‘I have searched and searched for help’: these Sudanese women left alone to scrape by in Chad’s arid settlements.

For an extended period, bouncing over the soggy dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and focused on stopping herself throwing up. She was in childbirth, in severe suffering after her womb tore, but was now being shaken violently in the ambulance that jumped along the dips and bumps of the road through the Chadian desert.

Most of the 878,000 Sudanese refugees who have fled to Chad since 2023, living hand to mouth in this inhospitable environment, are females. They reside in remote settlements in the desert with scarce resources, little employment and with medical help often a life-threateningly long distance away.

The medical center Mohammed needed was in Metche, one more encampment more than 120 minutes away.

“I continuously experienced infections during my term and I had to go the medical tent multiple occasions – when I was there, the delivery commenced. But I could not give birth normally because my uterus had collapsed,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I can think of the pain; it was so intense I became confused.”

Her mother, Ashe Khamis Abdullah, 40, was terrified she would be bereft of her daughter and baby grandson. But Mohammed was immediately taken for surgery when she reached the hospital and an emergency caesarean section saved her and her son, Muwais.

Chad was known for the world’s second most severe maternal death rate before the current influx of refugees, but the circumstances suffered by the Sudanese place additional women in risk.

At the hospital, where they have assisted in the arrival of 824 babies in frequently urgent circumstances this year, the medical staff are able to save many, but it is what happens to the women who are not able to reach the hospital that concerns them.

In the couple of years since the domestic strife in Sudan erupted, over four-fifths of the displaced persons who came and settled in Chad are women and children. In total, about one point two million Sudanese are being sheltered in the eastern part of the country, a large number of whom escaped the past violence in Darfur.

Chad has taken the lion’s share of the millions of people who have run from the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been displaced from their homes.

Many men have stayed behind to be near homes and land; some were slain, taken hostage or made to join the conflict. Those of adult age rapidly leave from Chad’s desolate refugee camps to find work in the capital, N’Djamena, or beyond, in neighbouring Libya.

It results in women are stranded, without the ability to feed the young and old left in their care. To reduce density near the border, the Chadian government has moved individuals to smaller camps such as Metche with average populations of about a large community, but in remote areas with no services and few opportunities.

Metche has a hospital established by a medical aid organization, which started off as a few tents but has expanded to include an procedure area, but little else. There is unemployment, families must journey for extended periods to find firewood, and each person must subsist with about minimal water of water a day – well under the recommended 20 litres.

This isolation means hospitals are treating women with problems in their pregnancy when it is almost too late. There is only a one medical transport to cover the route between the Metche hospital and the health post near the settlement of Alacha, where Mohammed is one of a large number of refugees. The medical team has encountered situations where women in severe suffering have had to endure a full night for the ambulance to reach them.

Imagine being expecting a child, in childbirth, and making a lengthy trip on a donkey-drawn vehicle to get to a medical facility

As well as being uneven, the path goes through valleys that flood during the monsoon, completely blocking travel.

A surgeon at the hospital in Metche said every case she sees is an crisis, with some women having to make long and difficult journeys to the hospital by on foot or on a donkey.

“Imagine being nine months pregnant, in delivery, and journeying for an extended time on a donkey cart to get to a hospital. The main problem is the lag but having to travel in this state also has an effect on the delivery,” says the surgeon.

Malnutrition, which is increasing, also increases the risk of complications in pregnancy, including the uterine ruptures that medical staff see regularly.

Mohammed has stayed at the medical facility in the couple of months since her C-section. Experiencing malnutrition, she contracted an illness, while her son has been closely watched. The father has gone to other towns in search of work, so Mohammed is completely reliant on her mother.

The undernourishment unit has grown to six tents and has individuals overflowing into other sections. Children lie under mosquito nets in extreme warmth in almost complete silence as doctors and nurses work, creating remedies and measuring kids on a instrument created using a bucket and rope.

In moderate instances children get packets of PlumpyNut, the specifically created peanut paste, but the worst cases need a daily dose of enriched milk. Mohammed’s baby is given his nourishment through a syringe.

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being nourished via a nasal drip. The infant has been sick for the past year but Abubakar was only provided with painkillers without any identification, until she made the journey from Alacha to Metche.

“Every day, I see additional kids joining us in this structure,” she says. “The nutrition we receive is low-quality, 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 relying on what we’re given.”

And what they are allocated is a limited quantity of sorghum, vegetable oil and salt, handed out every couple of months. Such a basic diet is deficient in nutrients, and the little cash she is given cannot buy much in the weekly food markets, where values have increased.

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

Unable to get employment in Chad, her partner has traveled to Libya in the hope of earning sufficient funds for them to come later. She stays with his family members, dividing up whatever meals they acquire.

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