🔗 Share this article

For an extended period, jolting along the waterlogged dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and concentrated on stopping herself vomiting. She was in labour, in severe suffering after her womb tore, but was now being jostled relentlessly in the ambulance that jumped along the uneven terrain of the road through the Chadian desert.

Most of the close to a million Sudanese people who ran to Chad since 2023, surviving precariously in this inhospitable environment, are females. They stay in isolated camps in the desert with limited water and food, little employment and with treatment often a perilously remote away.

The hospital Mohammed needed was in Metche, one more encampment more than two hours 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 without intervention because my uterus had collapsed,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I remember was the agony; it was so unbearable I became delirious.”

Her parent, Ashe Khamis Abdullah, 40, worried she would suffer the death of her child and grandchild. But Mohammed was immediately taken for 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-highest maternal death rate before the ongoing stream of refugees, but the conditions endured by the Sudanese put even more women in peril.

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 rescue numerous, but it is what affects the women who are fail to get to the hospital that worries the staff.

In the couple of years since the civil war in Sudan began, the vast majority of the displaced persons who came and stayed in Chad are women and children. In total, about over a million Sudanese are being accommodated in the eastern part of the country, 400,000 of whom escaped the earlier war in Darfur.

Chad has taken the lion’s share of the millions of people who have escaped the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been forced out of their homes.

Many men have not left to be in proximity to homes and land; some were slain, taken hostage or made to join the conflict. Those of working age move on quickly from Chad’s desolate refugee camps to look for jobs in the capital, N’Djamena, or beyond, in neighbouring Libya.

It results in women are left alone, without the ability to provide for the young and old left in their responsibility. To reduce density near the border, the Chadian government has relocated people to less crowded encampments such as Metche with usual resident counts of about fifty thousand, but in remote areas with few facilities and minimal chances.

Metche has a hospital set up by a medical aid organization, which started off as a few tents but has developed to contain an operating theatre, but not much more. There is unemployment, families must journey for extended periods to find fuel, and each person must get by with about nine litres of water a day – far below the suggested amount.

This isolation means hospitals are admitting women with problems in their pregnancy at a critical stage. There is only a single ambulance to cover the route 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 encountered situations where women in desperate pain have had to remain overnight for the ambulance to reach them.

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

As well as being rough, the route passes through valleys that fill with water during the monsoon, completely preventing travel.

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

“Imagine being in the late stages of pregnancy, in delivery, and journeying for an extended time on a animal-drawn vehicle to get to a clinic. The biggest factor is the delay but having to travel in this state also has an effect on the delivery,” says the surgeon.

Malnutrition, which is increasing, also raises the chance of complications in pregnancy, including the womb tears that medical staff often encounter.

Mohammed has stayed at the medical facility in the two months since her C-section. Experiencing malnutrition, she contracted an illness, while her son has been closely watched. The male guardian has travelled to other towns in seek jobs, so Mohammed is totally dependent on her mother.

The malnutrition ward has expanded to six tents and has cases exceeding capacity into other sections. Children are placed under mosquito nets in extreme warmth in almost complete silence as medical staff work, creating remedies and assessing weights on a device constructed from a container and string.

In less severe situations children get small bags of PlumpyNut, the specifically created peanut paste, but the most severe instances need a consistent supply of enriched milk. Mohammed’s baby is administered his nutrition through a medical device.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being nourished via a nose tube. The baby 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 further minors coming in in this shelter,” she says. “The meals we consume is inadequate, there’s not enough to eat and it’s not nutritious.

“If we were at home, we could’ve adapted ourselves. You can go and grow crops, you can get a job, but here we’re relying on what we’re provided.”

And what they are provided is a limited quantity of cereal, vegetable oil and salt, provided every 60 days. Such a simple food offers little sustenance, and the small amount of money she is given cannot buy much in the weekly food markets, where costs have risen.

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

Failing to secure jobs in Chad, her partner has gone to Libya in the desire to earning sufficient funds for them to come later. She resides with his relatives, sharing out whatever meals they acquire.

Abubakar says she has already observed food distributions being reduced and there are concerns that the sudden reductions in foreign support money by the US, UK and other European countries, could make things worse. Despite the war in Sudan having produced the 21st century’s gravest emergency and the {scale of needs|extent