‘I have looked everywhere for assistance’: the Sudanese females left alone to live hand to mouth in Chad’s desert camps.

For an extended period, bouncing over the waterlogged dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and tried hard stopping herself vomiting. She was in childbirth, in agonizing discomfort after her uterus ruptured, 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 harsh landscape, are women. They stay in isolated camps in the desert with limited water and food, little employment and with medical help often a life-threateningly long distance away.

The hospital Mohammed needed was in Metche, another refugee camp more than a considerable journey away.

“I kept getting infections during my pregnancy and I had to go the medical tent on numerous visits – when I was there, the pregnancy started. But I found it impossible to give birth normally because my uterine muscles failed,” says Mohammed. “I had to endure a long delay for the ambulance but all I can think of the agony; it was so intense I became confused.”

Her mother, Ashe Khamis Abdullah, 40, feared she would lose both her child and grandchild. But Mohammed was immediately taken for surgery when she reached the hospital and an urgent C-section saved her and her son, Muwais.

Chad was known for the world’s second worst maternal death rate before the current influx of refugees, but the conditions endured by the Sudanese put even more women in risk.

At the hospital, where they have birthed 824 babies in often critical situations this year, the medical staff are able to help plenty, but it is what occurs with the women who are not able to reach the hospital that alarms the professionals.

In the couple of years since the internal conflict in Sudan erupted, the vast majority of the people who reached and settled in Chad are women and children. In total, about one point two million Sudanese are being hosted in the eastern part of the country, 400,000 of whom ran from the previous conflict in Darfur.

Chad has accepted the majority of the over four million people who have fled the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been uprooted from their homes.

Many men have remained to be in proximity to homes and land; many were slain, captured or made to join the conflict. Those of working age move on quickly from Chad’s desolate refugee camps to seek employment in the main city, N’Djamena, or further, in neighbouring Libya.

It results in women are abandoned, without the resources to sustain the dependents left in their responsibility. To prevent congestion near the border, the Chadian government has moved individuals to smaller camps such as Metche with typical numbers of about fifty thousand, but in distant locations with limited infrastructure and scarce prospects.

Metche has a hospital established by a medical aid organization, which began as a few tents but has expanded to include an operating theatre, but few additional amenities. There is no work, families must travel long distances to find firewood, and each person must subsist with about a small amount of water a day – much less than the advised quantity.

This seclusion means hospitals are receiving women with problems in their pregnancy at a critical stage. There is only a single ambulance to cover the route between the Metche hospital and the health post near the Alacha encampment, where Mohammed is one of a large number of refugees. The medical team has seen cases where women in desperate pain have had to remain overnight for the ambulance to arrive.

Imagine being in the final trimester, in delivery, and travelling hours 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 cutting off travel.

A surgeon at the hospital in Metche said each patient she treats is an critical situation, 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 labour, and travelling hours on a donkey cart to get to a hospital. The main problem is the wait but having to travel in this state also has an impact on the delivery,” says the surgeon.

Undernourishment, which is increasing, also elevates the likelihood of problems in pregnancy, including the womb tears that medical staff see regularly.

Mohammed has remained in hospital in the two months since her surgical delivery. Afflicted by 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 completely reliant on her mother.

The nutritional care section has increased to six tents and has patients spilling over into other sections. Children rest beneath mosquito nets in extreme warmth in almost utter stillness as health workers work, mixing medications and assessing weights on a instrument created using a pail and cord.

In less severe situations children get sachets of PlumpyNut, the uniquely designed peanut paste, but the worst cases need a consistent supply 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 infant has been sick for the past year but Abubakar was consistently offered just painkillers without any diagnosis, until she made the travel from Alacha to Metche.

“Every day, I see more children coming in in this shelter,” she says. “The food we’re eating is poor, there’s insufficient food and it’s not nutritious.

“If we were at home, we could’ve adjusted our lives. You can go and cultivate plants, you can get a job, but here we’re dependent on what we’re provided.”

And what they are given is a small amount of cereal, edible oil and salt, handed out every 60 days. Such a basic diet lacks nutrition, and the meager funds she is given cannot buy much in the local bazaars, where costs have risen.

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

Failing to secure jobs in Chad, her husband has left for Libya in the aspiration to gathering adequate cash for them to come later. She resides with his family members, sharing out whatever food they can get.

Abubakar says she has already witnessed food supplies decreasing and there are fears that the abrupt cuts in international assistance funds by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having created the 21st century’s worst humanitarian disaster and the {scale of needs|extent