review) system in Sudan during the early stages of the escalating 2023 crisis. This commentary offers a reflective and, at times, critical account of the implementation of R-MDSR and demonstrates the feasibility and role of the tool in driving timely, action-oriented interventions to improve maternal health in fragile and conflict-affected settings.