‘I have searched and searched for help’: the Sudanese women left alone to survive day by day in Chad’s desert camps.

For hours, travelling roughly on the flooded dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and focused on stopping herself vomiting. She was in childbirth, in severe suffering after her uterus ruptured, but was now being shaken violently in the ambulance that bumped over the dips and bumps of the road through the Chadian desert.

Most of the hundreds of thousands of Sudanese displaced persons who escaped to Chad since 2023, barely getting by in this harsh landscape, are females. They reside in secluded encampments in the desert with insufficient supplies, little employment and with treatment often a life-threateningly long distance away.

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

“I kept getting infections during my pregnancy and I had to go the health post seven times – 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 remember was the pain; it was so bad I became delirious.”

Her maternal figure, Ashe Khamis Abdullah, 40, worried she would be bereft of her child and grandchild. But Mohammed was hurried into surgery when she got to the hospital and an critical surgical delivery preserved the lives of her and her son, Muwais.

Chad was known for the world’s second worst maternal death rate before the recent arrival of refugees, but the circumstances suffered by the Sudanese put even more women in danger.

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 rescue numerous, but it is what affects the women who are fail to get to the hospital that concerns them.

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 mothers and kids. In total, about 1.2 million Sudanese are being sheltered in the eastern part of the country, 400,000 of whom fled the earlier war in Darfur.

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

Many adult men have stayed behind to be near homes and land; many were killed, captured or conscripted. Those of employable age move on quickly from Chad’s isolated encampments to seek employment in the main city, N’Djamena, or beyond, in nearby Libya.

It implies women are abandoned, without the ability to feed the children and the elderly left in their care. To reduce density near the border, the Chadian government has moved individuals to more compact settlements such as Metche with average populations of about a large community, but in remote areas with no services and scarce prospects.

Metche has a hospital built by a medical aid organization, which began as a few tents but has grown to feature an procedure area, but little else. There is a lack of jobs, families must journey for extended periods to find firewood, and each person must get by with about nine litres of water a day – far below the recommended 20 litres.

This isolation means hospitals are admitting women with issues in their pregnancy when it is almost too late. There is only a single ambulance to serve the area between the Metche hospital and the medical tent near the settlement of Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has seen cases where women in extreme agony have had to wait an entire night for the ambulance to arrive.

Imagine being expecting a child, in delivery, and journeying for a long time on a cart pulled by a donkey to get to a hospital

As well as being rough, the road traverses valleys that become inundated during the monsoon, completely preventing travel.

A surgeon at the hospital in Metche said all the situations she encounters is an crisis, with some women having to make challenging travels to the hospital by on foot or on a donkey.

“Imagine being nine months pregnant, in childbirth, and travelling hours on a animal-drawn vehicle to get to a clinic. The primary issue is the delay but having to travel in this state also has an impact on the delivery,” says the surgeon.

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

Mohammed has continued under care in the couple of months since her caesarean. Afflicted by malnutrition, she got sick, while her son has been closely watched. The parent has journeyed 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 cases exceeding capacity into other sections. Children lie under mosquito nets in sweltering heat in almost total quiet as doctors and nurses work, creating remedies and measuring kids on a instrument created using a bucket and rope.

In moderate instances children get small bags of PlumpyNut, the uniquely designed peanut paste, but the worst cases need a daily dose of enriched milk. Mohammed’s baby is given his nourishment through a medical device.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being fed through a nasogastric tube. The child has been ill for the past year but Abubakar was consistently offered just painkillers without any diagnosis, until she made the trip from Alacha to Metche.

“Every day, I see additional kids joining us in this tent,” she says. “The meals we consume is low-quality, there’s too little nourishment and it’s not nutritious.

“If we were at home, we could’ve adapted ourselves. You can go and cultivate plants, you can find employment, but here we’re dependent on what we’re provided.”

And what they are allocated is a small amount of grain, vegetable oil and salt, provided every two months. Such a basic diet offers little sustenance, and the little cash she is given acquires minimal items in the regular markets, where values have increased.

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

Failing to secure jobs in Chad, her husband has gone to Libya in the aspiration to gathering adequate cash for them to follow. She lives with his relatives, sharing out whatever nourishment they obtain.

Abubakar says she has already observed food supplies decreasing and there are concerns that the sharp decreases in international assistance funds by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having produced the 21st century’s gravest emergency and the {scale of needs|extent