🔗 Share this article

For an extended period, jolting along the soggy dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and focused on stopping herself vomiting. She was in labour, in severe suffering after her uterus ruptured, but was now being tossed around in the ambulance that bumped over the dips and bumps of the road through the Chadian desert.

Most of the close to a million Sudanese refugees who have fled to Chad since 2023, barely getting by in this difficult terrain, are females. They live in remote settlements in the desert with limited water and food, little employment and with medical help often a perilously remote away.

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

“I repeatedly suffered from infections during my term and I had to go the health post seven times – when I was there, the delivery commenced. But I could not give birth normally because my womb had given way,” says Mohammed. “I had to wait two hours for the ambulance but all I can think of the suffering; it was so bad I became delirious.”

Her parent, 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 critical surgical delivery rescued her and her son, Muwais.

Chad was known for the world’s second worst maternal mortality 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 birthed 824 babies in mostly emergency conditions this year, the medics are able to save many, but it is what affects the women who are cannot access the hospital that alarms the professionals.

In the two years since the domestic strife in Sudan erupted, the vast majority of the refugees who have arrived and settled in Chad are women and children. In total, about over a million Sudanese are being hosted in the eastern region of the country, four hundred thousand of whom fled the previous conflict in Darfur.

Chad has hosted the bulk of the over four million people who have escaped the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been uprooted from their homes.

Many males have stayed behind to be in proximity to homes and land; some were slain, abducted or forced into fighting. Those of employable age move on quickly from Chad’s barren settlements to look for jobs in the main city, N’Djamena, or further, in adjacent Libya.

It means women are stranded, without the means to feed the dependents left in their responsibility. To reduce density near the border, the Chadian government has relocated people to more compact settlements such as Metche with average populations of about 50,000, but in remote areas with few facilities and scarce prospects.

Metche has a hospital set up by a medical aid organization, which was initially a few tents but has grown to feature an procedure area, but few additional amenities. There is no work, families must journey for extended periods to find burning material, and each person must get by with about a small amount of water a day – much less than the suggested amount.

This isolation means hospitals are treating women with complications in their pregnancy when it is almost too late. There is only a single ambulance 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 extreme agony have had to wait an entire night for the ambulance to reach them.

Imagine being expecting a child, in labour, and making a lengthy trip on a animal-drawn transport to get to a medical facility

As well as being uneven, the road traverses valleys that flood during the monsoon, completely preventing travel.

A surgeon at the hospital in Metche said each patient she treats is an critical situation, with some women having to make arduous trips to the hospital by on foot or on a mule.

“Imagine being nine months pregnant, in delivery, and journeying for an extended time on a donkey cart to get to a clinic. The primary issue is the lag but having to come in these conditions also has an impact on the delivery,” says the surgeon.

Poor nutrition, which is increasing, also elevates the likelihood of complications in pregnancy, including the womb tears that medical staff frequently observe.

Mohammed has remained in hospital in the couple of months since her caesarean. Afflicted by malnutrition, she contracted an illness, while her son has been closely watched. The male guardian has journeyed to other towns in search of work, so Mohammed is entirely leaning on her mother.

The malnutrition ward has increased 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, mixing medications and assessing weights on a instrument created using a pail and cord.

In mild cases children get sachets of PlumpyNut, the uniquely designed peanut paste, but the critical situations need a regular intake of enriched milk. Mohammed’s baby is given his nourishment through a injector.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being given nutrition by a nasogastric tube. The child has been sick for the past year but Abubakar was consistently offered just painkillers without any medical assessment, until she made the travel from Alacha to Metche.

“Every day, I see more children coming in in this tent,” she says. “The nutrition we receive is low-quality, there’s too little nourishment and it’s lacking in nutrients.

“If we were at home, we could’ve adjusted our lives. You can go and grow crops, you can find employment, but here we’re relying on what we’re provided.”

And what they are allocated is a small amount of grain, vegetable oil and salt, handed out every 60 days. Such a basic diet offers little sustenance, and the little cash she is given cannot buy much in the weekly food markets, where prices have become inflated.

Abubakar was relocated to Alacha after reaching from Sudan in 2023, having run from the militia Rapid Support Forces’ raid on her home city of El Geneina in June that year.

Failing to secure jobs in Chad, her spouse has traveled to Libya in the desire to earning sufficient funds for them to come later. She resides with his family members, distributing whatever meals they acquire.

Abubakar says she has already observed food supplies decreasing and there are concerns that the sudden reductions in international assistance funds by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having caused the 21st century’s most severe crisis and the {scale of needs|extent