The midwife carefully pulled on her latex gloves, her measuring tape pressing gently against the young woman’s swollen belly. It was unusually large for 36 weeks.
“Could be a big baby,” remarked Nancy Symgambaye, the resilient midwife dressed in pink scrubs. “Perhaps too much fluid. Or even twins.” Each possibility carried its own set of risks, amplified for Taiba Baraka, a 26-year-old Sudanese refugee.
In mid-August, Taiba lay on the bed, watching Nancy with apprehension. This was her final prenatal check-up, held in a makeshift tent at Aboutengué camp. This isolated refuge in Chad now shelters over 50,000 people, primarily women and children, all escaping the brutal civil war in neighboring Sudan.
Inside, thin floral fabrics served as the only partitions.
Chad, a vast Central African nation with sparse populations across its rugged deserts and rolling savannas, battles one of the world’s highest rates of maternal mortality, making it one of its poorest countries. Yet, it has bravely opened its borders to 900,000 people fleeing an immense humanitarian disaster in Sudan. Two years of civil war have left Sudan ravaged by famine, cholera outbreaks, and unimaginable suffering.
Until recently, dedicated medical staff like Nancy Symgambaye provided essential care to these refugees, often supported by funds from the United States. However, this year, the Trump administration announced a global cessation of U.S. foreign assistance, triggering immediate job losses for these vital workers.
For decades, U.S. officials advocated for foreign aid, asserting its benefits to American interests, its role in saving lives, and its capacity to extend American influence worldwide. The Trump administration, however, dramatically departed from this stance. They halted government funding, targeting agencies such as the United States Agency for International Development, which they controversially labeled as wasteful, fraudulent, and controlled by “radical lunatics.”
The sudden and poorly managed aid cuts have created catastrophic repercussions, with experts warning of increased mortality rates. The grim reality of these decisions is most apparent in places like Aboutengué’s maternity unit in Chad, which, until this year, relied almost entirely on U.S. funding.
In February, following President Trump’s executive order to halt all foreign aid, two of Aboutengué’s eight midwives were laid off. By December, three more will be gone, according to a senior official from the International Rescue Committee, which paid their modest salaries using American funds.
This leaves the maternity ward to function with only three midwives, who are expected to care for countless women, many of whom have endured unimaginable sexual violence. Among the tens of thousands of pregnant women escaping Sudan, a heartbreaking number are not pregnant by choice, but are survivors of rape in what the United Nations has tragically termed a war on women in Sudan.
The prevalence of sexual violence in Darfur—the western Sudanese region from which most of Chad’s refugees hail—is so extreme that it’s widely regarded as inescapable. Women face attacks in their homes, in the fields, and during their desperate flight. The International Criminal Court has confirmed that rape is deliberately being used as a weapon of war in this conflict-ridden area.
Disturbingly, more women are becoming pregnant than ever before, reported Dr. Raick Bell, the International Rescue Committee’s supervising doctor in the region. Dr. Bell attributes part of this surge to significant disruptions in birth control supplies, a direct consequence of the Trump administration’s decision to cease funding for family-planning programs in developing countries.
“We are facing a future with countless pregnancies, and women will not have adequate time to recover between births,” Dr. Bell explained, speaking from a corner of the sweltering maternity tent. Meanwhile, Nancy Symgambaye and her colleagues struggled to attend to the growing line of women waiting on a plastic mat at the entrance.
Evelyne Ndjepa, the midwife leading the unit, hobbled past, her ankle bandaged from a roof collapse during a storm the day before. Despite her injury, taking time off was unthinkable, given the severe understaffing. She diligently questioned a woman about missed periods before sending her for a pregnancy test.
Before the aid reductions, Ms. Ndjepa recalled that two midwives were always on duty during the night, when most women arrive to give birth. Now, due to the cuts, a single midwife must manage these critical night shifts alone.
“We simply cannot cope,” she stated bluntly.
She anxiously eyed the month’s handwritten schedule, precariously taped to a sagging tarpaulin. The looming threat of further staff reductions, she knew, was inevitable, leaving her with no clear path to maintain essential operations.
Soon after, another pregnant woman, Nafissa Adam, 38, arrived, leaning heavily on her teenage daughter. Weak from a week of near starvation, having given all her meager food to her children, she collapsed. Three people had to help her onto the scale, then carried her to a bed where she wept softly as a nurse administered an IV.
Like many in Aboutengué, Ms. Adam had lost everything when she fled Sudan.
The civil war, which erupted in 2023 between Sudan’s military and the rival Rapid Support Forces, has devastated one of Africa’s largest nations. External powers have exacerbated the conflict by choosing sides. Last year, a New York Times investigation exposed how the United Arab Emirates allegedly used a field hospital in eastern Chad, ostensibly for refugee aid, as a front to smuggle weapons across the border to the R.S.F. The United Arab Emirates has denied these allegations.
Accessing Aboutengué, like many other camps across Chad’s eastern rural expanse, is challenging. War refugees must navigate miles of cratered roads, passing cattle herds, occasional camels, and turbaned equestrians.
Most of the year, the camp is a barren, treeless landscape where mere survival is an arduous task. Then, August brings torrential rains, transforming the dust into thick mud, engulfing the camp in a swamp, and confining residents to their tiny shelters.
Many families in the camp once led comfortable lives before the war stripped them of everything. They yearn to regain self-sufficiency or at least supplement their meager U.N. food rations. However, income-generating opportunities in Aboutengué, such as support from aid organizations for small businesses, quickly vanished following the aid cuts.
Ms. Baraka, the young pregnant woman, carefully adjusted her orange wrap around her swollen abdomen and over her head. On the mat beside her, her 2-year-old daughter lay peacefully asleep in her best dress. This would be Ms. Baraka’s second child to survive infancy; her first had tragically passed away a day after birth five years prior.
That same little girl had been sleeping beside Ms. Baraka one May morning in 2023, as she prepared breakfast in Misterei, her Sudanese hometown in the Darfur region. Suddenly, five Rapid Support Forces fighters scaled her fence, setting her home ablaze. She instinctively snatched her daughter and fled.
After escaping the R.S.F. fighters, she and her baby managed to reach Chad. They arrived with nothing, and now share a shelter with other family members who also survived the war in Sudan.
Ms. Baraka shuffled towards Ms. Symgambaye’s desk and sank into a plastic chair. A language barrier complicated their conversation, as they spoke different Arabic dialects. The ward’s designated interpreter, a Sudanese refugee assisting the midwives, was busy trying to facilitate multiple conversations simultaneously.
Ms. Symgambaye informed Ms. Baraka that her delivery appeared challenging, urging her to return to the clinic immediately upon feeling contractions. “If you stay home, no one can help you,” she pleaded. “Please, please come here to deliver.”
A key part of the midwives’ mission is to persuade women to seek proper medical care at the clinic. Many women in the camp, however, choose to deliver at home, risking both their own lives and their child’s. With the maternity ward losing staff, such vital outreach efforts are dwindling.
Ms. Baraka heaved herself up from the plastic chair, making her way through the bustling tent towards her sleeping daughter. She slipped off her sandals, tucked them under the mat, and with a nod to her aunt, who had accompanied her, collapsed beside her toddler.
She wished she had grabbed her smartphone on the day she fled Sudan, she murmured. She wished she had clutched the $90 in cash she had saved. “I wish many things,” Ms. Baraka sighed. “But I can’t go back.”
She gently stroked her toddler’s leg, rousing her. They needed to return to their shelter before the imminent rains began.
Zainab Ali Abdallah also contributed to this report.