“If my leg was healed, I'd cook you a grilled chicken”
Surgeon Mahamat Zibert Hissein has been caring for refugees who have fled the brutal war in Sudan by crossing the border into neighbouring Chad. Here, he shares the story of a patient he'll never forget.
Mariam* is a 24-year-old mother of two from Sudan who had to flee the war. She was shot as she escaped the violence, the bullet fracturing a bone in her leg. She was seven months pregnant.
I’m a surgeon, and was working at the Médecins Sans Frontières / Doctors Without Borders (MSF) hospital Adré in Chad when Mariam arrived. Adré is a border town, only 400 metres away from neighbouring Sudan. Since the war began in May 2023, over 600,000 people have crossed the border, seeking refuge in Adré and the surrounding area.
An inflatable hospital
Many who arrive are in desperate need of medical care, including surgery. To make this possible, MSF has set up an inflatable hospital.
The hospital is an innovative system of tents with an inflatable framework, all made of durable, weatherproof materials. It can be erected anywhere in the world to quickly create a full surgical unit, with two operating theatres and a recovery room.
Among other services, in Adré we provide general emergency surgery, surgery for orthopaedic cases, and follow-up with physiotherapy.
In the operating theatre
It was clear that Mariam’s leg needed surgery and an external fixator: a stabilising frame which holds broken bones in position while they heal.
To place the fixator, screws must be inserted into the bone above and below the fracture. These pins extend through the skin, and the fixation device is then attached to the screws externally.
When I examined Mariam’s injury I could see that the bullet had fractured the lower third of her tibia, close to the joint. This would make it tricky to place the device.
Once in the operating theatre, we assessed the options. The priority was to preserve the function in Mariam’s leg as much as possible. Life in the refugee camps is difficult enough for able-bodied people. I knew that living with a disability would make things even tougher for Mariam and her children.
"Life in the refugee camps is difficult enough for able-bodied people"
Walking again
Thankfully we managed to place the fixator successfully. I was pleased, and when she recovered from the anaesthetic, I asked Mariam to be very careful and to take good care of her leg. I knew this wouldn’t be easy – most refugees are living in tents or makeshift shelters, without beds or mattresses.
But Mariam was determined. She came back regularly for dressings, which helped the wound to heal properly. She always kept her spirits up and kept smiling.
Every time I went into the tents, she would smile and say: "Hey Dr Zibert, if my leg was healed, I'd cook you a grilled chicken".
The fixator was recently removed, and Mariam started working with the physiotherapy team. Soon she was walking again.
Support our expert surgical teams working in crisis zones worldwide
Grilled chicken and recovery
Finally, the day arrived when Mariam was ready to leave the hospital. That day, she thanked me profusely and reminded me of her promise to cook me a grilled chicken one day. Refugees in Adré are currently surviving on very limited food, but her hope that things would improve, and her generous spirit, made a real impression on me.
Despite the difficult circumstances for refugees like Mariam, it was an immense joy to see a mother of two, pregnant with her third child, leave hospital healed and able to continue her life.
*Name has been changed
MSF and the crisis in Sudan
On Saturday 15 April, intense fighting broke out across Sudan with a wave of gunfire, shelling and airstrikes.
The violence between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) has trapped millions of people in the middle of an unexpected conflict. Many have been forced to flee their homes while access to essential services such as healthcare has become increasingly difficult.
Médecins Sans Frontières / Doctors Without Borders (MSF) teams already working in Sudan have been responding to the crisis since its first moments.