TINE - Medical staff treated refugee Mahamat Hamid Abakar for a serious head wound from a drone attack using bandages and compresses outside Tine hospital in eastern Chad, on the border with Sudan.
The 33-year-old, who fled his native Sudan as war erupted nearly three years ago, had just had a five-millimetre metal fragment removed from his skull.
Most of the wounded crossing the border are victims of drones, which have been much deployed in strikes by both sides in the conflict.
Sitting in the back of a pick-up truck, Abakar was travelling at night to deliver flour and sugar from Chad to his family who have stayed in Sudan.
"I was attacked by a drone in the area of Um Baru in Sudan three days ago," he said, despite difficulties in talking.
Three other occupants of the vehicle -- two men and a woman -- were burned to death in the explosion.
The travel companion seated next to him died from his injuries the next morning, shortly after being picked up by rescue teams, who transported them to the Chadian border 150 kilometres (90 miles) away.
Since April 2023, Sudan's government army has been fighting its former allies in the paramilitary Rapid Support Forces (RSF).
The war has killed tens of thousands of people, displaced more than 13 million, according to the United Nations, and triggered a humanitarian crisis.
- Drone attacks -
Set on a hill overlooking a parched river marking the border, the hospital at Tine is on the front line for receiving wounded Sudanese.
"Since the capture of El-Fasher at the end of October, we have taken in a thousand Sudanese," said Awadallah Yassine Mahamat, a carer from Sudan's western region of Darfur who volunteers at the hospital after fleeing to Tine a year and a half ago.
El Fasher is the state capital of North Darfur.
"In Darfur, many hospitals, health centres and even pharmacies were destroyed during fighting," he said, showing photographs on his phone of emaciated and charred bodies at the hospital where he worked before leaving.
Dressed in a thick, black jacket, the man in his 40s said most victims arriving in Chad had fractures following drone attacks.
In recent weeks, the wounded have flooded in from border areas being attacked by RSF forces.
Abakar Abdallah Kahwaya and Mahamat Abakar Hamdan, both aged 27, said they had been fighting for an army-aligned faction led by Darfur Governor Minni Minnawi.
They have been in hospital for two weeks after being wounded during clashes with the RSF in Girgira, a Sudanese town about 50 kilometres south of Tine.
"We put down our weapons to enter Chad and receive treatment," said Kahwaya, who has an abdomen wound.
"But as soon as we can fight again, we'll return to Sudan," Hamdan added.
Mahamat, the volunteer caregiver, stressed that the hospital accepted anyone who was wounded, whether civilian or combatant -- but acknowledged the limits of the care the hospital was able to give.
"We're short on caregivers and they are not sufficiently trained to care for all the wounded," he said.
- Treating trauma -
But the wounds are not only physical -- treating the mental distress of refugees poses a significant challenge.
"The lack of resources and prospects in the camps further increases their vulnerability," said Kindi Hassan, a mental health official with the International Rescue Committee (IRC) at the Goudrane camp, which accommodates around 60,000 refugees.
Hassan was helping 30-year-old Asma -- a pseudonym -- who escaped an RSF attack on Zamzam, the largest refugee camp in North Darfur, in April.
In tears, the woman recounted the day she spent holed up in a makeshift bunker dug beneath her home before managing to get out of the camp.
She left behind the bodies of 11 family members killed in a bombing.
"Soldiers arrested me and three friends as we were fleeing," she said, wiping away the tears with her headscarf.
"They beat us with the butts of their rifles until we couldn't walk anymore and took turns raping us until the morning," she said.
Medicine now helps to keep at bay the images that had haunted her and stopped her sleeping.
"Mental health is stigmatised and most cases of post-traumatic stress are kept quiet," Hassan, of the IRC, said.
She said refugees waited a long time before talking about their trauma, adding: "Our response is inadequate to meet the enormous needs."
Four NGOs are caring for the mental health of victims of conflict in Goudrane camp, including the IRC, which has helped almost 800 people in a year.
If additional resources don't arrive, the plight of refugees in Chad's camps risks worsening, warned Hassan, who spoke of an increasing trend of "suicidal thoughts".
"Some people even go so far as to poison or hang themselves to escape their distress," she said.
- by Joris Bolomey