‘I have looked everywhere for assistance’: the Sudanese women abandoned to survive day by day in Chad’s desert camps.

For hours, travelling roughly on the soggy dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and tried hard stopping herself being sick. She was in labour, in agonizing discomfort after her uterine wall split, 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 close to a million Sudanese refugees who have fled to Chad since 2023, living hand to mouth in this difficult terrain, 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 clinic Mohammed needed was in Metche, another refugee camp more than 120 minutes away.

“I repeatedly suffered from infections during my term and I had to go the health post on numerous visits – when I was there, the delivery commenced. But I found it impossible to give birth naturally because my womb had given way,” says Mohammed. “I had to endure a long delay for the ambulance but all I recall is the suffering; it was so intense I became delirious.”

Her maternal figure, Ashe Khamis Abdullah, 40, feared she would be bereft of her offspring and descendant. But Mohammed was hurried 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 most severe maternal death rate before the recent arrival of refugees, but the circumstances suffered by the Sudanese place additional women in danger.

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

In the couple of years since the civil war in Sudan started, the vast majority of the people who reached and settled in Chad are females and minors. In total, about over a million Sudanese are being sheltered in the eastern region of the country, a large number of whom ran from the earlier war in Darfur.

Chad has taken the lion’s share of the over four million people who have escaped the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been displaced from their homes.

Many men have stayed behind to be near homes and land; some were murdered, abducted or forced into fighting. Those of employable age soon depart from Chad’s barren settlements to find work in the main city, N’Djamena, or elsewhere, in adjacent Libya.

It means women are left alone, without the resources to feed the children and the elderly left in their responsibility. To avoid overcrowding near the border, the Chadian government has transferred refugees to smaller camps such as Metche with typical numbers of about 50,000, but in distant locations with few facilities and minimal chances.

Metche has a hospital set up by a medical aid organization, which was initially a few tents but has grown to feature an procedure area, but not much more. There is a lack of jobs, families must travel long distances to find burning material, and each person must subsist with about a small amount of water a day – much less than the suggested amount.

This remoteness means hospitals are receiving women with issues in their pregnancy dangerously late. There is only a single ambulance to serve the area between the Metche hospital and the health post near the camp at Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has encountered situations where women in desperate pain have had to remain overnight for the ambulance to come.

Imagine being nine months pregnant, in labour, and journeying for a long time on a animal-drawn transport to get to a medical facility

As well as being rough, the route passes through valleys that flood during the monsoon, completely blocking travel.

A surgeon at the hospital in Metche said all the situations she encounters is an emergency, with some women having to make long and difficult journeys to the hospital by foot or on a mule.

“Imagine being in the late stages of pregnancy, in labour, and travelling hours on a donkey cart to get to a clinic. The main problem is the delay but having to come in these conditions also has an impact on the delivery,” says the surgeon.

Poor nutrition, which is growing, also increases the risk of problems in pregnancy, including the womb tears that medical staff see regularly.

Mohammed has stayed at the medical facility in the couple of months since her surgical delivery. Suffering from malnutrition, she developed an infection, while her son has been regularly checked. The parent 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 cases exceeding capacity 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 scale made from a bucket and rope.

In moderate instances children get sachets of PlumpyNut, the specially formulated peanut paste, but the most severe instances need a regular intake of fortified formula. Mohammed’s baby is given his nourishment through a injector.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being given nutrition by a nasal drip. The baby has been sick for the past year but Abubakar was only provided with painkillers without any diagnosis, until she made the travel from Alacha to Metche.

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

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

And what they are allocated is a small amount of sorghum, edible oil and salt, provided every 60 days. Such a minimal nutrition lacks nutrition, and the small amount of money she is given purchases very little in the regular markets, where costs have risen.

Abubakar was moved to Alacha after arriving from Sudan in 2023, having fled the armed group Rapid Support Forces’ assault on her home city of El Geneina in June that year.

Finding no work in Chad, her husband has traveled to Libya in the aspiration to gathering adequate cash for them to follow. She resides with his family members, distributing whatever nourishment they obtain.

Abubakar says she has already seen food supplies decreasing and there are concerns that the sudden reductions in international assistance funds 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