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

For an extended period, bouncing over the soggy dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and tried hard stopping herself throwing up. She was in labour, in agonizing discomfort after her uterine wall split, but was now being jostled relentlessly in the ambulance that jumped along the dips and bumps of the road through the Chadian desert.

Most of the close to a million Sudanese displaced persons who escaped to Chad since 2023, barely getting by in this difficult terrain, are women. They reside in isolated camps in the desert with insufficient supplies, few job opportunities and with healthcare often a perilously remote away.

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

“I repeatedly suffered from infections during my gestation and I had to go the health post seven times – when I was there, the pregnancy started. 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 confused.”

Her mother, Ashe Khamis Abdullah, 40, worried 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 urgent C-section preserved the lives of her and her son, Muwais.

Chad already had the world’s second worst maternal mortality rate before the current influx of refugees, but the situations faced by the Sudanese expose further women in peril.

At the hospital, where they have assisted in the arrival of 824 babies in often critical situations this year, the medics are able to help plenty, but it is what occurs with the women who are fail to get to the hospital that alarms the professionals.

In the couple of years since the internal conflict in Sudan began, over four-fifths of the people who reached and remained in Chad are females and minors. In total, about one point two million Sudanese are being sheltered in the eastern part of the country, four hundred thousand of whom escaped the earlier war in Darfur.

Chad has hosted the bulk of the millions of people who have escaped the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been displaced from their homes.

Many adult men have not left to be in proximity to homes and land; many were killed, abducted or conscripted. Those of adult age rapidly leave from Chad’s desolate refugee camps to seek employment in the capital, N’Djamena, or further, in nearby Libya.

It means women are stranded, without the means to sustain the young and old left in their charge. To prevent congestion near the border, the Chadian government has moved individuals to less crowded encampments such as Metche with usual resident counts of about a large community, but in isolated regions with no services and minimal chances.

Metche has a hospital established by a medical aid organization, which started off as a few tents but has grown to feature an procedure area, but not much more. There is no work, families must journey for extended periods to find firewood, and each person must survive on about nine litres of water a day – well under the recommended 20 litres.

This seclusion means hospitals are treating women with complications in their pregnancy dangerously late. There is only a single ambulance to cover the route 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 desperate pain have had to endure a full night for the ambulance to reach them.

Imagine being in the final trimester, in labour, and journeying for a long time on a cart pulled by a donkey 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 all the situations she encounters is an emergency, with some women having to make challenging travels to the hospital by on foot or on a mule.

“Imagine being nine months pregnant, in delivery, and making a long trip on a donkey cart to get to a clinic. The biggest factor is the wait but having to come in these conditions also has an impact on the childbirth,” says the surgeon.

Malnutrition, which is increasing, also increases the risk of issues in pregnancy, including the womb tears that medical staff frequently observe.

Mohammed has remained in hospital in the couple of months since her caesarean. Experiencing malnutrition, she contracted an illness, while her son has been closely watched. The male guardian has gone 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 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 container and string.

In less severe situations children get sachets of PlumpyNut, the uniquely designed peanut paste, but the most severe instances need a regular intake of nutrient-rich liquid. Mohammed’s baby is given his nourishment through a injector.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being nourished via a nasogastric tube. The infant has been ill for the past year but Abubakar was only provided with 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 food we’re eating is poor, there’s too little nourishment and it’s deficient in vitamins.

“If we were at home, we could’ve adapted ourselves. You can go and cultivate plants, you can work to earn some money, but here we’re reliant on what we’re given.”

And what they are provided is a small amount of grain, edible oil and salt, provided every 60 days. Such a basic diet lacks nutrition, and the meager funds she is given acquires minimal items in the weekly food markets, where prices have become inflated.

Abubakar was relocated to Alacha after arriving from Sudan in 2023, having escaped the paramilitary Rapid Support Forces’ attack on her native town of El Geneina in June that year.

Failing to secure jobs in Chad, her spouse has gone to Libya in the hope of gathering adequate cash for them to join him. She resides with his kin, dividing up whatever meals they acquire.

Abubakar says she has already observed food supplies decreasing and there are worries that the sudden reductions in foreign support money 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