🔗 Share this article

For hours, bouncing over the flooded dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and focused on stopping herself throwing up. She was in delivery, in severe suffering after her uterine wall split, but was now being tossed around in the ambulance that lurched across the uneven terrain of the road through the Chadian desert.

Most of the 878,000 Sudanese people who ran to Chad since 2023, living hand to mouth in this harsh landscape, are women. They live 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, a different settlement more than a considerable journey away.

“I continuously experienced infections during my gestation and I had to go the clinic on numerous visits – when I was there, the pregnancy started. But I could not give birth normally because my uterine muscles failed,” says Mohammed. “I had to endure a long delay for the ambulance but all I remember was the pain; it was so unbearable I became delirious.”

Her mother, Ashe Khamis Abdullah, 40, was terrified she would suffer the death of her offspring and descendant. But Mohammed was immediately taken for surgery when she reached the hospital and an critical surgical delivery saved her and her son, Muwais.

Chad previously recorded the world’s second-highest maternal fatality statistic before the ongoing stream of refugees, but the conditions endured by the Sudanese expose further women in peril.

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

In the couple of years since the internal conflict in Sudan began, over four-fifths of the refugees who have arrived and remained in Chad are mothers and kids. In total, about over a million Sudanese are being accommodated in the eastern region of the country, four hundred thousand of whom fled the past violence in Darfur.

Chad has hosted the bulk of the over four million people who have escaped the war in Sudan; others have gone 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 in proximity to homes and land; many were killed, taken hostage or conscripted. Those of working age soon depart from Chad’s barren settlements to look for jobs in the main city, N’Djamena, or further, in nearby Libya.

It means women are stranded, without the resources to provide for the children and the elderly left in their care. To reduce density near the border, the Chadian government has transferred refugees to more compact settlements such as Metche with typical numbers of about a large community, but in distant locations with limited infrastructure and minimal chances.

Metche has a hospital set up by a medical aid organization, which began as a few tents but has expanded to include an procedure area, but few additional amenities. There is unemployment, families must journey for extended periods to find firewood, and each person must subsist with about nine litres of water a day – much less than the recommended 20 litres.

This seclusion means hospitals are treating women with problems in their pregnancy at a critical stage. There is only a sole emergency vehicle to cover the route between the Metche hospital and the medical tent near the Alacha encampment, where Mohammed is one of a large number of refugees. The medical team has seen cases where women in severe suffering have had to endure a full night for the ambulance to come.

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

As well as being uneven, the road traverses valleys that flood during the rainy season, completely cutting off 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 foot or on a donkey.

“Imagine being about to give birth, in labour, and travelling hours on a donkey cart to get to a hospital. The main problem is the wait but having to travel in this state also has an influence on the childbirth,” says the surgeon.

Undernourishment, which is growing, also raises the chance of problems in pregnancy, including the uterine ruptures that medical staff frequently observe.

Mohammed has continued under care in the 60 days since her C-section. Suffering from malnutrition, she developed an infection, while her son has been regularly checked. 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 lie under mosquito nets in oppressive temperatures in almost total quiet as medical staff work, mixing medications and weighing children on a scale made from a container and string.

In mild cases children get small bags of PlumpyNut, the specially formulated peanut paste, but the most severe instances need a regular intake of enriched milk. Mohammed’s baby is fed his through a medical device.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being fed through a nasal drip. The baby has been sick for the past year but Abubakar was consistently offered just painkillers without any medical assessment, until she made the travel from Alacha to Metche.

“Every day, I see more children arriving in this tent,” she says. “The nutrition we receive is low-quality, there’s not enough to eat and it’s not nutritious.

“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 relying on what we’re distributed.”

And what they are allocated is a meager portion of cereal, vegetable oil and salt, handed out every couple of months. Such a basic diet lacks nutrition, and the little cash she is given acquires minimal items in the weekly food markets, where costs have risen.

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

Unable to get employment in Chad, her partner has left for Libya in the hope of raising enough money for them to come later. She resides with his relatives, distributing whatever meals they acquire.

Abubakar says she has already witnessed food distributions being reduced and there are fears that the sudden reductions in international assistance funds by the US, UK and other European countries, could worsen the situation. Despite the war in Sudan having created the 21st century’s gravest emergency and the {scale of needs|extent