\n<\/p>\n
F<\/span>or hours, jolting along the waterlogged dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and focused on stopping herself vomiting. She was in labour, in extreme pain after her uterus ruptured, but was now being tossed around in the ambulance that jumped along the dips and bumps of the road through the Chadian desert.<\/p>\n Most of the 878,000 Sudanese refugees who have fled to Chad since 2023, living hand to mouth in this harsh landscape, are women. They stay in isolated camps in the desert with limited water and food, no work and with medical help often a life-threateningly long distance away.<\/p>\n The hospital Mohammed needed, run by the aid agency M\u00e9decins Sans Fronti\u00e8res (MSF), was in Metche, another refugee camp more than two hours away.<\/p>\n \u201cI kept getting infections during my pregnancy and I had to go the clinic seven times \u2013 when I was there, the pregnancy started. But I wasn\u2019t able to give birth normally because my uterus had collapsed,\u201d says Mohammed. \u201cI had to wait two hours for the ambulance but all I remember was the pain; it was so bad I became delirious.\u201d<\/p>\n <\/span>Ashe Khamis Abdullah feeds her two-month-old grandson with enriched milk. The uterus of the 18-year-old mother, Makka Ibraheem Mohammed, ruptured while in labour. <\/span> Photograph: Kaamil Ahmed\/The Guardian<\/p>\n Her mother, Ashe Khamis Abdullah, 40, feared she would lose both her daughter and baby grandson. But Mohammed was rushed straight into surgery when she arrived at the hospital and an emergency caesarean section saved her and her son, Muwais.<\/p>\n Chad already had the world\u2019s second-highest maternal mortality rate before the current influx of refugees, but the conditions endured by the Sudanese put even more women in danger.<\/p>\n At the MSF hospital, where they have delivered 824 babies in mostly emergency conditions this year, the medics are able to save many, but it is what happens to the women who are not able to reach the hospital that concerns them.<\/p>\n In the two years since the civil war in Sudan began, 86% of the refugees who have arrived and remained in Chad are women and children. In total, about 1.2 million Sudanese are being hosted in the eastern part of the country, 400,000 of whom fled the previous conflict in Darfur.<\/p>\n <\/span>A twice-weekly market in Metche is the only way for many refugees to get goods at the camp, which is hours away from the nearest town.<\/span> Photograph: Kaamil Ahmed\/The Guardian<\/p>\n Chad has taken the lion\u2019s share of the 4.1 million people who have escaped 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.<\/p>\n Many men have stayed behind to be close to homes and land; others have been killed, taken hostage or forced into fighting. Those of working age move on quickly from Chad\u2019s desolate refugee camps to find work in the capital, N\u2019Djamena, or further, in neighbouring Libya.<\/p>\n it means women are left alone, without the means to feed the children and the elderly left in their care. To avoid overcrowding near the border, the Chadian government has relocated people to smaller camps such as Metche <\/strong>with average populations of about 50,000, but in remote areas with no services and few opportunities.<\/p>\n Metche has a hospital built by MSF, which started off as a few tents but has expanded to include an operating theatre, but little else. There is no work, families must walk hours to find firewood, and each person must survive on about nine litres of water a day \u2013 far below the recommended 20 litres.<\/p>\n <\/span>The growing malnutrition ward in the MSF\u2019s field hospital.<\/span> Photograph: Kaamil Ahmed\/The Guardian<\/p>\n This isolation means hospitals are receiving women with complications in their pregnancy dangerously late. There is only a single ambulance to cover the route between the Metche hospital and the clinic near the camp at Alacha, where Mohammed is one of nearly 50,000 refugees. The MSF team has seen cases where women in desperate pain have had to wait an entire night for the ambulance to arrive.<\/p>\n Imagine being nine months pregnant, in labour, and travelling hours on a cart pulled by a donkey to get to a hospitalAlejandrina Cripovic, surgeon<\/p>\n As well as being rough, the route passes through valleys that flood during the rainy season, completely cutting off travel.<\/p>\n Alejandrina Cripovic, a surgeon at MSF\u2019s hospital in Metche, said every case she sees is an emergency, with some women having to make long and difficult journeys to the hospital by foot or on a donkey.