🔗 Share this article

For hours, jolting along the soggy dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and concentrated on stopping herself being sick. She was in childbirth, in severe suffering after her womb tore, but was now being tossed around in the ambulance that jumped along the dips and bumps of the road through the Chadian desert.

Most of the 878,000 Sudanese displaced persons who escaped to Chad since 2023, barely getting by in this inhospitable environment, are women. They live in secluded encampments in the desert with insufficient supplies, no work and with medical help often a dangerously far away.

The clinic Mohammed needed was in Metche, another refugee camp more than a considerable journey away.

“I kept getting infections during my term and I had to go the health post multiple occasions – when I was there, the pregnancy started. But I could not give birth naturally because my uterus had collapsed,” says Mohammed. “I had to endure a long delay for the ambulance but all I remember was the pain; it was so bad I became confused.”

Her mother, Ashe Khamis Abdullah, 40, feared she would be bereft of her child and grandchild. But Mohammed was rushed straight into surgery when she arrived at the hospital and an emergency caesarean section preserved the lives of her and her son, Muwais.

Chad was known for the world’s second most severe maternal mortality rate before the recent arrival of refugees, but the situations faced by the Sudanese place additional women in risk.

At the hospital, where they have delivered 824 babies in often critical situations this year, the doctors are able to help plenty, but it is what occurs with the women who are cannot access the hospital that worries the staff.

In the 24 months since the domestic strife in Sudan started, the vast majority of the people who reached and stayed in Chad are mothers and kids. In total, about over a million Sudanese are being hosted in the east of the country, a large number of whom escaped the earlier war in Darfur.

Chad has hosted the bulk of the over four million people who have run from the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been uprooted from their homes.

Many males have not left to be close to homes and land; some were slain, abducted or forced into fighting. Those of working age rapidly leave from Chad’s isolated encampments to look for jobs in the capital, N’Djamena, or further, in adjacent Libya.

It means women are left alone, without the means to feed the young and old left in their responsibility. To avoid overcrowding near the border, the Chadian government has moved individuals to less crowded encampments such as Metche with average populations of about fifty thousand, but in isolated regions with limited infrastructure and few opportunities.

Metche has a hospital set up by a medical aid organization, which was initially a few tents but has expanded to include an operating theatre, but few additional amenities. There is no work, families must walk hours to find burning material, and each person must subsist with about nine litres of water a day – well under the advised quantity.

This isolation means hospitals are receiving women with complications in their pregnancy at a critical stage. There is only a single ambulance to travel the path between the Metche hospital and the medical tent near the settlement of Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has encountered situations where women in desperate pain have had to remain overnight for the ambulance to come.

Imagine being expecting a child, in labour, and journeying for a long time on a donkey-drawn vehicle to get to a hospital

As well as being uneven, the path goes through valleys that become inundated during the wet period, completely cutting off travel.

A surgeon at the hospital in Metche said each patient she treats is an crisis, with some women having to make long and difficult journeys to the hospital by foot or on a mule.

“Imagine being about to give birth, in labour, and travelling hours on a cart pulled by a donkey to get to a clinic. The primary issue is the lag but having to arrive under such circumstances also has an impact on the childbirth,” says the surgeon.

Malnutrition, which is on the rise, also elevates the likelihood of issues in pregnancy, including the uterine splits that medical staff see regularly.

Mohammed has stayed at the medical facility in the couple of months since her surgical delivery. Afflicted by malnutrition, she contracted an illness, while her son has been regularly checked. The parent has travelled to other towns in search of work, so Mohammed is totally dependent on her mother.

The malnutrition ward has grown to six tents and has patients spilling over into other sections. Children lie under mosquito nets in extreme warmth in almost utter stillness as doctors and nurses work, preparing treatments and weighing children on a scale made from a bucket and rope.

In moderate instances children get small bags of PlumpyNut, the specially formulated peanut paste, but the most severe instances need a regular intake of nutrient-rich liquid. Mohammed’s baby is fed his through a injector.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being nourished via a nose tube. The infant has been ill for the past year but Abubakar was consistently offered just painkillers without any diagnosis, until she made the journey from Alacha to Metche.

“Every day, I see more children coming in in this structure,” she says. “The nutrition we receive is poor, there’s not enough to eat and it’s deficient in vitamins.

“If we were at home, we could’ve adjusted our lives. You can go and cultivate plants, you can work to earn some money, but here we’re reliant on what we’re given.”

And what they are given is a limited quantity of cereal, vegetable oil and salt, provided every 60 days. Such a minimal nutrition is deficient in nutrients, and the small amount of money she is given cannot buy much in the regular markets, where prices have become inflated.

Abubakar was relocated to Alacha after arriving from Sudan in 2023, having run from the militia Rapid Support Forces’ assault on her native town of El Geneina in June that year.

Failing to secure jobs in Chad, her spouse has left for Libya in the aspiration to gathering adequate cash for them to follow. She resides with his relatives, dividing up whatever meals they acquire.

Abubakar says she has already observed food rations being cut and there are fears that the sudden reductions in overseas aid budgets by the US, UK and other European countries, could worsen the situation. Despite the war in Sudan having created the 21st century’s most severe crisis and the {scale of needs|extent