🔗 Share this article

For hours, travelling roughly on the soggy dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and focused on stopping herself throwing up. She was in labour, in agonizing discomfort after her uterus ruptured, but was now being tossed around in the ambulance that bumped over the uneven terrain of the road through the Chadian desert.

Most of the hundreds of thousands of Sudanese refugees who have fled to Chad since 2023, living hand to mouth in this inhospitable environment, are women. They live in remote settlements in the desert with limited water and food, little employment and with healthcare often a perilously remote away.

The hospital Mohammed needed was in Metche, one more encampment more than 120 minutes away.

“I kept getting infections during my term and I had to go the medical tent seven times – 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 remain for 120 minutes for the ambulance but all I can think of the suffering; it was so intense I became confused.”

Her mother, Ashe Khamis Abdullah, 40, feared she would suffer the death of her child and grandchild. But Mohammed was rushed straight into surgery when she got to the hospital and an critical surgical delivery saved her and her son, Muwais.

Chad was known for the world’s second worst maternal fatality statistic before the current influx of refugees, but the circumstances suffered by the Sudanese expose further women in risk.

At the hospital, where they have birthed 824 babies in mostly emergency conditions this year, the doctors are able to help plenty, but it is what affects the women who are cannot access the hospital that alarms the professionals.

In the 24 months since the domestic strife in Sudan began, 86% of the people who reached and settled in Chad are mothers and kids. In total, about over a million Sudanese are being sheltered in the eastern region of the country, 400,000 of whom escaped the past violence in Darfur.

Chad has hosted the bulk of the millions of people who have escaped the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been uprooted from their homes.

Many males have not left to be in proximity to homes and land; many were murdered, taken hostage or forced into fighting. Those of working age rapidly leave from Chad’s isolated encampments to seek employment in the capital, N’Djamena, or beyond, in nearby Libya.

It means women are left alone, without the means to provide for the dependents left in their care. To prevent congestion near the border, the Chadian government has moved individuals to smaller camps such as Metche with average populations of about 50,000, but in isolated regions with limited infrastructure and minimal chances.

Metche has a hospital built by a medical aid organization, which began as a few tents but has expanded to include an operating theatre, but not much more. There is unemployment, families must journey for extended periods to find burning material, and each person must get by with about a small amount of water a day – well under the suggested amount.

This isolation means hospitals are admitting women with problems in their pregnancy at a critical stage. There is only a one medical transport to cover the route between the Metche hospital and the health post near the settlement of Alacha, where Mohammed is one of nearly 50,000 refugees. The medical team has observed instances where women in desperate pain have had to wait an entire night for the ambulance to arrive.

Imagine being nine months pregnant, in labour, and making a lengthy trip on a donkey-drawn vehicle to get to a medical facility

As well as being rough, the road traverses valleys that become inundated during the wet period, completely preventing travel.

A surgeon at the hospital in Metche said every case she sees 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 journeying for an extended time on a cart pulled by a donkey to get to a medical center. The primary issue is the lag but having to arrive under such circumstances also has an impact on the childbirth,” says the surgeon.

Poor nutrition, which is on the rise, also raises the chance of problems in pregnancy, including the uterine splits that medical staff frequently observe.

Mohammed has continued under care in the two months since her surgical delivery. Afflicted by malnutrition, she developed an infection, while her son has been closely watched. The father has travelled to other towns in seek jobs, so Mohammed is completely reliant on her mother.

The malnutrition ward has expanded to six tents and has individuals overflowing into other sections. Children are placed under mosquito nets in oppressive temperatures in almost total quiet as health workers work, creating remedies and assessing weights on a device constructed from a bucket and rope.

In mild cases children get sachets of PlumpyNut, the specially formulated peanut paste, but the worst cases need a regular intake of enriched milk. Mohammed’s baby is administered his nutrition through a injector.

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being given nutrition by a nasogastric tube. The child 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 additional kids arriving in this tent,” she says. “The meals we consume is poor, there’s not enough to eat and it’s not nutritious.

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

And what they are allocated is a limited quantity of sorghum, vegetable oil and salt, provided every two months. Such a minimal nutrition offers little sustenance, and the small amount of money she is given acquires minimal items in the weekly food markets, where costs have risen.

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

Finding no work in Chad, her spouse has gone to Libya in the aspiration to earning sufficient funds for them to come later. She lives with his family members, dividing up whatever food they can get.

Abubakar says she has already witnessed food supplies decreasing 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