🔗 Share this article

For an extended period, travelling roughly on the soggy dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and focused on stopping herself vomiting. She was in labour, in extreme pain after her womb tore, but was now being jostled relentlessly in the ambulance that bumped over the potholes and ridges of the road through the Chadian desert.

Most of the close to a million Sudanese displaced persons who escaped to Chad since 2023, living hand to mouth in this difficult terrain, are women. They reside in remote settlements in the desert with insufficient supplies, no work and with healthcare often a dangerously far away.

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

“I repeatedly suffered from infections during my pregnancy and I had to go the clinic seven times – when I was there, the delivery commenced. But I wasn’t able to give birth naturally because my uterine muscles failed,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I remember was the suffering; it was so intense I became disoriented.”

Her parent, Ashe Khamis Abdullah, 40, feared she would lose both her daughter and baby grandson. But Mohammed was immediately taken for surgery when she reached the hospital and an urgent C-section preserved the lives of her and her son, Muwais.

Chad already had the world’s second most severe maternal fatality statistic before the recent arrival of refugees, but the conditions endured by the Sudanese place additional women in risk.

At the hospital, where they have assisted in the arrival of 824 babies in mostly emergency conditions this year, the medical staff are able to save many, but it is what affects the women who are not able to reach the hospital that worries the staff.

In the two years since the domestic strife in Sudan began, over four-fifths of the people who reached and settled in Chad are females and minors. In total, about 1.2 million Sudanese are being sheltered in the eastern region of the country, 400,000 of whom escaped the earlier war in Darfur.

Chad has accepted the majority of the millions of people who have escaped the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been displaced from their homes.

Many men have not left to be near homes and land; others have been killed, captured or made to join the conflict. Those of adult age soon depart from Chad’s barren settlements to seek employment in the capital, N’Djamena, or beyond, in nearby Libya.

It implies women are left alone, without the resources to feed the children and the elderly left in their responsibility. To prevent congestion near the border, the Chadian government has transferred refugees to smaller camps such as Metche with usual resident counts of about 50,000, but in isolated regions with limited infrastructure and few opportunities.

Metche has a hospital established by a medical aid organization, which began as a few tents but has expanded to include an surgical room, but not much more. There is no work, families must travel long distances to find firewood, and each person must survive on about minimal water of water a day – far below the suggested amount.

This isolation means hospitals are receiving women with issues in their pregnancy dangerously late. There is only a sole emergency vehicle to serve the area 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 seen cases where women in desperate pain have had to wait an entire night for the ambulance to arrive.

Imagine being nine months pregnant, in labour, and journeying for a long time on a animal-drawn transport to get to a clinic

As well as being uneven, the road traverses valleys that fill with water during the wet period, completely preventing travel.

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

“Imagine being in the late stages of pregnancy, in delivery, and journeying for an extended time on a donkey cart to get to a medical center. The main problem is the wait but having to come in these conditions also has an influence on the childbirth,” says the surgeon.

Undernourishment, which is on the rise, also elevates the likelihood of issues in pregnancy, including the uterine ruptures that medical staff often encounter.

Mohammed has stayed at the medical facility in the 60 days since her surgical delivery. Afflicted by malnutrition, she got sick, while her son has been closely watched. The male guardian has journeyed to other towns in seek jobs, so Mohammed is completely reliant on her mother.

The malnutrition ward has increased to six tents and has cases exceeding capacity into other sections. Children are placed under mosquito nets in sweltering heat in almost complete silence as health workers work, creating remedies and weighing children on a instrument created using a bucket and rope.

In moderate instances children get packets of PlumpyNut, the specifically created peanut paste, but the critical situations need a daily dose of enriched milk. Mohammed’s baby is fed his through a injector.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being given nutrition by a nasal drip. The child has been unwell for the past year but Abubakar was consistently offered just painkillers without any diagnosis, until she made the travel 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 insufficient food and it’s lacking in nutrients.

“If we were at home, we could’ve adapted ourselves. You can go and farm produce, you can find employment, but here we’re relying on what we’re given.”

And what they are allocated is a meager portion of grain, edible oil and salt, handed out every two months. Such a minimal nutrition is deficient in nutrients, and the meager funds she is given purchases very little in the regular markets, where values have increased.

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

Finding no work in Chad, her partner has gone to Libya in the aspiration to earning sufficient funds for them to follow. She lives with his family members, dividing up whatever food they can get.

Abubakar says she has already witnessed food distributions being reduced and there are concerns that the sharp decreases in overseas aid budgets 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