‘I have sought aid repeatedly’: the Sudanese women left alone to live hand to mouth in Chad’s arid settlements.

For hours, travelling roughly on the soggy dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and focused on stopping herself being sick. She was in delivery, in severe suffering after her womb tore, but was now being jostled relentlessly in the ambulance that lurched across the dips and bumps of the road through the Chadian desert.

Most of the 878,000 Sudanese people who ran to Chad since 2023, surviving precariously in this difficult terrain, are females. They live in secluded encampments in the desert with insufficient supplies, little employment and with treatment often a life-threateningly long distance away.

The medical center Mohammed needed was in Metche, another refugee camp more than 120 minutes away.

“I continuously experienced infections during my pregnancy and I had to go the clinic seven times – when I was there, the labour began. But I found it impossible 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 suffering; it was so intense I became confused.”

Her maternal figure, Ashe Khamis Abdullah, 40, was terrified she would be bereft of her daughter and baby grandson. But Mohammed was rushed straight into 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 fatality statistic before the current influx of refugees, but the situations faced by the Sudanese put even more women in risk.

At the hospital, where they have birthed 824 babies in mostly emergency conditions this year, the doctors are able to save many, but it is what occurs with the women who are fail to get to the hospital that concerns them.

In the two years since the internal conflict in Sudan erupted, 86% of the refugees who have arrived and settled in Chad are women and children. In total, about 1.2 million Sudanese are being sheltered in the eastern region of the country, a large number of whom fled the previous conflict in Darfur.

Chad has taken the lion’s share of the millions of people who have run from the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been forced out of their homes.

Many males have stayed behind to be close to homes and land; some were murdered, captured or made to join the conflict. Those of adult age soon depart from Chad’s barren settlements to find work in the main city, N’Djamena, or further, in neighbouring Libya.

It implies women are stranded, without the ability to sustain the children and the elderly left in their responsibility. To avoid overcrowding near the border, the Chadian government has relocated people to smaller camps such as Metche with average populations of about fifty thousand, but in isolated regions 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 expanded to include an operating theatre, but few additional amenities. There is unemployment, families must walk hours to find firewood, and each person must subsist with about a small amount of water a day – far below the suggested amount.

This isolation means hospitals are admitting women with issues in their pregnancy dangerously late. There is only a one medical transport to serve the area between the Metche hospital and the clinic near the Alacha encampment, where Mohammed is one of nearly 50,000 refugees. The medical team has seen cases where women in extreme agony have had to endure a full night for the ambulance to reach them.

Imagine being nine months pregnant, in childbirth, and journeying for a long time on a cart pulled by a donkey to get to a medical facility

As well as being bumpy, the road traverses valleys that fill with water during the wet period, completely cutting off travel.

A surgeon at the hospital in Metche said all the situations she encounters is an critical situation, with some women having to make arduous trips to the hospital by walking or on a donkey.

“Imagine being nine months pregnant, in labour, and journeying for an extended time on a animal-drawn vehicle to get to a medical center. The main problem is the lag but having to travel in this state also has an impact on the delivery,” says the surgeon.

Undernourishment, which is growing, also increases the risk of issues in pregnancy, including the uterine splits that medical staff frequently observe.

Mohammed has continued under care in the two months since her caesarean. Afflicted by malnutrition, she got sick, while her son has been regularly checked. The father has travelled to other towns in search of work, so Mohammed is totally dependent on her mother.

The malnutrition ward has grown to six tents and has individuals overflowing into other sections. Children are placed under mosquito nets in extreme warmth in almost complete silence as health workers work, creating remedies and weighing children on a scale made from a bucket and rope.

In moderate instances children get small bags of PlumpyNut, the uniquely designed peanut paste, but the critical situations need a regular intake of nutrient-rich liquid. Mohammed’s baby is administered his nutrition through a syringe.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being nourished via a nose tube. The baby has been unwell 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 further minors coming in in this shelter,” she says. “The meals we consume is poor, there’s insufficient food and it’s lacking in nutrients.

“If we were at home, we could’ve coped better. You can go and grow crops, you can find employment, but here we’re reliant on what we’re provided.”

And what they are given is a limited quantity of sorghum, cooking oil and salt, distributed every two months. Such a minimal nutrition lacks nutrition, and the little cash she is given cannot buy much in the regular markets, where prices have become inflated.

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

Finding no work in Chad, her husband has traveled to Libya in the desire to raising enough money for them to come later. She resides with his family members, distributing whatever meals they acquire.

Abubakar says she has already seen food rations being cut and there are worries that the sharp decreases in international assistance funds by the US, UK and other European countries, could make things worse. Despite the war in Sudan having caused the 21st century’s most severe crisis and the {scale of needs|extent