🔗 Share this article

For a long time, jolting along the flooded dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and concentrated on stopping herself being sick. She was in delivery, in extreme pain after her womb tore, 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, living hand to mouth in this inhospitable environment, are females. They stay in isolated camps in the desert with scarce resources, few job opportunities and with treatment often a life-threateningly long distance away.

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

“I continuously experienced infections during my gestation and I had to go the medical tent seven times – when I was there, the pregnancy started. But I wasn’t able to give birth normally because my uterus had collapsed,” says Mohammed. “I had to endure a long delay for the ambulance but all I remember was the pain; it was so intense I became confused.”

Her parent, Ashe Khamis Abdullah, 40, worried she would be bereft of her daughter and baby grandson. But Mohammed was immediately taken for surgery when she reached the hospital and an urgent C-section rescued 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 circumstances suffered by the Sudanese expose further women in peril.

At the hospital, where they have assisted in the arrival of 824 babies in often critical situations this year, the doctors are able to rescue numerous, but it is what affects the women who are cannot access the hospital that alarms the professionals.

In the two years since the domestic strife in Sudan started, the vast majority of the refugees who have arrived and settled in Chad are mothers and kids. In total, about one point two million Sudanese are being sheltered in the east of the country, four hundred thousand of whom ran from the previous conflict in Darfur.

Chad has taken the lion’s share of the 4.1 million people who have fled the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been uprooted from their homes.

Many males have stayed behind to be in proximity to homes and land; many were murdered, taken hostage or forced into fighting. Those of employable age move on quickly from Chad’s barren settlements to find work in the capital, N’Djamena, or beyond, in neighbouring Libya.

It implies women are abandoned, without the ability to provide for the dependents left in their charge. To avoid overcrowding near the border, the Chadian government has moved individuals to more compact settlements such as Metche with average populations of about a large community, but in remote areas with no services and scarce prospects.

Metche has a hospital established by a medical aid organization, which was initially a few tents but has developed to contain an procedure area, but not much more. There is no work, families must walk hours to find firewood, and each person must survive on about minimal water of water a day – well under the suggested amount.

This remoteness means hospitals are treating women with issues in their pregnancy at a critical stage. There is only a sole emergency vehicle to serve the area between the Metche hospital and the clinic near the settlement of 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 reach them.

Imagine being expecting a child, in delivery, and making a lengthy trip on a cart pulled by a donkey to get to a medical facility

As well as being rough, the path goes through valleys that fill with water during the monsoon, completely preventing travel.

A surgeon at the hospital in Metche said every case she sees is an critical situation, with some women having to make challenging travels to the hospital by walking or on a donkey.

“Imagine being nine months pregnant, in labour, and making a long trip on a cart pulled by a donkey to get to a clinic. The biggest factor is the delay but having to come in these conditions also has an effect on the birth,” says the surgeon.

Malnutrition, which is on the rise, also increases the risk of problems in pregnancy, including the uterine ruptures that medical staff often encounter.

Mohammed has stayed at the medical facility in the couple of months since her surgical delivery. Experiencing malnutrition, she got sick, while her son has been carefully monitored. The parent has travelled to other towns in look for employment, so Mohammed is completely reliant on her mother.

The undernourishment unit has expanded to six tents and has patients spilling over into other sections. Children are placed under mosquito nets in sweltering heat in almost total quiet as medical staff work, preparing treatments and assessing weights on a scale made from a container and string.

In moderate instances children get small bags of PlumpyNut, the specially formulated peanut paste, but the most severe instances need a daily dose of enriched milk. Mohammed’s baby is given his nourishment through a medical device.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being nourished via a nasal drip. The infant has been sick for the past year but Abubakar was consistently offered just painkillers without any medical assessment, until she made the trip from Alacha to Metche.

“Every day, I see more children joining us in this tent,” she says. “The meals we consume is low-quality, there’s too little nourishment and it’s lacking in nutrients.

“If we were at home, we could’ve adapted ourselves. You can go and grow crops, you can get a job, but here we’re reliant on what we’re provided.”

And what they are provided is a meager portion of sorghum, vegetable oil and salt, distributed every 60 days. Such a simple food is deficient in nutrients, and the meager funds she is given cannot buy much in the weekly food markets, where values have increased.

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

Failing to secure jobs in Chad, her spouse has left for Libya in the hope of earning sufficient funds for them to follow. She resides with his kin, distributing whatever food they can get.

Abubakar says she has already seen food distributions being reduced 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 worst humanitarian disaster and the {scale of needs|extent