🔗 Share this article

For a long time, bouncing over the flooded dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and tried hard stopping herself throwing up. She was in childbirth, in extreme pain after her womb tore, but was now being tossed around in the ambulance that lurched across the uneven terrain of the road through the Chadian desert.

Most of the hundreds of thousands of Sudanese refugees who have fled to Chad since 2023, living hand to mouth in this difficult terrain, are women. They stay in isolated camps in the desert with scarce resources, no work and with treatment often a perilously remote away.

The hospital Mohammed needed was in Metche, a different settlement more than two hours away.

“I repeatedly suffered from infections during my gestation 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 uterus had collapsed,” says Mohammed. “I had to wait two hours for the ambulance but all I recall is the pain; it was so bad I became delirious.”

Her parent, Ashe Khamis Abdullah, 40, feared she would suffer the death of her child and grandchild. But Mohammed was hurried into surgery when she arrived at the hospital and an critical surgical delivery saved her and her son, Muwais.

Chad previously recorded the world’s second-highest maternal fatality statistic before the ongoing stream of refugees, but the situations faced by the Sudanese place additional women in peril.

At the hospital, where they have birthed 824 babies in frequently urgent circumstances this year, the medical staff 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 couple of years since the civil war in Sudan began, 86% of the displaced persons who came and stayed in Chad are females and minors. In total, about 1.2 million Sudanese are being accommodated in the eastern part of the country, four hundred thousand of whom fled the earlier war in Darfur.

Chad has hosted the bulk of the 4.1 million people who have escaped the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been uprooted from their homes.

Many males have not left to be near homes and land; others have been killed, taken hostage or conscripted. Those of employable age soon depart from Chad’s isolated encampments to seek employment in the capital, N’Djamena, or elsewhere, in adjacent Libya.

It results in women are left alone, without the resources to provide for the dependents left in their care. To avoid overcrowding near the border, the Chadian government has transferred refugees to less crowded encampments such as Metche with average populations of about a large community, but in isolated regions with limited infrastructure and scarce prospects.

Metche has a hospital established by a medical aid organization, which started off as a few tents but has grown to feature an procedure area, but little else. There is no work, families must journey for extended periods to find fuel, and each person must survive on about a small amount of water a day – well under the advised quantity.

This remoteness means hospitals are admitting women with problems in their pregnancy when it is almost too late. There is only a one medical transport to cover the route between the Metche hospital and the clinic near the camp at 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 endure a full night for the ambulance to arrive.

Imagine being in the final trimester, in childbirth, and making a lengthy trip on a animal-drawn transport to get to a hospital

As well as being rough, the road traverses valleys that become inundated during the monsoon, completely cutting off travel.

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

“Imagine being about to give birth, in labour, and journeying for an extended time on a cart pulled by a donkey to get to a medical center. The main problem is the delay but having to arrive under such circumstances also has an influence on the childbirth,” says the surgeon.

Poor nutrition, which is increasing, also elevates the likelihood of complications in pregnancy, including the uterine splits that medical staff see regularly.

Mohammed has stayed at the medical facility in the two months since her caesarean. Afflicted by malnutrition, she got sick, while her son has been regularly checked. The male guardian has travelled to other towns in seek jobs, so Mohammed is totally dependent 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 sweltering heat in almost complete silence as medical staff work, mixing medications and weighing children on a scale made from a pail and cord.

In mild cases children get sachets of PlumpyNut, the uniquely designed peanut paste, but the critical situations need a daily dose of nutrient-rich liquid. Mohammed’s baby is fed his through a medical device.

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

“Every day, I see further minors joining us in this shelter,” she says. “The meals we consume is poor, there’s insufficient food 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 relying on what we’re distributed.”

And what they are allocated is a small amount of grain, vegetable oil and salt, handed out every two months. Such a simple food is deficient in nutrients, and the small amount of money she is given acquires minimal items in the weekly food markets, where prices have become inflated.

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

Failing to secure jobs in Chad, her partner has left for Libya in the desire to earning sufficient funds for them to come later. She lives with his relatives, sharing out whatever food they can get.

Abubakar says she has already witnessed food rations being cut and there are fears that the sudden reductions in international assistance funds 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