🔗 Share this article

For hours, bouncing over the flooded dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and focused on stopping herself throwing up. She was in delivery, in severe suffering after her uterine wall split, but was now being shaken violently in the ambulance that bumped over the dips and bumps of the road through the Chadian desert.

Most of the hundreds of thousands of Sudanese refugees who have fled to Chad since 2023, barely getting by in this harsh landscape, are women. They live in secluded encampments in the desert with insufficient supplies, no work and with treatment often a perilously remote away.

The hospital Mohammed needed was in Metche, a different settlement more than 120 minutes away.

“I kept getting infections during my gestation and I had to go the health post on numerous visits – when I was there, the labour began. But I found it impossible to give birth without intervention because my womb had given way,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I recall is the agony; it was so intense I became confused.”

Her maternal figure, Ashe Khamis Abdullah, 40, worried she would be bereft of her offspring and descendant. But Mohammed was rushed straight into surgery when she reached the hospital and an emergency caesarean section saved her and her son, Muwais.

Chad already had the world’s second worst maternal death rate before the current influx of refugees, but the situations faced by the Sudanese put even more women in peril.

At the hospital, where they have assisted in the arrival of 824 babies in often critical situations this year, the doctors are able to save many, but it is what happens to the women who are fail to get to the hospital that concerns them.

In the two years since the internal conflict in Sudan erupted, 86% of the people who reached and stayed in Chad are females and minors. In total, about 1.2 million Sudanese are being sheltered in the eastern part of the country, 400,000 of whom ran from the previous conflict in Darfur.

Chad has accepted the majority of the 4.1 million people who have fled the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been uprooted from their homes.

Many adult men have not left to be near homes and land; others have been slain, captured or made to join the conflict. Those of employable age rapidly leave from Chad’s desolate refugee camps to find work in the main city, N’Djamena, or beyond, in nearby Libya.

It results in women are left alone, without the ability to feed the young and old left in their charge. To avoid overcrowding near the border, the Chadian government has transferred refugees to more compact settlements such as Metche with usual resident counts of about fifty thousand, but in isolated regions with limited infrastructure and minimal chances.

Metche has a hospital set up by a medical aid organization, which started off as a few tents but has grown to feature an procedure area, but not much more. There is unemployment, families must walk hours to find burning material, and each person must subsist with about nine litres of water a day – well under the recommended 20 litres.

This isolation means hospitals are admitting women with problems in their pregnancy when it is almost too late. There is only a sole emergency vehicle to serve the area between the Metche hospital and the medical tent near the Alacha encampment, where Mohammed is one of close to fifty thousand refugees. The medical team has observed instances where women in severe suffering have had to endure a full night for the ambulance to reach them.

Imagine being in the final trimester, in childbirth, and making a lengthy trip on a cart pulled by a donkey to get to a hospital

As well as being uneven, the road traverses valleys that become inundated during the wet period, completely cutting off travel.

A surgeon at the hospital in Metche said every case she sees is an crisis, with some women having to make challenging travels to the hospital by foot or on a donkey.

“Imagine being in the late stages of pregnancy, in childbirth, and travelling hours on a cart pulled by a donkey to get to a medical center. The primary issue is the lag but having to come in these conditions also has an effect on the childbirth,” says the surgeon.

Poor nutrition, which is growing, also increases the risk of complications in pregnancy, including the uterine splits that medical staff often encounter.

Mohammed has continued under care in the couple of months since her C-section. Experiencing malnutrition, she developed an infection, while her son has been closely watched. The father has travelled to other towns in search of work, so Mohammed is totally dependent on her mother.

The nutritional care section has grown to six tents and has cases exceeding capacity into other sections. Children are placed under mosquito nets in extreme warmth in almost total quiet as medical staff work, preparing treatments and weighing children on a instrument created using a bucket and rope.

In moderate instances children get small bags of PlumpyNut, the specifically created peanut paste, but the most severe instances need a consistent supply of fortified formula. Mohammed’s baby is given his nourishment through a medical device.

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being fed through a nose tube. The infant has been sick for the past year but Abubakar was consistently offered just painkillers without any identification, until she made the journey from Alacha to Metche.

“Every day, I see more children coming in in this shelter,” she says. “The food we’re eating is poor, there’s too little nourishment and it’s deficient in vitamins.

“If we were at home, we could’ve adapted ourselves. You can go and cultivate plants, you can find employment, but here we’re dependent on what we’re distributed.”

And what they are provided is a small amount of cereal, vegetable oil and salt, distributed every two months. Such a basic diet is deficient in nutrients, and the little cash she is given acquires minimal items in the regular markets, where prices have become inflated.

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

Unable to get employment in Chad, her spouse has left for Libya in the aspiration to gathering adequate cash for them to come later. She stays with his family members, distributing whatever meals they acquire.

Abubakar says she has already observed food distributions being reduced and there are worries that the sharp decreases in international assistance funds by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having created the 21st century’s gravest emergency and the {scale of needs|extent