🔗 Share this article

For an extended period, bouncing over the soggy dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and concentrated on stopping herself throwing up. She was in labour, in agonizing discomfort after her uterus ruptured, but was now being tossed around in the ambulance that bumped over the uneven terrain of the road through the Chadian desert.

Most of the 878,000 Sudanese people who ran to Chad since 2023, living hand to mouth in this harsh landscape, are women. They stay in remote settlements in the desert with limited water and food, few job opportunities and with medical help often a perilously remote away.

The medical center Mohammed needed was in Metche, another refugee camp more than two hours away.

“I repeatedly suffered from infections during my term and I had to go the medical tent on numerous visits – when I was there, the pregnancy started. But I could not give birth naturally because my uterine muscles failed,” says Mohammed. “I had to endure a long delay for the ambulance but all I remember was the agony; it was so intense I became delirious.”

Her parent, Ashe Khamis Abdullah, 40, worried she would suffer the death of her daughter and baby grandson. But Mohammed was rushed straight into surgery when she got to the hospital and an critical surgical delivery preserved the lives of her and her son, Muwais.

Chad previously recorded the world’s second most severe maternal fatality statistic before the recent arrival of refugees, but the situations faced by the Sudanese expose further women in peril.

At the hospital, where they have delivered 824 babies in often critical situations this year, the medics are able to help plenty, but it is what affects the women who are not able to reach the hospital that concerns them.

In the two years since the civil war in Sudan erupted, the vast majority of the displaced persons who came and stayed in Chad are females and minors. In total, about one point two million Sudanese are being accommodated in the eastern part of the country, 400,000 of whom escaped the past violence in Darfur.

Chad has taken the lion’s share of the over four million people who have run from the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been displaced from their homes.

Many men have not left to be near homes and land; some were slain, captured or forced into fighting. Those of adult age rapidly leave from Chad’s barren settlements to seek employment in the capital, N’Djamena, or beyond, in adjacent Libya.

It means women are abandoned, without the means to provide for the dependents left in their responsibility. To avoid overcrowding near the border, the Chadian government has moved individuals to more compact settlements such as Metche with usual resident counts of about 50,000, but in remote areas with no services and scarce prospects.

Metche has a hospital set up by a medical aid organization, which started off as a few tents but has grown to feature an surgical room, but little else. There is a lack of jobs, families must travel long distances to find burning material, and each person must survive on about minimal water of water a day – far below the advised quantity.

This remoteness means hospitals are receiving women with problems in their pregnancy at a critical stage. There is only a one medical transport to serve the area between the Metche hospital and the health post near the camp at Alacha, where Mohammed is one of nearly 50,000 refugees. The medical team has encountered situations where women in severe suffering have had to endure a full night for the ambulance to come.

Imagine being nine months pregnant, in labour, and travelling hours on a donkey-drawn vehicle to get to a clinic

As well as being bumpy, the path goes through valleys that become inundated during the rainy season, completely cutting off travel.

A surgeon at the hospital in Metche said all the situations she encounters is an emergency, with some women having to make challenging travels to the hospital by on foot or on a pack animal.

“Imagine being about to give birth, in labour, and making a long trip on a animal-drawn vehicle to get to a hospital. The primary issue is the lag but having to arrive under such circumstances also has an impact on the childbirth,” says the surgeon.

Undernourishment, which is increasing, also raises the chance of complications in pregnancy, including the womb tears that medical staff frequently observe.

Mohammed has stayed at the medical facility in the 60 days since her C-section. Afflicted by malnutrition, she developed an infection, while her son has been regularly checked. The male guardian has journeyed to other towns in seek jobs, so Mohammed is completely reliant on her mother.

The undernourishment unit has grown to six tents and has individuals overflowing into other sections. Children are placed under mosquito nets in oppressive temperatures in almost complete silence as medical staff work, preparing treatments and weighing children on a device constructed from a pail and cord.

In mild cases children get sachets of PlumpyNut, the specifically created peanut paste, but the worst cases need a daily dose of enriched milk. Mohammed’s baby is administered his nutrition through a injector.

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

“Every day, I see additional kids arriving in this shelter,” she says. “The food we’re eating 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 cultivate plants, you can get a job, 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 couple of months. Such a minimal nutrition lacks nutrition, and the small amount of money she is given purchases very little in the regular markets, where costs have risen.

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

Unable to get employment in Chad, her partner has gone to Libya in the aspiration to earning sufficient funds for them to come later. She resides with his family members, sharing out whatever food they can get.

Abubakar says she has already seen food distributions being reduced and there are concerns 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 caused the 21st century’s gravest emergency and the {scale of needs|extent