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WASHINGTON — One woman miscarried in the lobby restroom of a Texas emergency room as front desk staff refused to check her in. Another woman learned that her fetus had no heartbeat at a Florida hospital, the day after a security guard turned her away from the facility. And in North Carolina, a woman gave birth in a car after an emergency room couldn’t offer an ultrasound. The baby later died. Complaints that pregnant women were turned away from U.S. emergency rooms spiked in 2022 after the U.S. Supreme Court overturned Roe v. Wade, federal documents obtained by The Associated Press reveal. The cases raise alarms about the state of emergency pregnancy care in the U.S., especially in states that enacted strict abortion laws and sparked confusion around the treatment doctors can provide. "It is shocking, it’s absolutely shocking," said Amelia Huntsberger, an OB/GYN in Oregon. "It is appalling that someone would show up to an emergency room and not receive care -- this is inconceivable." It’s happened despite federal mandates that the women be treated. Federal law requires emergency rooms to treat or stabilize patients who are in active labor and provide a medical transfer to another hospital if they don’t have the staff or resources to treat them. Medical facilities must comply with the law if they accept Medicare funding. The Supreme Court will hear arguments Wednesday that could weaken those protections. The Biden administration has sued Idaho over its abortion ban, even in medical emergencies, arguing it conflicts with the federal law. "No woman should be denied the care she needs," Jennifer Klein, director of the White House Gender Policy Council, said in a statement. "All patients, including women who are experiencing pregnancy-related emergencies, should have access to emergency medical care required under the Emergency Medical Treatment and Labor Act (EMTALA)." Pregnancy care after Roe Pregnant patients have "become radioactive to emergency departments" in states with extreme abortion restrictions, said Sara Rosenbaum, a George Washington University health law and policy professor. "They are so scared of a pregnant patient, that the emergency medicine staff won’t even look. They just want these people gone," Rosenbaum said. Consider what happened to a woman who was nine months pregnant and having contractions when she arrived at the Falls Community Hospital in Marlin, Texas, in July 2022, a week after the Supreme Court’s ruling on abortion. The doctor on duty refused to see her. "The physician came to the triage desk and told the patient that we did not have obstetric services or capabilities," hospital staff told federal investigators during interviews, according to documents. "The nursing staff informed the physician that we could test her for the presence of amniotic fluid. However, the physician adamantly recommended the patient drive to a Waco hospital." Investigators with the Centers for Medicare and Medicaid Services concluded Falls Community Hospital broke the law. Reached by phone, an administrator at the hospital declined to comment on the incident. The investigation was one of dozens the AP obtained from a Freedom of Information Act request filed in February 2023 that sought all pregnancy-related EMTALA complaints the previous year. One year after submitting the request, the federal government agreed to release only some complaints and investigative documents filed across just 19 states. The names of patients, doctors and medical staff were redacted from the documents. Federal investigators looked into just over a dozen pregnancy-related complaints in those states during the months leading up to the U.S. Supreme Court’s pivotal ruling on abortion in 2022. But more than two dozen complaints about emergency pregnancy care were lodged in the months after the decision was unveiled. It is not known how many complaints were filed last year as the records request only asked for 2022 complaints and the information is not publicly available otherwise. The documents did not detail what happened to the patient turned away from the Falls Community Hospital. 'She is bleeding a lot' Other pregnancies ended in catastrophe, the documents show. At Sacred Heart Emergency Center in Houston, front desk staff refused to check in one woman after her husband asked for help delivering her baby that September. She miscarried in a restroom toilet in the emergency room lobby while her husband called 911 for help. "She is bleeding a lot and had a miscarriage," the husband told first responders in his call, which was transcribed from Spanish in federal documents. "I’m here at the hospital but they told us they can’t help us because we are not their client." Emergency crews, who arrived 20 minutes later and transferred the woman to a hospital, appeared confused over the staff’s refusal to help the woman, according to 911 call transcripts. One first responder told federal investigators that when a Sacred Heart Emergency Center staffer was asked about the gestational age of the fetus, the staffer replied: "No, we can’t tell you, she is not our patient. That’s why you are here." A manager for Sacred Heart Emergency Center declined to comment. The facility is licensed in Texas as a freestanding emergency room, which means it is not physically connected to a hospital. State law requires those facilities to treat or stabilize patients, a spokesperson for the Texas Health and Human Services agency said in an email to AP. Sacred Heart Emergency’s website says that it no longer accepts Medicare, a change that was made sometime after the woman miscarried, according to publicly available archives of the center’s website. Meanwhile, the staff at Person Memorial Hospital in Roxboro, North Carolina, told a pregnant woman, who was complaining of stomach pain, that they would not be able to provide her with an ultrasound. The staff failed to tell her how risky it could be for her to depart without being stabilized, according to federal investigators. While en route to another hospital 45 minutes away, the woman gave birth in a car to a baby who did not survive. Person Memorial Hospital self-reported the incident. A spokeswoman said the hospital continues to "provide ongoing education for our staff and providers to ensure compliance." In Melbourne, Florida, a security guard at Holmes Regional Medical Center refused to let a pregnant woman into the triage area because she had brought a child with her. When the patient came back the next day, medical staff were unable to locate a fetal heartbeat. The center declined to comment on the case. What’s the penalty? Emergency rooms are subject to hefty fines when they turn away patients, fail to stabilize them or transfer them to another hospital for treatment. Violations can also put hospitals’ Medicare funding at risk. But it’s unclear what fines might be imposed on more than a dozen hospitals that the Biden administration says failed to properly treat pregnant patients in 2022. It can take years for fines to be levied in these cases. The Health and Human Services agency, which enforces the law, declined to share if the hospitals have been referred to the agency’s Office of Inspector General for penalties. For Huntsberger, the OB/GYN, EMTALA was one of the few ways she felt protected to treat pregnant patients in Idaho, despite the state’s abortion ban. She left Idaho last year to practice in Oregon because of the ban. The threat of fines or loss of Medicare funding for violating EMTALA is a big deterrent that keeps hospitals from dumping patients, she said. Many couldn’t keep their doors open if they lost Medicare funding. She has been waiting to see how HHS penalizes two hospitals in Missouri and Kansas that HHS announced last year it was investigating after a pregnant woman, who was in preterm labor at 17 weeks, was denied an abortion. "A lot of these situations are not reported, but even the ones that are — like the cases out of the Midwest — they’re investigated but nothing really comes of it," Huntsberger said. "People are just going to keep providing substandard care or not providing care. The only way that changes is things like this." President Joe Biden and top U.S. health official Xavier Becerra have both publicly vowed vigilance in enforcing the law. Even as states have enacted strict abortion laws, the White House has argued that if hospitals receive Medicare funds they must provide stabilizing care, including abortions. In a statement to the AP, Becerra called it the "nation’s bedrock law protecting Americans’ right to life- and health-saving emergency medical care." "And doctors, not politicians, should determine what constitutes emergency care," he added. Idaho’s law allows abortion only if the life, not the health, of the mother is at risk. But the state’s attorney general has argued that its abortion ban is "consistent" with federal law, which calls for emergency rooms to protect an unborn child in medical emergencies. "The Biden administration has no business rewriting federal law to override Idaho’s law and force doctors to perform abortions," Idaho Attorney General Raúl Labrador said in a statement earlier this year. Now, the Supreme Court will weigh in. The case could have implications in other states like Arizona, which is reinstating an 1864 law that bans all abortions, with an exception only if the mother’s life is at risk. EMTALA was initially introduced decades ago because private hospitals would dump patients on county or state hospitals, often because they didn’t have insurance, said Alexa Kolbi-Molinas of the American Civil Liberties Union. Some hospitals also refused to see pregnant women when they did not have an established relationship with physicians on staff. If the court nullifies or weakens those protections, it could result in more hospitals turning away patients without fear of penalty from the federal government, she said. "The government knows there’s a problem and is investigating and is doing something about that," Kolbi-Molinas said. "Without EMTALA, they wouldn’t be able to do that."