<\/p>\n \u201cImagine being nine months pregnant, in labour, and travelling hours on a cart pulled by a donkey to get to a hospital. The biggest factor is the delay but having to come in these conditions also has an impact on the birth,\u201d says Cripovic.<\/p>\n <\/span>A waiting area at the MSF hospital in Metche. <\/span> Photograph: Kaamil Ahmed\/The Guardian<\/p>\n Malnutrition, which is on the rise, also increases the risk of complications in pregnancy, including the uterine ruptures that MSF staff see regularly.<\/p>\n Mohammed has remained in hospital in the two months since her caesarean. Suffering from malnutrition, she developed an infection, while her son has been carefully monitored. The father has travelled to other towns in search of work, so Mohammed is completely reliant on her mother.<\/p>\n The malnutrition ward has expanded to six tents and has patients spilling over into other sections. Children lie under mosquito nets in sweltering heat in almost complete silence as medical staff work, preparing treatments and weighing children on a scale made from a bucket and rope.<\/p>\n In mild cases children get sachets of PlumpyNut, the specially formulated peanut paste, but the worst cases need a regular intake of enriched milk. Mohammed\u2019s baby is fed his through a syringe.<\/p>\n Suhayba Abdullah Abubakar\u2019s 11-month-old boy, Sufian Sulaiman, is being fed through a nasal drip. The infant has been ill for the past year but Abubakar was repeatedly given only painkillers without any diagnosis, until she made the journey from Alacha to Metche.<\/p>\n <\/span>Suhayba Abdullah Abubakar, 25, cares for her 11-month-old son, who became severely malnourished. The boy has to receive milk through his nose because he cannot be fed normally. <\/span> Photograph: Kaamil Ahmed\/The Guardian<\/p>\n \u201cEvery day, I see more children joining us in this tent,\u201d she says. \u201cThe food we\u2019re eating is poor, there\u2019s not enough to eat and it\u2019s not nutritious.<\/p>\n \u201cIf we were at home, we could\u2019ve adapted ourselves. You can go and grow crops, you can work to earn some money, but here we\u2019re reliant on what we\u2019re given.\u201d<\/p>\n And what they are given is a small amount of sorghum, cooking oil and salt, handed out every two months. Such a basic diet lacks nutrition, and the little cash she is given cannot buy much in the weekly food markets, where prices have become inflated.<\/p>\n Abubakar was relocated to Alacha after arriving from Sudan in 2023, having fled the paramilitary Rapid Support Forces\u2019 attack on her home city of El Geneina in June that year.<\/p>\n skip past newsletter promotion<\/p>\n Sign up to Global Dispatch<\/span><\/p>\n Get a different world view with a roundup of the best news, features and pictures, curated by our global development team<\/p>\n Privacy Notice: <\/strong>Newsletters may contain information about charities, online ads, and content funded by outside parties. If you do not have an account, we will create a guest account for you on theguardian.com to send you this newsletter. You can complete full registration at any time. For more information about how we use your data see our Privacy Policy. We use Google reCaptcha to protect our website and the Google Privacy Policy and Terms of Service apply.<\/span><\/p>\n after newsletter promotion<\/p>\n Finding no work in Chad, her husband has gone to Libya in the hope of raising enough money for them to follow. She lives with his relatives, sharing out whatever food they can get.<\/p>\n Abubakar says she has already seen food distributions being reduced and there are concerns that the abrupt cuts in overseas aid budgets by the US, UK and other European countries, could make things worse. Despite the war in Sudan having created the 21st century\u2019s worst humanitarian disaster and the scale of needs of the refugees continuing to arrive, only 69% of the international funding needed in Chad was received by UN agencies in 2024.<\/p>\n The World Food Programme warned in June that without further money, it would need to cut food aid further.<\/p>\n <\/span>The Sudanese women all have stories of hardship and illness. <\/span> Photograph: Kaamil Ahmed\/The Guardian<\/p>\n In Metche, a group of Sudanese women sit under a tree. Azza Dahiye Osman, 65, is weaving dried palm leaves into items she can sell at the market. Some of the others sell small bags of peanuts, or get work from local farmers, but often end up being exploited and not paid.<\/p>\n They all have their own stories of hardship. One woman miscarried after she was turned away by health clinics, despite the pain she was in.<\/p>\n Osman suffers from hypertension but says there is no treatment for chronic diseases in the camps until the illness reaches an emergency stage. \u201cSo if I have diabetes or hypertension, do I have to die to get treated?