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

For a long time, jolting along the soggy dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and concentrated on stopping herself vomiting. She was in delivery, in agonizing discomfort after her womb tore, but was now being shaken violently in the ambulance that jumped along the potholes and ridges of the road through the Chadian desert.

Most of the 878,000 Sudanese refugees who have fled to Chad since 2023, surviving precariously in this inhospitable environment, are females. They live in secluded encampments in the desert with scarce resources, few job opportunities and with treatment often a dangerously far away.

The clinic Mohammed needed was in Metche, a different settlement more than a considerable journey away.

“I kept getting infections during my pregnancy and I had to go the health post on numerous visits – when I was there, the delivery commenced. But I wasn’t able to give birth naturally because my uterine muscles failed,” says Mohammed. “I had to wait two hours for the ambulance but all I can think of the suffering; it was so intense I became delirious.”

Her mother, Ashe Khamis Abdullah, 40, was terrified she would be bereft of her child and grandchild. But Mohammed was immediately taken for surgery when she arrived at the hospital and an urgent C-section preserved the lives of her and her son, Muwais.

Chad already had the world’s second most severe maternal mortality rate before the current influx of refugees, but the conditions endured by the Sudanese expose further women in risk.

At the hospital, where they have assisted in the arrival of 824 babies in mostly emergency conditions this year, the doctors are able to rescue numerous, but it is what happens to the women who are fail to get to the hospital that worries the staff.

In the couple of years since the civil war in Sudan began, 86% of the refugees who have arrived and stayed in Chad are women and children. In total, about one point two million Sudanese are being hosted in the eastern region of the country, four hundred thousand of whom fled the past violence in Darfur.

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

Many males have stayed behind to be in proximity to homes and land; others have been murdered, taken hostage or made to join the conflict. Those of adult age rapidly leave from Chad’s desolate refugee camps to seek employment in the capital, N’Djamena, or beyond, in adjacent Libya.

It results in women are abandoned, without the ability to feed the young and old left in their responsibility. To avoid overcrowding near the border, the Chadian government has transferred refugees to more compact settlements such as Metche with usual resident counts of about fifty thousand, but in isolated regions with few facilities 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 surgical room, but little else. There is unemployment, families must travel long distances to find burning material, and each person must survive on about a small amount of water a day – well under the suggested amount.

This seclusion means hospitals are admitting women with complications in their pregnancy at a critical stage. There is only a single ambulance to cover the route between the Metche hospital and the medical tent near the Alacha encampment, where Mohammed is one of close to fifty thousand refugees. The medical team has observed instances where women in severe suffering have had to endure a full night for the ambulance to arrive.

Imagine being expecting a child, in delivery, and travelling hours on a animal-drawn transport to get to a medical facility

As well as being bumpy, the route passes through valleys that flood during the monsoon, completely cutting off travel.

A surgeon at the hospital in Metche said every case she sees is an emergency, with some women having to make arduous trips to the hospital by foot or on a mule.

“Imagine being in the late stages of pregnancy, in labour, and making a long trip on a donkey cart to get to a medical center. The biggest factor is the lag but having to come in these conditions also has an effect on the delivery,” says the surgeon.

Undernourishment, which is increasing, also elevates the likelihood of issues in pregnancy, including the uterine splits that medical staff see regularly.

Mohammed has continued under care in the 60 days since her caesarean. Suffering from malnutrition, she contracted an illness, while her son has been closely watched. The father has travelled to other towns in look for employment, so Mohammed is totally dependent on her mother.

The nutritional care section has grown to six tents and has individuals overflowing into other sections. Children lie under mosquito nets in sweltering heat in almost complete silence as medical staff work, creating remedies and weighing children on a device constructed from a container and string.

In moderate instances children get packets of PlumpyNut, the specifically created peanut paste, but the worst cases need a daily dose of fortified formula. Mohammed’s baby is administered his nutrition through a medical device.

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being nourished via a nasogastric tube. The child has been ill for the past year but Abubakar was consistently offered just painkillers without any identification, 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 low-quality, there’s not enough to eat and it’s lacking in nutrients.

“If we were at home, we could’ve coped better. You can go and farm produce, you can work to earn some money, but here we’re reliant on what we’re distributed.”

And what they are provided is a meager portion of sorghum, edible oil and salt, handed out every 60 days. Such a basic diet lacks nutrition, and the little cash she is given cannot buy much in the local bazaars, where values have increased.

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

Unable to get employment in Chad, her spouse has gone to Libya in the desire to raising enough money for them to join him. She lives with his relatives, dividing up whatever meals they acquire.

Abubakar says she has already observed food rations being cut and there are fears that the sudden reductions in overseas aid budgets by the US, UK and other European countries, could make things worse. Despite the war in Sudan having produced the 21st century’s gravest emergency and the {scale of needs|extent