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NIAMEY, Niger — Drug seizures soared in the West African Sahel region according to figures released Friday in a new U.N. report, indicating the conflict-ridden region is becoming an influential route for drug trafficking. In 2022, 1,466 kilograms of cocaine were seized in Mali, Chad, Burkina Faso and Niger compared to an average of 13 kilograms between 2013 and 2020 , said the report from the U.N. Office on Drugs and Crime. Cocaine is the most seized drug in the Sahel after cannabis resin, the report said. The analysis comes as Senegal, which borders on the Sahel, announced Sunday a record-breaking cocaine seizure of 1,137 kilograms – the most ever intercepted on land and valued at $146 million – near an artisanal mine in the east of the country. Incidents like this are becoming more common in the region: In one incident last year in December, the Senegalese navy seized a total of 3 tons of cocaine at sea. The location of the Sahel, lying south of the Sahara desert and running from the Atlantic to the Arabian Ocean, makes it a natural transit point for the increasing amount of cocaine produced in South America and destined for Europe. The trafficking has detrimental impacts for both peace and health, locally and globally, said Amado Philip de Andrés, UNODC Regional Representative in West and Central Africa. "The involvement of various armed groups in drug trafficking continues to undermine peace and stability in the region," said Philip de Andrés. The report said the drug trade provides financial resources to armed groups in the Sahel, where Islamic extremist networks have flourished as the region struggles with a recent spate of coups. Increased trafficking networks in the region is spilling out onto local markets and leading to higher drug consumption, said Lucia Bird, director of the West Africa observatory of illicit economies at the Global Initiative against Transnational Organized Crime. "We've had reports of rising crack cocaine consumption in Agadez, Niger driven by payment in kind," said Bird. "Smaller traffickers get paid in drugs and offload it onto local markets because they don't have the contacts in more lucrative consumption destinations." A patrol in southwest Niger on Monday intercepted a shipment of cannabis and Tramadol, an opioid painkiller pill, worth $50,000, according to a national TV announcement. Another significant trend in the region is the direct exchange of Moroccan hashish for South American cocaine via West Africa, said Bird. This arrangement – which has been developing since 2020 — bypasses the need for cash payments and exploits differences in the prices of drugs across continents, she explained, adding that this increases the amount of drugs trafficked overland which transit from West African ports across some of the most conflict-affected areas of the Sahel. Corruption and money laundering are major enablers of drug trafficking and recent seizures and arrests revealed that political elite, community leaders and leaders of armed groups facilitate the drug trade in the Sahel, the UN report added. "States in the Sahel region — along with the international community — must take urgent, coordinated, and comprehensive action to dismantle drug trafficking networks," said Leonardo Santos Simão, Special Representative of the UN Secretary-General for West Africa.