\u201d she says. \u201cI have searched and searched and searched for help but I cannot even get the medicine I need.\u201d<\/p>\n <\/span>Azza Dahiye Osman cannot get treated for her chronic disease. <\/span> Photograph: Kaamil Ahmed\/The Guardian<\/p>\n Osman left Sudan two years ago, fleeing the RSF advance onEl Geneina, the first city in the Darfur region to fall to the paramilitaries. Now in Metche, people are anxious for news of the RSF\u2019s push to take El Fasher, the last city in Darfur still resisting the rebels.<\/p>\n The RSF claims it is pushing back against the Sudanese government, which it says is made up of elites who have long ignored the marginalised.<\/p>\n \u201cThey are liars; there\u2019s nothing to believe,\u201d says Osman. \u201cThey are the ones who killed us \u2013 we cannot live under them.\u201d<\/p>\n RSF control of Darfur, and the parallel government it has established there, means no going back for the refugees in Chad. It is a bleak prospect. There are few jobs on offer for young men, just local brickfields or in northern Chad\u2019s goldmines. So most leave to try their luck further afield.<\/p>\n Afaf Abdulmalik, 21, feels she will have to move soon. She left behind a comfortable life and a government job in El Fasher in 2023, after her brother-in-law was killed in front of his family during the RSF\u2019s first failed attempts to take the city.<\/p>\n <\/span>Afaf Abdulmalik in her shelter in the Metche refugee camp. She has not heard from her brother and sister in El Fasher for two years. <\/span> Photograph: Kaamil Ahmed\/The Guardian<\/p>\n Her older brother and sister remain in El Fasher but she has not heard from them and does not know whether they are alive. Her life is focused on the daily survival of her elderly mother, sister and young niece, searching for water and firewood.<\/p>\n There is no schooling available for her niece, who is still traumatised by her father\u2019s killing. The UN\u2019s refugee agency, UNHCR, has warned that aid cuts by international donors have threatened secondary education programmes and could mean 155,000 out of school by next year.<\/p>\n The teenager saw her father shot in front of her by RSF fighters, who used to raid their neighbourhood on motorbikes, killing and kidnapping the residents.<\/p>\n \u201cWe cannot forget what we saw there,\u201d says Abdulmalik. \u201cMy niece still freezes if she sees a man on a motorbike.\u201d<\/p>\n <\/span>Afaf Abdulmalik tends to the garden she cultivated in the Metche refugee camp as a reminder of their home in Sudan.<\/span> Photograph: Kaamil Ahmed\/The Guardian<\/p>\n But she has also tried to cultivate a little joy: the family\u2019s shelter is surrounded by plants, mostly vegetables but also flowers that remind them of a Sudan in bloom with lemon trees and pomegranates.<\/p>\n The garden has taken time \u2013 she cannot buy seeds so Abdulmalik takes cuttings of plants she comes across while she goes about her daily tasks and brings them home. To see her work flourish, she had to wait for the recent rainy season.<\/p>\n \u201cSometimes in the morning I take a cup of tea and stand in the garden, it gives me some happiness; it helps me remember life before the war and forget everything that\u2019s happened,\u201d she says. \u201cI get this feeling for a moment that maybe everything will be OK.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":" For hours, jolting along the waterlogged dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and focused on stopping herself vomiting. She was in labour, in extreme pain after her uterus ruptured, but was now being tossed around in the ambulance that jumped along the dips and bumps of<\/p>\n","protected":false},"author":1,"featured_media":26671,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[55],"tags":[10509,15987,15986,12754,2056,1199,132,15985,15983,15984,418],"class_list":{"0":"post-26670","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-social-issues","8":"tag-camps","9":"tag-chad","10":"tag-chads","11":"tag-desert","12":"tag-hand","13":"tag-left","14":"tag-live","15":"tag-mouth","16":"tag-searched","17":"tag-sudanese","18":"tag-women"},"_links":{"self":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/26670","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=26670"}],"version-history":[{"count":0,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/26670\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/media\/26671"}],"wp:attachment":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=26670"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=26670"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=26670"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}