‘I have looked everywhere for assistance’: these Sudanese women abandoned to scrape by in Chad’s arid settlements.

For a long time, bouncing over the waterlogged dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and concentrated on stopping herself throwing up. She was in childbirth, in agonizing discomfort after her uterine wall split, but was now being shaken violently in the ambulance that lurched across the uneven terrain of the road through the Chadian desert.

Most of the 878,000 Sudanese people who ran to Chad since 2023, surviving precariously in this inhospitable environment, are females. They stay in secluded encampments in the desert with insufficient supplies, little employment and with healthcare often a dangerously far away.

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

“I kept getting infections during my gestation and I had to go the clinic seven times – when I was there, the pregnancy started. But I found it impossible to give birth normally because my uterine muscles failed,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I recall is the agony; it was so bad I became confused.”

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

Chad was known for the world’s second-highest maternal fatality statistic before the current influx of refugees, but the situations faced by the Sudanese place additional women in danger.

At the hospital, where they have delivered 824 babies in often critical situations this year, the doctors are able to help plenty, but it is what occurs with the women who are not able to reach the hospital that worries the staff.

In the 24 months since the civil war in Sudan began, 86% of the displaced persons who came and remained in Chad are women and children. In total, about one point two million Sudanese are being accommodated in the east of the country, 400,000 of whom ran from the past violence in Darfur.

Chad has hosted the bulk 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 not left to be near homes and land; others have been murdered, abducted or forced into fighting. Those of working age move on quickly from Chad’s desolate refugee camps to find work in the main city, N’Djamena, or further, in nearby Libya.

It means women are left alone, 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 more compact settlements such as Metche with average populations of about fifty thousand, but in isolated regions with limited infrastructure 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 not much more. There is a lack of jobs, families must walk hours to find burning material, and each person must subsist with about nine litres of water a day – far below the advised quantity.

This seclusion means hospitals are treating women with problems in their pregnancy when it is almost too late. There is only a one medical transport to travel the path between the Metche hospital and the health post near the settlement of Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has seen cases where women in desperate pain have had to remain overnight for the ambulance to come.

Imagine being nine months pregnant, in delivery, and making a lengthy trip on a donkey-drawn vehicle to get to a clinic

As well as being rough, the road traverses valleys that fill with water during the wet period, completely preventing travel.

A surgeon at the hospital in Metche said each patient she treats is an crisis, with some women having to make challenging travels to the hospital by foot or on a pack animal.

“Imagine being about to give birth, in delivery, and making a long trip on a donkey cart to get to a hospital. The main problem is the delay but having to come in these conditions also has an influence on the childbirth,” says the surgeon.

Malnutrition, which is on the rise, also raises the chance of complications in pregnancy, including the uterine ruptures that medical staff frequently observe.

Mohammed has continued under care in the couple of months since her surgical delivery. Suffering from malnutrition, she contracted an illness, while her son has been carefully monitored. The male guardian has journeyed to other towns in seek jobs, so Mohammed is entirely leaning on her mother.

The undernourishment unit has expanded to six tents and has patients spilling over into other sections. Children rest beneath mosquito nets in extreme warmth in almost total quiet as health workers work, mixing medications and assessing weights on a instrument created using a pail and cord.

In moderate instances children get packets of PlumpyNut, the specially formulated peanut paste, but the most severe instances need a regular intake of fortified formula. Mohammed’s baby is fed his through a medical device.

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

“Every day, I see more children arriving in this shelter,” she says. “The nutrition we receive is inadequate, there’s not enough to eat and it’s not nutritious.

“If we were at home, we could’ve adapted ourselves. You can go and grow crops, you can find employment, but here we’re dependent on what we’re distributed.”

And what they are given is a limited quantity of cereal, cooking oil and salt, distributed every 60 days. Such a minimal nutrition is deficient in nutrients, and the meager funds she is given cannot buy much in the regular markets, where costs have risen.

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

Failing to secure jobs in Chad, her partner has gone to Libya in the hope of raising enough money for them to come later. She lives with his relatives, distributing whatever food they can get.

Abubakar says she has already observed food distributions being reduced and there are concerns that the abrupt cuts in international assistance funds by the US, UK and other European countries, could worsen the situation. Despite the war in Sudan having caused the 21st century’s gravest emergency and the {scale of needs|extent