Give us 5 minutes, and we'll give you the world. Around the clock, Voice of America keeps you in touch with the latest news. We bring you reports from our correspondents and interviews with newsmakers from across the world.

Give us 5 minutes, and we'll give you the world. Around the clock, Voice of America keeps you in touch with the latest news. We bring you reports from our correspondents and interviews with newsmakers from across the world.

washington — This month, when a story claiming Ukrainian President Volodymyr Zelenskyy had secretly purchased a $24 million castle from the British royal family went viral on China's Weibo social media platform, something interesting happened. A fake-news function on the platform debunked it as misinformation. Since Russia launched its invasion of Ukraine in early 2022, Chinese social media platforms have been full of pro-Russia false claims and conspiracy theories, some of which the Chinese government has endorsed. Influential Chinese nationalist bloggers, as well as Russia's state media RT, regularly post and spread misinformation on Weibo. Less than 20 hours after RT posted the misinformation about Zelenskyy, Weibo attached a fact-checking note to the post. Public criticism of Russian state media is rare in China, but the fact-check function is part of Weibo's latest effort to regulate misinformation on the site. Weibo rolled out the feature, called Side Note, last August. Side Note allows qualified users to submit fact-checking notes on others' posts for Weibo to review. Over the past few months, users have added Side Note to posts from high-profile Weibo bloggers and foreign government-backed accounts, including RT and the U.S. Embassy in China. Weibo has tried to appear neutral when deciding what kind of misinformation to fact-check, debunking false claims from both liberal and nationalist influencers. But it has also used the feature to push Beijing's talking points on international issues. So far, Chinese government and state media accounts have not been subject to any fact-checking. Weibo's version of Community Note In July 2023, China's internet regulator told social media companies to crack down on false information. " 'Personal media' that create and publish rumors, stir up hot societal topics or matrix [linked cross-platform] publish and transmit illegal or negative information, creating a vile impact, are all to be closed, included in the platform database of blacklisted accounts, and reported to the internet information departments," said a memo from Central Cyberspace Administration of China. A month later, Weibo, one of China's biggest social media apps with a focus on news and current issues, came out with the Side Note feature. Like the Community Note function on X, Side Note lets qualified users take on the job of fact-checking, with Weibo getting the final say on approval or rejection. Other U.S. social media firms offer similar features. Facebook and Instagram offer "community standards" and "community guidelines," respectively, which flag posts containing disinformation. But unlike these firms, Weibo itself decides which posts stay up. The company says it selects qualified users from those with verified identities or high Weibo credit scores and is gradually expanding the feature to include more users. Side Note targets US Embassy Since January, posts by the U.S. Embassy in China have been tagged with Side Note at least three times. A post detailing U.S. Secretary of State Antony Blinken's expressed concerns about China's religious freedom received two notes, one accusing Blinken of having "no regard for facts." A February post sanctioning 17 Chinese companies for helping Russia's war effort in Ukraine got a note that included a Chinese Foreign Ministry spokesperson's public remarks. And a post last month condemning Beijing for a collision between Chinese and Philippine coast guard vessels got a Side Note message from Shen Yi, a prominent Chinese international relations professor with a strong nationalistic leaning.  In the note, Shen accused the U.S. of spreading misinformation on multiple "global social media platforms" to "smear China's national image." Chinese government accounts immune Most posts tagged with Side Note belong to influencers, including nationalist bloggers. For example, Shu Chang, who runs the popular nationalist account Guyan Muchan, saw a Side Note added to a post last week claiming that schoolchildren in the U.S. have to learn how to use "bulletproof boards" in classrooms. The Side Note clarified that the photos were from a hurricane self-protection exercise. In recent years, nationalist bloggers like Shu have become some of the most traffic-drawing opinion leaders on Weibo. Eric Liu, who analyzes Chinese censorship at China Digital Times, says one shouldn't read too much into Weibo fact-checking Shu's post. "A lot of her stuff isn't state narratives. She sensationalized it herself," Liu told VOA. "Weibo doesn't really have to protect her. Plus, [fact-checking her posts] adds to the credibility of the Side Note feature." Liu, who worked as a censor for Weibo and other Chinese internet companies before moving to the U.S., pointed out that Weibo has not used Side Note to fact-check government accounts or false information from state media. In a November post, Weibo thanked users for submitting Side Notes. "Ever since Side Note went online, active participation from every Side Note-er has effectively lowered the negative impact of controversial content and biased information, helping all users access information that's truer and more comprehensive," the post said. But Liu doesn't think of Side Note as a feature that truly gives users the power to regulate speech on the platform, because Weibo remains the final arbitrator of what notes can be added to what posts. "Weibo's Side Note isn't something that netizens can fully edit, as it's still user-generated content," he said. "In the end, it still needs to be reviewed by censors." Weibo did not respond to VOA's request for comment. Evie Steele contributed to this report.

