🔗 Share this article

For an extended period, jolting along the soggy dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and concentrated on stopping herself vomiting. She was in delivery, in agonizing discomfort after her uterus ruptured, 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 close to a million Sudanese people who ran to Chad since 2023, living hand to mouth in this inhospitable environment, are women. They stay in secluded encampments in the desert with insufficient supplies, no work and with treatment often a life-threateningly long distance away.

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

“I kept getting infections during my gestation and I had to go the health post on numerous visits – when I was there, the labour began. But I wasn’t able to give birth naturally because my uterine muscles failed,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I can think of the pain; it was so intense I became delirious.”

Her mother, Ashe Khamis Abdullah, 40, was terrified she would lose both her child and grandchild. But Mohammed was immediately taken for surgery when she got to the hospital and an urgent C-section preserved the lives of her and her son, Muwais.

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

At the hospital, where they have birthed 824 babies in often critical situations this year, the medical staff are able to rescue numerous, but it is what occurs with the women who are fail to get to the hospital that worries the staff.

In the 24 months since the internal conflict in Sudan began, 86% of the displaced persons who came and stayed in Chad are women and children. In total, about over a million Sudanese are being sheltered in the eastern region of the country, 400,000 of whom ran from the earlier war in Darfur.

Chad has taken the lion’s share of the millions of people who have run from 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 men have stayed behind to be close to homes and land; many were killed, captured or conscripted. Those of adult age move on quickly from Chad’s isolated encampments to find work in the capital, N’Djamena, or elsewhere, in neighbouring Libya.

It means women are stranded, without the means to provide for the dependents left in their responsibility. To prevent congestion near the border, the Chadian government has relocated people to less crowded encampments such as Metche with usual resident counts of about a large community, but in isolated regions with no services and scarce prospects.

Metche has a hospital set up by a medical aid organization, which was initially a few tents but has developed to contain an procedure area, but little else. There is a lack of jobs, families must walk hours to find burning material, and each person must get by with about a small amount of water a day – much less than the recommended 20 litres.

This remoteness means hospitals are treating women with complications 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 a large number of refugees. The medical team has observed instances where women in severe suffering have had to wait an entire night for the ambulance to come.

Imagine being nine months pregnant, in labour, and travelling hours on a animal-drawn transport to get to a hospital

As well as being bumpy, the route passes through valleys that fill with water during the monsoon, completely preventing travel.

A surgeon at the hospital in Metche said all the situations she encounters is an critical situation, 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 childbirth, and travelling hours on a donkey cart to get to a hospital. The main problem is the wait but having to come in these conditions also has an influence on the delivery,” says the surgeon.

Undernourishment, which is growing, also elevates the likelihood of complications in pregnancy, including the womb tears that medical staff frequently observe.

Mohammed has continued under care in the 60 days since her surgical delivery. Afflicted by malnutrition, she developed an infection, while her son has been carefully monitored. The parent has journeyed to other towns in look for employment, so Mohammed is totally dependent on her mother.

The malnutrition ward has increased to six tents and has cases exceeding capacity into other sections. Children are placed under mosquito nets in sweltering heat in almost complete silence as health workers work, preparing treatments and measuring kids on a scale made from a container and string.

In less severe situations children get small bags 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 medical device.

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

“Every day, I see more children joining us in this shelter,” she says. “The nutrition we receive is poor, there’s too little nourishment and it’s deficient in vitamins.

“If we were at home, we could’ve coped better. You can go and farm produce, you can get a job, but here we’re reliant on what we’re given.”

And what they are given is a limited quantity of sorghum, cooking oil and salt, provided every two months. Such a minimal nutrition is deficient in nutrients, and the little cash she is given cannot buy much in the local bazaars, where values have increased.

Abubakar was transferred to Alacha after coming from Sudan in 2023, having run from the paramilitary Rapid Support Forces’ attack on her native town of El Geneina in June that year.

Unable to get employment in Chad, her spouse has gone to Libya in the desire to gathering adequate cash for them to come later. She lives with his relatives, sharing out whatever meals they acquire.

Abubakar says she has already witnessed food distributions being reduced and there are worries that the abrupt cuts in foreign support money 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