🔗 Share this article

For hours, bouncing over the waterlogged dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and tried hard stopping herself vomiting. She was in childbirth, in extreme pain after her womb tore, but was now being shaken violently in the ambulance that bumped over the dips and bumps of the road through the Chadian desert.

Most of the hundreds of thousands of Sudanese people who ran to Chad since 2023, barely getting by in this harsh landscape, are females. They live in remote settlements in the desert with insufficient supplies, little employment and with treatment often a life-threateningly long distance away.

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

“I repeatedly suffered from infections during my gestation and I had to go the medical tent on numerous visits – when I was there, the delivery commenced. But I could not give birth naturally because my uterus had collapsed,” says Mohammed. “I had to wait two hours for the ambulance but all I remember was the agony; it was so bad I became disoriented.”

Her mother, Ashe Khamis Abdullah, 40, worried she would suffer the death of her child and grandchild. But Mohammed was hurried into surgery when she arrived at the hospital and an urgent C-section rescued her and her son, Muwais.

Chad was known for the world’s second worst maternal fatality statistic before the recent arrival of refugees, but the situations faced by the Sudanese put even more women in risk.

At the hospital, where they have assisted in the arrival of 824 babies in frequently urgent circumstances this year, the doctors are able to help plenty, but it is what happens to the women who are cannot access the hospital that alarms the professionals.

In the 24 months since the civil war in Sudan started, the vast majority of the people who reached and remained in Chad are females and minors. In total, about one point two million Sudanese are being sheltered in the eastern part of the country, four hundred thousand of whom fled the earlier war in Darfur.

Chad has accepted the majority of the over four million people who have run from the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been displaced from their homes.

Many males have remained to be in proximity to homes and land; others have been killed, taken hostage or forced into fighting. Those of employable age rapidly leave from Chad’s isolated encampments to find work in the capital, N’Djamena, or beyond, in nearby Libya.

It results in women are left alone, without the resources to feed the young and old left in their charge. To reduce density near the border, the Chadian government has relocated people to more compact settlements such as Metche with average populations of about a large community, but in remote areas 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 grown to feature an procedure area, but few additional amenities. There is a lack of jobs, families must travel long distances to find fuel, and each person must get by with about minimal water of water a day – well under the advised quantity.

This seclusion means hospitals are receiving women with issues in their pregnancy when it is almost too late. There is only a single ambulance 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 severe suffering have had to wait an entire night for the ambulance to come.

Imagine being expecting a child, in childbirth, and making a lengthy trip on a animal-drawn transport to get to a clinic

As well as being rough, the route passes through valleys that fill with water during the monsoon, completely cutting off travel.

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

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

Poor nutrition, which is on the rise, also increases the risk of issues in pregnancy, including the uterine ruptures that medical staff see regularly.

Mohammed has remained in hospital in the 60 days since her caesarean. Experiencing malnutrition, she contracted an illness, while her son has been regularly checked. The father has journeyed to other towns in look for employment, so Mohammed is totally dependent on her mother.

The nutritional care section has grown to six tents and has cases exceeding capacity into other sections. Children lie under mosquito nets in sweltering heat in almost complete silence as medical staff work, creating remedies and weighing children on a device constructed from a container and string.

In moderate instances children get small bags of PlumpyNut, the specifically created peanut paste, but the critical situations need a daily dose of nutrient-rich liquid. Mohammed’s baby is administered his nutrition through a injector.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being nourished via a nasal drip. The child has been unwell for the past year but Abubakar was repeatedly given only painkillers without any medical assessment, until she made the travel from Alacha to Metche.

“Every day, I see more children arriving in this structure,” she says. “The meals we consume is low-quality, there’s not enough to eat and it’s deficient in vitamins.

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

And what they are allocated is a meager portion of sorghum, cooking oil and salt, handed out every 60 days. Such a basic diet offers little sustenance, and the small amount of money she is given purchases very little in the regular markets, where costs have risen.

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

Unable to get employment in Chad, her spouse has traveled to Libya in the aspiration to raising enough money for them to follow. She stays with his kin, sharing out whatever food they can get.

Abubakar says she has already witnessed food rations being cut and there are worries that the sudden reductions in foreign support money by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having produced the 21st century’s most severe crisis and the {scale of needs|extent