🔗 Share this article

For a long time, bouncing over the flooded dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and tried hard stopping herself throwing up. She was in delivery, in agonizing discomfort after her uterus ruptured, 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 difficult terrain, are females. They stay in remote settlements in the desert with insufficient supplies, no work and with treatment often a perilously remote away.

The medical center Mohammed needed was in Metche, another refugee camp more than two hours away.

“I repeatedly suffered from infections during my pregnancy and I had to go the medical tent multiple occasions – when I was there, the pregnancy started. But I could not give birth normally because my womb had given way,” says Mohammed. “I had to endure a long delay for the ambulance but all I recall is the suffering; it was so bad I became disoriented.”

Her mother, Ashe Khamis Abdullah, 40, feared she would suffer the death of her offspring and descendant. But Mohammed was rushed straight into surgery when she got to the hospital and an urgent C-section saved 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 delivered 824 babies in often critical situations this year, the medical staff are able to help plenty, but it is what occurs with the women who are fail to get to the hospital that alarms the professionals.

In the 24 months since the domestic strife in Sudan started, the vast majority of the people who reached and stayed in Chad are mothers and kids. In total, about over a million Sudanese are being accommodated in the east of the country, a large number of whom escaped the past violence in Darfur.

Chad has taken the lion’s share 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 almost twelve million Sudanese have been uprooted from their homes.

Many adult men have remained to be near homes and land; some were slain, abducted or made to join the conflict. Those of employable age soon depart from Chad’s desolate refugee camps to seek employment in the main city, N’Djamena, or further, in nearby Libya.

It implies women are abandoned, without the means to provide for the young and old left in their charge. To reduce density near the border, the Chadian government has moved individuals to less crowded encampments such as Metche with typical numbers of about fifty thousand, but in distant locations with no services and few opportunities.

Metche has a hospital established by a medical aid organization, which started off as a few tents but has developed to contain an operating theatre, but few additional amenities. There is no work, families must travel long distances to find firewood, and each person must survive on about minimal water of water a day – well under the recommended 20 litres.

This seclusion means hospitals are receiving women with complications in their pregnancy at a critical stage. There is only a sole emergency vehicle to travel the path between the Metche hospital and the medical tent near the camp at Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has encountered situations where women in severe suffering have had to remain overnight for the ambulance to arrive.

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

As well as being bumpy, the route passes through 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 arduous trips to the hospital by foot or on a mule.

“Imagine being about to give birth, in delivery, and making a long trip on a donkey cart to get to a medical center. The primary issue is the wait but having to travel in this state also has an effect on the childbirth,” says the surgeon.

Poor nutrition, which is growing, also elevates the likelihood of complications in pregnancy, including the womb tears that medical staff often encounter.

Mohammed has continued under care in the two months since her surgical delivery. Experiencing malnutrition, she contracted an illness, while her son has been closely watched. The parent has travelled to other towns in look for employment, so Mohammed is totally dependent on her mother.

The nutritional care section has increased to six tents and has individuals overflowing into other sections. Children rest beneath mosquito nets in extreme warmth in almost complete silence as doctors and nurses work, preparing treatments and weighing children on a instrument created using a container and string.

In mild cases children get sachets of PlumpyNut, the specially formulated peanut paste, but the most severe instances need a regular intake of nutrient-rich liquid. Mohammed’s baby is given his nourishment through a medical device.

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being nourished via a nasogastric tube. The infant has been sick for the past year but Abubakar was only provided with painkillers without any diagnosis, until she made the trip from Alacha to Metche.

“Every day, I see more children arriving in this shelter,” she says. “The meals we consume is low-quality, there’s too little nourishment and it’s not nutritious.

“If we were at home, we could’ve coped better. You can go and cultivate plants, 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 grain, vegetable oil and salt, handed out every 60 days. Such a minimal nutrition offers little sustenance, and the meager funds she is given acquires minimal items in the weekly food markets, where values have increased.

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

Finding no work in Chad, her spouse has traveled to Libya in the aspiration to earning sufficient funds for them to come later. She lives with his relatives, dividing up whatever meals they acquire.

Abubakar says she has already witnessed food supplies decreasing and there are concerns that the sudden reductions in foreign support money by the US, UK and other European countries, could make things worse. Despite the war in Sudan having created the 21st century’s gravest emergency and the {scale of needs|extent