🔗 Share this article

For a long time, travelling roughly on the waterlogged dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and tried hard stopping herself throwing up. She was in labour, in agonizing discomfort after her womb tore, but was now being tossed around in the ambulance that lurched across the dips and bumps of the road through the Chadian desert.

Most of the hundreds of thousands of Sudanese displaced persons who escaped to Chad since 2023, barely getting by in this inhospitable environment, are women. They stay in isolated camps in the desert with scarce resources, little employment and with healthcare often a life-threateningly long distance away.

The clinic Mohammed needed was in Metche, another refugee camp more than a considerable journey away.

“I continuously experienced infections during my gestation and I had to go the health post on numerous visits – when I was there, the delivery commenced. But I wasn’t able to give birth naturally because my uterine muscles failed,” says Mohammed. “I had to endure a long delay for the ambulance but all I can think of the pain; it was so unbearable I became disoriented.”

Her parent, Ashe Khamis Abdullah, 40, feared she would suffer the death of her daughter and baby grandson. But Mohammed was rushed straight into surgery when she reached the hospital and an emergency caesarean section saved her and her son, Muwais.

Chad previously recorded the world’s second-highest maternal death rate before the current influx of refugees, but the circumstances suffered by the Sudanese place additional women in risk.

At the hospital, where they have delivered 824 babies in mostly emergency conditions this year, the medical staff are able to rescue numerous, but it is what happens to the women who are fail to get to the hospital that alarms the professionals.

In the 24 months since the internal conflict in Sudan started, the vast majority of the people who reached and settled in Chad are mothers and kids. In total, about over a million Sudanese are being sheltered in the eastern region of the country, four hundred thousand of whom fled the past violence in Darfur.

Chad has taken the lion’s share of the 4.1 million people who have run from the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been uprooted from their homes.

Many adult men have not left to be in proximity to homes and land; many were slain, abducted or made to join the conflict. Those of adult age move on quickly from Chad’s desolate refugee camps to find work in the capital, N’Djamena, or elsewhere, in neighbouring Libya.

It implies women are stranded, without the means to sustain the dependents left in their care. To prevent congestion near the border, the Chadian government has relocated people to more compact settlements such as Metche with usual resident counts of about 50,000, but in remote areas with no services and few opportunities.

Metche has a hospital built by a medical aid organization, which began as a few tents but has grown to feature an surgical room, but not much more. There is unemployment, families must journey for extended periods to find firewood, and each person must subsist with about a small amount of water a day – well under the recommended 20 litres.

This seclusion means hospitals are admitting women with problems in their pregnancy at a critical stage. There is only a single ambulance to serve the area between the Metche hospital and the clinic near the camp at Alacha, where Mohammed is one of nearly 50,000 refugees. The medical team has seen cases where women in severe suffering have had to wait an entire night for the ambulance to reach them.

Imagine being in the final trimester, in childbirth, and travelling hours on a animal-drawn transport to get to a hospital

As well as being rough, the road traverses valleys that become inundated during the wet period, completely preventing travel.

A surgeon at the hospital in Metche said each patient she treats is an crisis, with some women having to make challenging travels to the hospital by on foot or on a donkey.

“Imagine being nine months pregnant, in labour, and travelling hours on a donkey cart to get to a medical center. The main problem is the delay but having to travel in this state also has an effect on the childbirth,” says the surgeon.

Undernourishment, which is on the rise, also elevates the likelihood of problems in pregnancy, including the womb tears that medical staff often encounter.

Mohammed has remained in hospital in the two months since her C-section. Suffering from malnutrition, she contracted an illness, while her son has been carefully monitored. The male guardian has gone to other towns in look for employment, so Mohammed is entirely leaning on her mother.

The nutritional care section has grown to six tents and has individuals overflowing into other sections. Children rest beneath mosquito nets in oppressive temperatures in almost complete silence as doctors and nurses work, mixing medications and measuring kids on a scale made from a pail and cord.

In mild cases children get small bags of PlumpyNut, the specifically created peanut paste, but the most severe instances need a daily dose of fortified formula. Mohammed’s baby is given his nourishment through a syringe.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being fed through a nasal drip. The infant has been sick for the past year but Abubakar was only provided with painkillers without any identification, until she made the travel from Alacha to Metche.

“Every day, I see further minors arriving in this shelter,” she says. “The food we’re eating is poor, there’s insufficient food and it’s lacking in nutrients.

“If we were at home, we could’ve adapted ourselves. You can go and cultivate plants, you can work to earn some money, but here we’re relying on what we’re provided.”

And what they are given is a small amount of grain, cooking oil and salt, handed out every 60 days. Such a simple food lacks nutrition, and the little cash she is given purchases very little in the regular markets, where costs have risen.

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

Unable to get employment in Chad, her partner has traveled to Libya in the desire to raising enough money for them to come later. She lives with his family members, dividing up whatever meals they acquire.

Abubakar says she has already seen food supplies decreasing and there are worries that the sharp decreases in foreign support money by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having caused the 21st century’s gravest emergency and the {scale of needs|extent