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

For a long time, bouncing over the soggy dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and focused on stopping herself being sick. She was in childbirth, in severe suffering after her womb tore, but was now being jostled relentlessly in the ambulance that jumped along the uneven terrain of the road through the Chadian desert.

Most of the 878,000 Sudanese people who ran to Chad since 2023, barely getting by in this harsh landscape, are females. They reside in secluded encampments in the desert with insufficient supplies, few job opportunities and with healthcare often a dangerously far away.

The clinic Mohammed needed was in Metche, one more encampment more than a considerable journey away.

“I kept getting infections during my term and I had to go the clinic seven times – when I was there, the labour began. But I could not give birth without intervention because my womb had given way,” says Mohammed. “I had to endure a long delay for the ambulance but all I can think of the pain; it was so intense I became disoriented.”

Her parent, Ashe Khamis Abdullah, 40, was terrified she would be bereft of her offspring and descendant. But Mohammed was rushed straight into surgery when she reached the hospital and an urgent C-section preserved the lives of her and her son, Muwais.

Chad already had the world’s second-highest maternal mortality rate before the recent arrival of refugees, but the situations faced by the Sudanese place additional women in danger.

At the hospital, where they have delivered 824 babies in often critical situations this year, the doctors are able to help plenty, but it is what occurs with the women who are cannot access the hospital that concerns them.

In the two years since the civil war in Sudan began, over four-fifths of the refugees who have arrived and remained in Chad are females and minors. In total, about over a million Sudanese are being sheltered in the east of the country, a large number of whom fled the earlier war in Darfur.

Chad has accepted the majority of the over four million people who have fled the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been displaced from their homes.

Many men have not left to be in proximity to homes and land; others have been killed, captured or conscripted. Those of working age move on quickly from Chad’s isolated encampments to seek employment in the main city, N’Djamena, or elsewhere, in nearby Libya.

It implies women are left alone, without the ability to sustain the dependents left in their charge. To avoid overcrowding near the border, the Chadian government has moved individuals to less crowded encampments such as Metche with typical numbers of about 50,000, but in distant locations with limited infrastructure 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 surgical room, but few additional amenities. 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 – far below the suggested amount.

This seclusion means hospitals are receiving women with problems in their pregnancy when it is almost too late. There is only a sole emergency vehicle to serve the area between the Metche hospital and the clinic near the settlement of Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has seen cases where women in desperate pain have had to wait an entire night for the ambulance to arrive.

Imagine being in the final trimester, in childbirth, and travelling hours on a animal-drawn transport to get to a hospital

As well as being bumpy, the path goes through valleys that become inundated during the wet period, completely cutting off travel.

A surgeon at the hospital in Metche said all the situations she encounters is an emergency, with some women having to make arduous trips to the hospital by walking or on a mule.

“Imagine being in the late stages of pregnancy, in childbirth, and travelling hours on a cart pulled by a donkey to get to a hospital. The biggest factor is the wait but having to travel in this state also has an influence on the delivery,” says the surgeon.

Poor nutrition, which is on the rise, also raises the chance of problems in pregnancy, including the womb tears that medical staff see regularly.

Mohammed has stayed at the medical facility in the two months since her caesarean. Afflicted by malnutrition, she got sick, while her son has been regularly checked. The male guardian has travelled 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 patients spilling over 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 mild cases children get sachets of PlumpyNut, the uniquely designed peanut paste, but the worst cases need a daily dose of nutrient-rich liquid. Mohammed’s baby is given his nourishment through a syringe.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being nourished via a nasal drip. The infant has been ill 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 more children joining us in this shelter,” she says. “The nutrition we receive is low-quality, 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 grow crops, you can work to earn some money, but here we’re dependent on what we’re given.”

And what they are allocated is a small amount of sorghum, edible oil and salt, handed out every two months. Such a basic diet lacks nutrition, and the small amount of money she is given purchases very little in the local bazaars, where values have increased.

Abubakar was relocated to Alacha after coming from Sudan in 2023, having escaped the paramilitary Rapid Support Forces’ attack on her native town of El Geneina in June that year.

Failing to secure jobs in Chad, her partner has gone to Libya in the desire to earning sufficient funds for them to come later. She lives with his relatives, distributing whatever meals they acquire.

Abubakar says she has already observed food rations being cut and there are fears that the sudden reductions in foreign support money by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having produced the 21st century’s most severe crisis and the {scale of needs|extent