The midwife donned her latex gloves and placed her measuring tape flat against the young pregnant woman’s exposed belly. It was larger than anticipated for 36 weeks.
“It could be a big baby,” said the midwife, Nancy Symgambaye, according to The New York Times. “Maybe there’s too much fluid. Or it could be twins.”
All these situations could be dangerous for any pregnant woman, especially for Taiba Baraka, a 26-year-old refugee from Sudan. Ms. Baraka looked worried as she lay in bed while Ms. Symgambaye continued her examination.
It was mid-August, and the ward she had come to for her last prenatal appointment before giving birth was a run-down tent in Aboutengué camp, an isolated refugee station in Chad housing more than 50,000 people, most of them women and children fleeing the civil war in neighboring Sudan. The stark reality of her situation weighed heavily on her —a once vibrant life now reduced to surviving in a makeshift camp where basic necessities are scarce and medical care often inadequate.
The uncertainty of her pregnancy only compounded her anxiety; she had heard stories of complications that could arise in such conditions, and the thought of facing those alone was terrifying. As Ms. Symgambaye jotted down notes and reassured her with a calm demeanor, Ms. Baraka tried to focus on the flicker of hope that her baby would arrive healthy.
Chad, a country marked by its sparse population and pervasive poverty, also faces one of the highest maternal mortality rates in the world. But despite these daunting challenges, it has opened its borders to approximately 900,000 refugees escaping the turmoil of the civil war in Sudan, where dire conditions have led to widespread hunger, cholera outbreaks and deep-seated trauma.
Healthcare professionals, including dedicated individuals—like Ms. Symgambaye—have stepped up to provide crucial medical care to vulnerable patients, often with the support of funding from the United States. However, the landscape shifted dramatically following the Trump administration’s decision to slash U.S. foreign aid, leaving many of these essential medical workers without jobs and further exacerbating the already fragile healthcare situation.
For years, U.S. officials argued that foreign aid was not just a humanitarian necessity but also a strategic tool that saved lives and bolstered American relationships abroad. But as many of us know, the Trump administration took a different approach, framing such aid as wasteful and corrupt, labeling organizations like the United States Agency for International Development (U.S.A.I.D.) as managed by “radical lunatics.”
The rapid cuts to foreign aid have thrown relief efforts into disarray, leaving workers scrambling to cope with the dire fallout. In Chad, the maternity unit in Aboutengué has felt the brunt of these changes, which came as a shock to many, especially when the U.S. was previously its largest donor. Following Trump’s abrupt executive order to halt all foreign aid in February, the unit lost two of its eight midwives almost immediately. This decision not only diminished the staff but also increased the risk for expectant mothers in a region already struggling with medical access.
Experts are sounding the alarm, noting that lives are now at greater risk, with more people succumbing to preventable complications. As if that weren’t enough, a senior official from the International Rescue Committee revealed that three more midwives are set to be laid off in December, which will further worsen the crisis. The lack of clear communication surrounding these cuts has left relief organizations in a lurch, unable to sufficiently prepare for or respond to the growing needs of the community.
In a grim reality, the maternity ward is set to function with just three midwives, who are caring for women who have endured horrific sexual violence. Many of the tens of thousands of pregnant women fleeing Sudan did not choose the path of motherhood; rather, they are survivors of rape that resulted in their pregnancies, a situation the United Nations has labeled as a war on women in Sudan.
According to recent reports from Amnesty International, sexual violence in Darfur has reached alarming levels so rife that many regard it as an unavoidable aspect of life in the region, particularly for women. These women face horrendous attacks not only while working in the fields or fleeing their circumstances but also in their homes, making every aspect of their existence fraught with danger. The International Criminal Court has classified these acts of rape as a weapon of war, highlighting the systematic and brutal nature of the violence that plagues this area.
The repercussions of this violence extend beyond immediate physical harm, as evidenced by the rising number of women becoming pregnant due to these assaults. Dr. Raick Bell, a supervising doctor with the International Rescue Committee, notes that the disruption of birth control supply chains—heightened by the cessation of funding for family-planning programs under the Trump administration – has significantly contributed to this crisis.
“We will find ourselves with numerous pregnancies – women who don’t have enough time to be able to recover afterward,” he told The Times.
The harrowing mix of war, violence and inadequate healthcare creates a devastating situation for women in Darfur—the area in western Sudan where many refugees in Chad originate—who are not only battling the ongoing threat of assault but are also facing the consequences of unplanned pregnancies in an already unstable environment. The plight of these women demands urgent attention and compassionate action from the global community, as their suffering underscores the dire need for comprehensive support and resources aimed at safeguarding their rights and well-being.
The civil war in Sudan that began in 2023 between the military and the Rapid Support Forces (R.S.F.) has led to extensive devastation. Foreign nations are becoming involved, with reports suggesting the United Arab Emirates may have used a field hospital in eastern Chad, intended for Sudanese refugees, to secretly supply weapons to the R.S.F., a claim the UAE denies.
Aboutengué, like many refugee camps in eastern Chad, is hard to reach, and the camp is harsh and dry for most of the year. But heavy rains in August turn it into mud, trapping residents in their small shelters.
Many families once enjoyed comfortable lives before the war took everything. They are eager to work or obtain more food to supplement their limited U.N. rations, but opportunities in Aboutengué, including aid for small businesses, have diminished due to funding cuts.
As for Ms. Baraka, Ms. Symgambaye expressed her concerns about the challenges that might accompany her delivery and gently urged her to return to the clinic at the first signs of contractions. With a warm and empathetic demeanor, Ms. Symgambaye reassured Ms. Baraka that seeking timely care could make all the difference in ensuring both her safety and that of her baby.
“If you stay home, nobody can help you,” she pleaded. “Please, please come here to deliver.”
Midwives play a crucial role in advocating for the health and safety of women and their newborns, particularly in challenging environments like a refugee camp. Their efforts to encourage women to seek proper medical care at the clinic are vital, as many women still opt for home deliveries, often putting themselves and their children at significant risk. But, as experienced professionals leave due to various pressures, the support and education that midwives provide are dwindling, leaving many women without the guidance they desperately need.
Baraka nodded and gently caressed her slumbering two-year-old’s leg to rouse her from sleep.
They needed to return to their shelter before the rain began to fall.
How We Can Help
One of the best ways to assist women and girls in Sudan is to focus resources and attention specifically on them and the organizations providing essential services on the ground. This is critical, as local, women-led initiatives currently receive less than 2% of humanitarian funding.
Below are some reputable organizations with a strong track of supporting women and girls in Sudan.
The Women’s Peace and Humanitarian Fund
