🔗 Share this article

For an extended period, bouncing over the waterlogged dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and tried hard stopping herself vomiting. She was in childbirth, in extreme pain after her uterine wall split, but was now being tossed around in the ambulance that jumped along the uneven terrain of the road through the Chadian desert.

Most of the close to a million Sudanese displaced persons who escaped to Chad since 2023, barely getting by in this difficult terrain, are females. They stay in secluded encampments in the desert with limited water and food, little employment and with healthcare often a dangerously far away.

The hospital Mohammed needed was in Metche, one more encampment more than two hours away.

“I repeatedly suffered from infections during my term and I had to go the clinic multiple occasions – when I was there, the delivery commenced. But I found it impossible to give birth naturally because my womb had given way,” says Mohammed. “I had to endure a long delay for the ambulance but all I remember was the agony; it was so bad I became delirious.”

Her parent, Ashe Khamis Abdullah, 40, worried she would suffer the death of her offspring and descendant. But Mohammed was rushed straight into surgery when she got to 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 mortality rate before the current influx of refugees, but the conditions endured by the Sudanese place additional women in risk.

At the hospital, where they have birthed 824 babies in frequently urgent circumstances this year, the medics are able to save many, but it is what affects the women who are fail to get to the hospital that concerns them.

In the 24 months since the civil war in Sudan began, 86% of the displaced persons who came and remained in Chad are women and children. In total, about 1.2 million Sudanese are being sheltered in the east of the country, a large number of whom escaped the past violence in Darfur.

Chad has taken the lion’s share of the millions of people who have fled the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been uprooted from their homes.

Many men have remained to be close to homes and land; others have been murdered, abducted or forced into fighting. Those of working age soon depart from Chad’s desolate refugee camps to look for jobs in the capital, N’Djamena, or beyond, in nearby Libya.

It means women are left alone, without the ability to feed the dependents left in their charge. To avoid overcrowding 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 began as a few tents but has developed to contain an procedure area, but few additional amenities. There is no work, families must journey for extended periods to find burning material, and each person must subsist with about minimal water of water a day – much less than the recommended 20 litres.

This isolation means hospitals are admitting women with issues in their pregnancy when it is almost too late. There is only a one medical transport to travel the path between the Metche hospital and the medical tent near the settlement of Alacha, where Mohammed is one of a large number of refugees. The medical team has encountered situations where women in desperate pain have had to remain overnight for the ambulance to come.

Imagine being in the final trimester, in labour, and making a lengthy trip on a cart pulled by a donkey to get to a hospital

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

A surgeon at the hospital in Metche said every case she sees is an emergency, with some women having to make arduous trips to the hospital by walking or on a mule.

“Imagine being in the late stages of pregnancy, in labour, and journeying for an extended time on a animal-drawn vehicle to get to a clinic. The main problem is the wait but having to arrive under such circumstances also has an influence on the birth,” says the surgeon.

Poor nutrition, which is increasing, also raises the chance of issues in pregnancy, including the uterine ruptures that medical staff frequently observe.

Mohammed has continued under care in the 60 days since her caesarean. Experiencing malnutrition, she contracted an illness, while her son has been carefully monitored. The parent has travelled 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 sweltering heat in almost complete silence as doctors and nurses work, preparing treatments and measuring kids on a instrument created using a pail and cord.

In mild cases children get sachets of PlumpyNut, the uniquely designed peanut paste, but the critical situations need a consistent supply of enriched milk. Mohammed’s baby is fed his through a injector.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being nourished via a nasogastric tube. The child has been sick for the past year but Abubakar was repeatedly given only painkillers without any diagnosis, until she made the journey from Alacha to Metche.

“Every day, I see further minors joining us in this tent,” she says. “The meals we consume is low-quality, there’s insufficient food and it’s lacking in nutrients.

“If we were at home, we could’ve coped better. You can go and cultivate plants, you can work to earn some money, but here we’re reliant on what we’re distributed.”

And what they are provided is a limited quantity of cereal, edible oil and salt, provided every two months. Such a basic diet offers little sustenance, and the little cash she is given purchases very little in the local bazaars, where costs have risen.

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

Unable to get employment in Chad, her husband has left for Libya in the desire to raising enough money for them to join him. She stays with his family members, sharing out whatever meals they acquire.

Abubakar says she has already witnessed food rations being cut and there are worries 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