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washington — The United States will withdraw its troops from Niger, a source familiar with the matter said late on Friday, adding that an agreement was reached between U.S Deputy Secretary of State Kurt Campbell and Niger's leadership.  As of last year, there were a little more than 1,000 U.S. troops in Niger, where the U.S. military operated out of two bases, including a drone base known as Air Base 201 near Agadez in central Niger at a cost of more than $100 million.  Since 2018, the base has been used to target Islamic State militants and Jama'at Nusrat al-Islam wal Muslimeen, an al-Qaida affiliate, in the Sahel region.   Last year, Niger's army seized power in a coup. Until the coup, Niger had remained a key security partner of the United States and France.   But the new authorities in Niger joined juntas in neighboring Mali and Burkina Faso in ending military deals with one-time Western allies like Washington and Paris, quitting the regional political and economic bloc ECOWAS, and fostering closer ties with Russia.  In the coming days, there will be conversations about how that drawdown of troops will look, the source told Reuters, asking not to identified.  The source said there would still be diplomatic and economic relationships between the U.S. and Niger despite this step.  Earlier Friday, The New York Times reported that more than 1,000 American military personnel will leave Niger in coming months.  Last month, Niger's ruling junta said it revoked with immediate effect a military accord that allowed military personnel and civilian staff from the U.S. Department of Defense on its soil.  The Pentagon had said thereafter it was seeking clarification about the way ahead. It added that the U.S. government had "direct and frank" conversations in Niger ahead of the junta's announcement and was continuing to communicate with Niger's ruling military council.  Hundreds took to the streets of Niger's capital last week to demand the departure of U.S. troops after the ruling junta further shifted its strategy by ending the military accord with the United States and welcoming Russian military instructors.  Eight coups in West and Central Africa over four years, including in Burkina Faso, Mali and Niger, have prompted growing concerns over democratic backsliding in the region. 

Restored mangroves earn Pakistan millions of dollars in global carbon credit markets. But political turmoil is keeping Pakistan from using the funds to strengthen its defense against climate change. VOA Pakistan Bureau Chief Sarah Zaman reports from deep in the Indus River delta.

