‘I have searched and searched for help’: these Sudanese women abandoned to live hand to mouth in Chad’s desert camps.

For hours, travelling roughly on 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 being sick. She was in childbirth, in severe suffering after her womb tore, but was now being tossed around 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, surviving precariously in this inhospitable environment, are women. They reside in isolated camps 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 a considerable journey away.

“I repeatedly suffered from infections during my term and I had to go the clinic multiple occasions – when I was there, the labour began. But I wasn’t able to give birth without intervention because my uterine muscles failed,” says Mohammed. “I had to wait two hours for the ambulance but all I recall is the suffering; it was so unbearable I became disoriented.”

Her maternal figure, Ashe Khamis Abdullah, 40, was terrified she would suffer the death of her offspring and descendant. But Mohammed was immediately taken for surgery when she reached the hospital and an critical surgical delivery saved her and her son, Muwais.

Chad was known for the world’s second-highest maternal fatality statistic before the recent arrival of refugees, but the situations faced by the Sudanese put even more women in peril.

At the hospital, where they have birthed 824 babies in mostly emergency conditions this year, the medics are able to save many, but it is what affects the women who are fail to get to the hospital that alarms the professionals.

In the 24 months since the internal conflict in Sudan erupted, over four-fifths of the people who reached and remained in Chad are mothers and kids. In total, about one point two million Sudanese are being accommodated in the eastern part of the country, 400,000 of whom fled the past violence in Darfur.

Chad has accepted the majority of the millions of people who have fled the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been forced out of their homes.

Many males have stayed behind to be close to homes and land; many were killed, captured or forced into fighting. Those of adult age rapidly leave from Chad’s barren settlements to find work in the capital, N’Djamena, or further, in nearby Libya.

It results in women are left alone, without the means to provide for the dependents left in their responsibility. To avoid overcrowding near the border, the Chadian government has relocated people to less crowded encampments such as Metche with typical numbers of about 50,000, but in isolated regions with no services and few opportunities.

Metche has a hospital established by a medical aid organization, which began as a few tents but has grown to feature an procedure area, but few additional amenities. There is a lack of jobs, families must journey for extended periods to find firewood, and each person must subsist with about a small amount of water a day – far below the suggested amount.

This seclusion means hospitals are receiving women with issues in their pregnancy at a critical stage. There is only a single ambulance to travel the path between the Metche hospital and the clinic near the camp at 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 remain overnight for the ambulance to arrive.

Imagine being in the final trimester, in delivery, and making a lengthy trip on a donkey-drawn vehicle to get to a clinic

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

A surgeon at the hospital in Metche said each patient she treats is an crisis, with some women having to make arduous trips to the hospital by foot or on a donkey.

“Imagine being nine months pregnant, in labour, and journeying for an extended time on a animal-drawn vehicle to get to a medical center. The main problem is the delay but having to travel in this state also has an impact on the childbirth,” says the surgeon.

Undernourishment, which is on the rise, also elevates the likelihood of problems in pregnancy, including the uterine splits that medical staff often encounter.

Mohammed has stayed at the medical facility in the couple of months since her surgical delivery. Experiencing malnutrition, she contracted an illness, while her son has been regularly checked. The father has gone to other towns in seek jobs, so Mohammed is totally dependent on her mother.

The nutritional care section has grown to six tents and has cases exceeding capacity into other sections. Children rest beneath mosquito nets in extreme warmth in almost complete silence as medical staff work, creating remedies and assessing weights on a device constructed from a pail and cord.

In less severe situations children get sachets of PlumpyNut, the uniquely designed peanut paste, but the worst cases need a regular intake of enriched milk. Mohammed’s baby is given his nourishment through a injector.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being fed through a nasogastric tube. The infant has been ill 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 arriving in this shelter,” she says. “The meals we consume is poor, there’s not enough to eat and it’s not nutritious.

“If we were at home, we could’ve adapted ourselves. You can go and cultivate plants, 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 cereal, vegetable oil and salt, provided every 60 days. Such a basic diet lacks nutrition, and the small amount of money she is given cannot buy much in the weekly food markets, where prices have become inflated.

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

Finding no work in Chad, her husband has gone to Libya in the hope of earning sufficient funds for them to follow. She stays with his relatives, sharing out 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