‘I have looked everywhere for assistance’: these Sudanese females abandoned to live hand to mouth in Chad’s arid settlements.

For an extended period, travelling roughly on the flooded dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and concentrated on stopping herself throwing up. She was in labour, in extreme pain after her womb tore, 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 hundreds of thousands of Sudanese people who ran to Chad since 2023, surviving precariously in this harsh landscape, are women. They stay in remote settlements in the desert with insufficient supplies, little employment and with medical help often a dangerously far away.

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

“I repeatedly suffered from infections during my pregnancy and I had to go the clinic on numerous visits – when I was there, the labour began. But I found it impossible to give birth naturally because my womb had given way,” says Mohammed. “I had to wait two hours for the ambulance but all I recall is the agony; it was so unbearable I became disoriented.”

Her parent, Ashe Khamis Abdullah, 40, feared she would be bereft of her child and grandchild. But Mohammed was immediately taken for surgery when she got to the hospital and an urgent C-section rescued her and her son, Muwais.

Chad already had the world’s second worst maternal fatality statistic before the ongoing stream of refugees, but the conditions endured by the Sudanese place additional women in risk.

At the hospital, where they have assisted in the arrival of 824 babies in mostly emergency conditions this year, the medical staff are able to save many, but it is what occurs with the women who are not able to reach the hospital that worries the staff.

In the two years since the domestic strife in Sudan erupted, 86% of the refugees who have arrived and stayed in Chad are women and children. In total, about 1.2 million Sudanese are being accommodated in the east of the country, 400,000 of whom ran from the previous conflict in Darfur.

Chad has taken the lion’s share of the over four million people who have fled the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been uprooted from their homes.

Many adult men have remained to be near homes and land; some were 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 beyond, in neighbouring Libya.

It results in women are left alone, without the ability to provide for the young and old left in their charge. To prevent congestion near the border, the Chadian government has relocated people to more compact settlements such as Metche with usual resident counts of about 50,000, but in remote areas with no services and minimal chances.

Metche has a hospital built by a medical aid organization, which started off as a few tents but has expanded to include an surgical room, but little else. There is a lack of jobs, families must walk hours to find fuel, and each person must get by with about a small amount of water a day – much less than the recommended 20 litres.

This remoteness means hospitals are admitting women with complications in their pregnancy dangerously late. There is only a one medical transport to travel the path between the Metche hospital and the medical tent near the camp at Alacha, where Mohammed is one of nearly 50,000 refugees. The medical team has observed instances where women in extreme agony have had to wait an entire night for the ambulance to come.

Imagine being expecting a child, in labour, and making a lengthy trip on a donkey-drawn vehicle to get to a clinic

As well as being rough, the route passes through valleys that flood during the rainy season, completely cutting off 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 on foot or on a mule.

“Imagine being nine months pregnant, in labour, and making a long trip on a cart pulled by a donkey to get to a medical center. The biggest factor is the lag but having to travel in this state also has an effect on the childbirth,” says the surgeon.

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

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 male guardian has travelled to other towns in seek jobs, so Mohammed is entirely leaning on her mother.

The malnutrition ward has grown to six tents and has patients spilling over into other sections. Children are placed under mosquito nets in sweltering heat in almost complete silence as doctors and nurses work, mixing medications and measuring kids on a device constructed from a bucket and rope.

In mild cases children get packets of PlumpyNut, the uniquely designed peanut paste, but the worst cases need a consistent supply of enriched milk. Mohammed’s baby is fed his through a syringe.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being given nutrition by a nasogastric tube. The child has been sick for the past year but Abubakar was repeatedly given only painkillers without any medical assessment, until she made the trip from Alacha to Metche.

“Every day, I see more children coming in in this structure,” she says. “The nutrition we receive is poor, there’s too little nourishment and it’s not nutritious.

“If we were at home, we could’ve adjusted our lives. 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 provided is a small amount of grain, cooking oil and salt, handed out every two months. 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 reaching from Sudan in 2023, having escaped the militia Rapid Support Forces’ raid on her native town of El Geneina in June that year.

Unable to get employment in Chad, her partner has gone to Libya in the aspiration to gathering adequate cash for them to follow. She lives with his relatives, dividing up whatever nourishment they obtain.

Abubakar says she has already seen food rations being cut and there are fears that the sharp decreases 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 gravest emergency and the {scale of needs|extent