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

For hours, bouncing over the flooded dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and tried hard stopping herself throwing up. She was in labour, in extreme pain after her uterine wall split, but was now being tossed around in the ambulance that bumped over the potholes and ridges of the road through the Chadian desert.

Most of the close to a million Sudanese displaced persons who escaped to Chad since 2023, barely getting by in this difficult terrain, are females. They live in isolated camps in the desert with limited water and food, no work and with healthcare often a dangerously far away.

The hospital Mohammed needed was in Metche, another refugee camp more than 120 minutes away.

“I kept getting infections during my pregnancy and I had to go the clinic seven times – when I was there, the labour began. But I found it impossible to give birth normally because my womb had given way,” says Mohammed. “I had to endure a long delay for the ambulance but all I recall is the agony; it was so intense I became disoriented.”

Her parent, Ashe Khamis Abdullah, 40, was terrified she would suffer the death of her daughter and baby grandson. But Mohammed was immediately taken for surgery when she arrived at the hospital and an emergency caesarean section preserved the lives of her and her son, Muwais.

Chad was known for the world’s second most severe maternal fatality statistic before the recent arrival of refugees, but the situations faced 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 save many, but it is what occurs with the women who are cannot access the hospital that alarms the professionals.

In the two years since the domestic strife in Sudan erupted, 86% of the displaced persons who came and settled in Chad are mothers and kids. In total, about over a million Sudanese are being accommodated in the eastern region of the country, 400,000 of whom ran from the past violence in Darfur.

Chad has hosted the bulk of the over four million people who have run from 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 adult men have not left to be near homes and land; others have been murdered, abducted or conscripted. Those of employable age move on quickly from Chad’s isolated encampments to look for jobs in the main city, N’Djamena, or further, in adjacent Libya.

It means women are left alone, without the means to sustain the young and old left in their responsibility. To reduce density near the border, the Chadian government has transferred refugees to smaller camps such as Metche with typical numbers of about fifty thousand, but in remote areas with no services and scarce prospects.

Metche has a hospital established by a medical aid organization, which was initially a few tents but has grown to feature an surgical room, but few additional amenities. There is a lack of jobs, families must travel long distances to find firewood, and each person must subsist with about minimal water of water a day – well under the recommended 20 litres.

This remoteness means hospitals are treating women with complications in their pregnancy at a critical stage. There is only a one medical transport to cover the route between the Metche hospital and the health post near the camp at Alacha, where Mohammed is one of nearly 50,000 refugees. The medical team has encountered situations where women in desperate pain have had to endure a full night for the ambulance to reach them.

Imagine being in the final trimester, in labour, and making a lengthy trip on a animal-drawn transport to get to a clinic

As well as being rough, the route passes through valleys that fill with water during the monsoon, completely cutting off travel.

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

“Imagine being about to give birth, in childbirth, and journeying for an extended time on a donkey cart to get to a hospital. The biggest factor is the delay but having to come in these conditions also has an influence on the childbirth,” says the surgeon.

Malnutrition, which is growing, also increases the risk of complications in pregnancy, including the womb tears that medical staff frequently observe.

Mohammed has remained in hospital in the couple of months since her surgical delivery. Afflicted by malnutrition, she developed an infection, while her son has been carefully monitored. The parent has travelled to other towns in seek jobs, so Mohammed is totally dependent on her mother.

The nutritional care section has expanded to six tents and has patients spilling over into other sections. Children lie under mosquito nets in sweltering heat in almost utter stillness as medical staff work, mixing medications and assessing weights on a scale made from a container and string.

In less severe situations 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 administered his nutrition through a injector.

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being given nutrition by a nose tube. The child has been unwell for the past year but Abubakar was only provided with painkillers without any medical assessment, until she made the trip from Alacha to Metche.

“Every day, I see further minors coming in in this shelter,” she says. “The meals we consume is low-quality, there’s too little nourishment and it’s lacking in nutrients.

“If we were at home, we could’ve adjusted our lives. You can go and grow crops, you can get a job, but here we’re relying on what we’re given.”

And what they are given is a limited quantity of grain, cooking oil and salt, provided every 60 days. Such a minimal nutrition lacks nutrition, and the little cash she is given cannot buy much in the local bazaars, where values have increased.

Abubakar was transferred to Alacha after coming from Sudan in 2023, having run from 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 stays with his kin, distributing whatever nourishment they obtain.

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