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For an extended period, bouncing over the flooded dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and tried hard stopping herself throwing up. She was in childbirth, in severe suffering after her womb tore, but was now being tossed around in the ambulance that lurched across the potholes and ridges of the road through the Chadian desert.

Most of the hundreds of thousands of Sudanese displaced persons who escaped to Chad since 2023, living hand to mouth in this inhospitable environment, are females. They reside in isolated camps in the desert with scarce resources, few job opportunities and with healthcare often a life-threateningly long distance away.

The clinic Mohammed needed was in Metche, one more encampment more than 120 minutes away.

“I continuously experienced infections during my term and I had to go the medical tent multiple occasions – when I was there, the pregnancy started. But I found it impossible to give birth naturally because my womb had given way,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I recall is the suffering; it was so bad I became confused.”

Her parent, Ashe Khamis Abdullah, 40, worried she would lose both her daughter and baby grandson. But Mohammed was immediately taken for surgery when she got to the hospital and an urgent C-section preserved the lives of her and her son, Muwais.

Chad previously recorded the world’s second most severe maternal mortality rate before the ongoing stream of refugees, but the situations faced by the Sudanese expose further women in risk.

At the hospital, where they have delivered 824 babies in frequently urgent circumstances this year, the medics are able to save many, but it is what occurs with the women who are cannot access the hospital that alarms the professionals.

In the couple of years since the civil war in Sudan began, the vast majority of the people who reached and remained in Chad are mothers and kids. In total, about over a million Sudanese are being hosted in the eastern part of the country, 400,000 of whom fled the earlier war in Darfur.

Chad has hosted the bulk of the 4.1 million people who have run from the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been forced out of their homes.

Many men have remained to be in proximity to homes and land; some were slain, taken hostage or made to join the conflict. Those of working age soon depart from Chad’s isolated encampments to find work in the capital, N’Djamena, or beyond, in nearby Libya.

It results in women are stranded, without the ability to sustain the dependents left in their responsibility. To prevent congestion near the border, the Chadian government has moved individuals to less crowded encampments such as Metche with typical numbers of about a large community, but in remote areas with few facilities and scarce prospects.

Metche has a hospital set up by a medical aid organization, which began as a few tents but has developed to contain an surgical room, but not much more. There is no work, families must travel long distances to find firewood, and each person must survive on about a small amount of water a day – well under the recommended 20 litres.

This remoteness means hospitals are receiving women with complications in their pregnancy dangerously late. There is only a one medical transport to cover the route between the Metche hospital and the health post near the Alacha encampment, where Mohammed is one of a large number of refugees. The medical team has encountered situations where women in extreme agony have had to remain overnight for the ambulance to reach them.

Imagine being expecting a child, in delivery, and travelling hours on a cart pulled by a donkey to get to a medical facility

As well as being uneven, the path goes through valleys that fill with water during the rainy season, completely cutting off travel.

A surgeon at the hospital in Metche said every case she sees is an critical situation, with some women having to make challenging travels to the hospital by on foot or on a mule.

“Imagine being nine months pregnant, in labour, and journeying for an extended time on a donkey cart to get to a clinic. The primary issue is the delay but having to come in these conditions also has an effect on the childbirth,” says the surgeon.

Poor nutrition, which is growing, also elevates the likelihood of problems in pregnancy, including the womb tears that medical staff frequently observe.

Mohammed has continued under care in the couple of months since her C-section. Experiencing malnutrition, she developed an infection, while her son has been carefully monitored. The parent has gone to other towns in seek jobs, so Mohammed is entirely leaning on her mother.

The undernourishment unit has expanded to six tents and has cases exceeding capacity into other sections. Children are placed under mosquito nets in oppressive temperatures in almost total quiet as health workers work, mixing medications and assessing weights on a scale made from a bucket and rope.

In less severe situations children get small bags of PlumpyNut, the specifically created peanut paste, but the worst cases need a consistent supply of nutrient-rich liquid. Mohammed’s baby is given his nourishment through a syringe.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being nourished via a nose tube. The child has been unwell for the past year but Abubakar was consistently offered just painkillers without any medical assessment, until she made the travel from Alacha to Metche.

“Every day, I see further minors coming in in this shelter,” she says. “The nutrition we receive is low-quality, there’s not enough to eat and it’s lacking in nutrients.

“If we were at home, we could’ve adapted ourselves. You can go and farm produce, you can get a job, but here we’re dependent on what we’re given.”

And what they are provided is a limited quantity of grain, edible oil and salt, handed out every couple of months. Such a simple food lacks nutrition, and the meager funds she is given cannot buy much in the local bazaars, where costs have risen.

Abubakar was transferred to Alacha after reaching from Sudan in 2023, having escaped the militia Rapid Support Forces’ assault on her native town of El Geneina in June that year.

Failing to secure jobs in Chad, her husband has gone to Libya in the hope of earning sufficient funds for them to follow. She resides with his relatives, dividing up whatever food they can get.

Abubakar says she has already witnessed food rations being cut and there are concerns that the sudden reductions in international assistance funds by the US, UK and other European countries, could worsen the situation. Despite the war in Sudan having caused the 21st century’s most severe crisis and the {scale of needs|extent