🔗 Share this article

For hours, jolting along the soggy dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and tried hard stopping herself being sick. She was in labour, in severe suffering after her uterine wall split, but was now being jostled relentlessly 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, surviving precariously in this difficult terrain, are females. They stay in secluded encampments in the desert with scarce resources, few job opportunities and with treatment often a perilously remote away.

The hospital Mohammed needed was in Metche, one more encampment more than a considerable journey away.

“I continuously experienced infections during my pregnancy and I had to go the clinic multiple occasions – when I was there, the pregnancy started. But I found it impossible to give birth without intervention because my uterine muscles failed,” says Mohammed. “I had to endure a long delay for the ambulance but all I remember was the suffering; it was so bad I became confused.”

Her parent, Ashe Khamis Abdullah, 40, worried she would suffer the death of her daughter and baby grandson. But Mohammed was hurried into surgery when she reached the hospital and an critical surgical delivery rescued her and her son, Muwais.

Chad already had the world’s second most severe maternal mortality rate before the current influx of refugees, but the situations faced by the Sudanese expose further women in peril.

At the hospital, where they have assisted in the arrival of 824 babies in frequently urgent circumstances this year, the medics are able to save many, but it is what occurs with the women who are not able to reach the hospital that alarms the professionals.

In the two years since the internal conflict in Sudan started, the vast majority of the people who reached and stayed in Chad are women and children. In total, about 1.2 million Sudanese are being sheltered in the eastern part of the country, four hundred thousand of whom fled the past violence in Darfur.

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

Many adult men have not left to be near homes and land; many were murdered, captured or forced into fighting. Those of adult age move on quickly from Chad’s isolated encampments to find work in the capital, N’Djamena, or beyond, in nearby Libya.

It results in women are abandoned, without the means to feed the children and the elderly left in their care. To avoid overcrowding near the border, the Chadian government has transferred refugees to smaller camps such as Metche with average populations of about 50,000, but in isolated regions with no services and few opportunities.

Metche has a hospital set up by a medical aid organization, which began as a few tents but has grown to feature an operating theatre, but few additional amenities. There is a lack of jobs, families must travel long distances to find fuel, and each person must subsist with about minimal water of water a day – well under the suggested amount.

This remoteness means hospitals are receiving women with issues in their pregnancy at a critical stage. There is only a sole emergency vehicle to cover the route between the Metche hospital and the clinic near the Alacha encampment, where Mohammed is one of close to fifty thousand refugees. The medical team has encountered situations where women in extreme agony have had to wait an entire night for the ambulance to reach them.

Imagine being in the final trimester, in delivery, and making a lengthy trip on a donkey-drawn vehicle to get to a clinic

As well as being rough, the road traverses valleys that become inundated during the rainy season, completely blocking travel.

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

“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 biggest factor is the wait but having to arrive under such circumstances also has an effect on the delivery,” says the surgeon.

Undernourishment, which is on the rise, also increases the risk of complications in pregnancy, including the uterine ruptures that medical staff frequently observe.

Mohammed has continued under care in the couple of months since her caesarean. Suffering from malnutrition, she got sick, while her son has been carefully monitored. The parent has journeyed to other towns in search of work, so Mohammed is entirely leaning on her mother.

The undernourishment unit has expanded to six tents and has individuals overflowing into other sections. Children are placed under mosquito nets in extreme warmth in almost utter stillness as doctors and nurses work, creating remedies and measuring kids on a device constructed from a container and string.

In moderate instances children get packets of PlumpyNut, the uniquely designed peanut paste, but the most severe instances need a daily dose of enriched milk. Mohammed’s baby is fed his through a syringe.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being fed through a nasogastric tube. The baby has been unwell 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 tent,” she says. “The nutrition we receive is inadequate, there’s too little nourishment and it’s deficient in vitamins.

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

And what they are allocated is a meager portion of grain, edible oil and salt, distributed every couple of months. Such a minimal nutrition offers little sustenance, and the small amount of money she is given purchases very little in the weekly food markets, where values have increased.

Abubakar was moved to Alacha after coming from Sudan in 2023, having fled the armed group Rapid Support Forces’ attack on her birthplace of El Geneina in June that year.

Failing to secure jobs in Chad, her husband has traveled to Libya in the aspiration to gathering adequate cash for them to join him. She stays with his kin, sharing out whatever meals they acquire.

Abubakar says she has already seen food rations being cut and there are concerns that the sudden reductions in international assistance funds by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having created the 21st century’s most severe crisis and the {scale of needs|extent