Will Israel and Iran heed the call of world leaders to de-escalate tensions that could potentially lead to a region-wide war. Iran vowed a massive response but has so far had a muted reaction. In another tense part of the world, U.S. and European leaders stress the urgency of air defense for Kyiv as Russin attacks intensify. After months of delay, U.S. lawmakers plan to vote on aid for Ukraine Saturday. And a look at a coordinated international effort to support Ukraine’s government in its investigation and prosecution of Russian war crimes since its invasion in February 2022.

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United Nations — Two senior United Nations officials raised the alarm Friday that an attack on the North Darfur capital of El Fasher could be imminent and may trigger a deadly intercommunal conflict across Darfur. "In Darfur, recent reports indicate a possible imminent RSF attack on El Fasher, raising the specter of a new front in the conflict," U.N. political and peacebuilding chief Rosemary DiCarlo told the Security Council. The RSF are the Rapid Support Forces, the rebel militia that has been fighting the Sudanese Armed Forces (SAF) for the past year. The two generals leading them were once allies in Sudan’s transitional government after a 2021 coup but have become rivals for power. The war began last April in the capital, Khartoum. It has since spread to other parts of the country, forcing more than 8 million people from their homes in search of safety. Nearly 2 million of them have fled Sudan to neighboring countries. Of those who remain, 25 million need humanitarian assistance. DiCarlo said clashes between the RSF and SAF-aligned members of the Joint Protection Forces have erupted in Mellit, a strategic town to the north of El Fasher. "Fighting in El Fasher could unleash bloody intercommunal strife throughout Darfur," she said. "It would also further impede the delivery of humanitarian assistance in an area already on the brink of famine." El Fasher is an established humanitarian hub. Fighting there would make it even more dangerous and complicated to store and deliver aid. "Beyond Darfur, greater Khartoum continues to be the epicenter of fighting between the SAF and the RSF," DiCarlo added. "Galvanized by recent gains, the SAF has intensified aerial raids in Khartoum, the Kordofan regions and parts of Darfur." The U.N. says the violence threatens 800,000 civilians living in El Fasher and risks setting off more violence in other parts of Darfur – where more than 9 million people need humanitarian assistance. "On 13 April, following weeks of rising tensions and airstrikes, RSF-affiliated militias attacked and burned villages west of El Fasher," Edem Wosornu told council members. "Since then, there have been continuing reports of clashes in the eastern and northern parts of the city, resulting in more than 36,000 people displaced," the director of operations and advocacy in the Office for the Coordination of Humanitarian Affairs said. She said medical charity Doctors Without Borders, or MSF, has reported that more than a hundred trauma patients have arrived at their El Fasher facility in recent days but said the number of civilian casualties is likely much higher. Final battle for Darfur A report released Friday by the Yale University Humanitarian Research Lab says satellite imagery and open-source information indicates that the RSF is either close to El Fasher or already inside its eastern and northeastern neighborhoods. "At least 11 villages are confirmed burned to the ground on the western access on the approach to El Fasher," Nathaniel Raymond, executive director of the lab, told VOA. He said it is their assessment that the RSF likely controls the north, east and west roads into El Fasher, and they have credible reports that the Sudanese army had to be re-supplied by air in the past week. "This suggests that SAF has already assessed that they do not have a ground route for resupply or escape," Raymond said. That means civilians are also trapped, including thousands of African Zaghawa, Masalit, Fur, and other non-Arab ethnic groups. "This is the final battle for Darfur," Raymond said. "If RSF is victorious, then they will be able to complete the genocide begun at the beginning of the 21st century, and all indications are consistent with the fact that they intend to." He said a victory in El Fasher would be pivotal, giving the RSF control over all the regional capitals in the Darfur region and creating a stronghold from which they can fight the remaining elements of the SAF for years to come. Darfur saw large-scale ethnic violence, crimes against humanity and genocide in the early 2000s when Arab "Janjaweed" militias targeted the Fur, Masalit and Zaghawa. 

Give us 5 minutes, and we'll give you the world. Around the clock, Voice of America keeps you in touch with the latest news. We bring you reports from our correspondents and interviews with newsmakers from across the world.

Give us 5 minutes, and we'll give you the world. Around the clock, Voice of America keeps you in touch with the latest news. We bring you reports from our correspondents and interviews with newsmakers from across the world.

Ukraine has appealed for its European allies to urgently step up weapons supplies as it struggles to hold ground against invading Russian forces. As Henry Ridgwell reports, Germany has called for allies to provide more air defense systems, as Russian drones and missiles rain down on Ukrainian cities.

Russia’s top diplomats walked out of the U.N. Security Council meeting when Israel’s representative took the stage.