🔗 Share this article

For hours, jolting along the flooded dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and focused on stopping herself throwing up. She was in childbirth, in severe suffering after her uterine wall split, but was now being shaken violently in the ambulance that bumped over the uneven terrain of the road through the Chadian desert.

Most of the 878,000 Sudanese refugees who have fled to Chad since 2023, barely getting by in this difficult terrain, are women. They reside in isolated camps in the desert with limited water and food, little employment and with healthcare often a dangerously far away.

The clinic Mohammed needed was in Metche, a different settlement more than a considerable journey away.

“I continuously experienced infections during my pregnancy and I had to go the health post on numerous visits – when I was there, the labour began. But I wasn’t able to give birth normally because my uterus had collapsed,” says Mohammed. “I had to wait two hours for the ambulance but all I remember was the suffering; it was so unbearable I became disoriented.”

Her maternal figure, Ashe Khamis Abdullah, 40, feared she would be bereft of her offspring and descendant. But Mohammed was immediately taken for surgery when she got to the hospital and an urgent C-section rescued her and her son, Muwais.

Chad already had the world’s second worst maternal death rate before the current influx of refugees, but the circumstances suffered by the Sudanese place additional women in danger.

At the hospital, where they have assisted in the arrival of 824 babies in mostly emergency conditions this year, the doctors are able to help plenty, but it is what happens to the women who are cannot access the hospital that alarms the professionals.

In the two years since the civil war in Sudan started, 86% of the displaced persons who came and stayed in Chad are women and children. In total, about one point two million Sudanese are being sheltered in the eastern part of the country, 400,000 of whom fled the earlier war in Darfur.

Chad has hosted the bulk of the millions of people who have fled the war in Sudan; some have travelled 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 near homes and land; others have been murdered, abducted or forced into fighting. Those of working age soon depart from Chad’s barren settlements to seek employment in the capital, N’Djamena, or beyond, in adjacent Libya.

It results in women are stranded, without the ability to provide for the young and old left in their responsibility. To reduce density near the border, the Chadian government has transferred refugees to less crowded encampments such as Metche with typical numbers of about a large community, but in isolated regions 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 developed to contain an operating theatre, but not much more. There is unemployment, families must travel long distances to find firewood, and each person must survive on about nine litres of water a day – well under the suggested amount.

This seclusion means hospitals are treating women with issues 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 medical tent near the camp at Alacha, where Mohammed is one of nearly 50,000 refugees. The medical team has seen cases where women in desperate pain have had to endure a full night for the ambulance to come.

Imagine being in the final trimester, in delivery, and journeying for a long time on a cart pulled by a donkey to get to a medical facility

As well as being rough, 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 emergency, with some women having to make long and difficult journeys to the hospital by walking or on a pack animal.

“Imagine being about to give birth, in labour, and making a long trip on a donkey cart to get to a medical center. The biggest factor is the wait but having to come in these conditions also has an effect on the childbirth,” says the surgeon.

Poor nutrition, which is growing, also raises the chance of problems in pregnancy, including the womb tears that medical staff often encounter.

Mohammed has remained in hospital in the 60 days since her C-section. Suffering from malnutrition, she developed an infection, while her son has been carefully monitored. The father has travelled to other towns in look for employment, so Mohammed is entirely leaning on her mother.

The malnutrition ward has expanded to six tents and has individuals overflowing into other sections. Children lie under mosquito nets in oppressive temperatures in almost complete silence as health workers work, creating remedies and assessing weights on a instrument created using a pail and cord.

In mild cases children get small bags of PlumpyNut, the uniquely designed peanut paste, but the worst cases need a regular intake of nutrient-rich liquid. Mohammed’s baby is given his nourishment through a syringe.

Suhayba Abdullah Abubakar’s 11-month-old boy, 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 diagnosis, until she made the travel from Alacha to Metche.

“Every day, I see additional kids arriving in this shelter,” she says. “The nutrition we receive is inadequate, there’s insufficient food and it’s deficient in vitamins.

“If we were at home, we could’ve adapted ourselves. You can go and grow crops, you can find employment, but here we’re reliant on what we’re distributed.”

And what they are given is a limited quantity of sorghum, edible oil and salt, provided every two months. Such a basic diet lacks nutrition, and the meager funds she is given acquires minimal items in the weekly food markets, where prices have become inflated.

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

Unable to get employment in Chad, her partner has gone to Libya in the aspiration to raising enough money for them to join him. She resides with his relatives, sharing out whatever meals they acquire.

Abubakar says she has already observed food rations being cut and there are fears that the abrupt cuts in overseas aid budgets by the US, UK and other European countries, could make things worse. Despite the war in Sudan having caused the 21st century’s worst humanitarian disaster and the {scale of needs|extent