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For hours, travelling roughly on the flooded dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and concentrated on stopping herself throwing up. She was in delivery, in agonizing discomfort after her uterus ruptured, but was now being tossed around in the ambulance that jumped along the potholes and ridges of the road through the Chadian desert.

Most of the hundreds of thousands of Sudanese people who ran to Chad since 2023, barely getting by in this inhospitable environment, are females. They reside in isolated camps in the desert with insufficient supplies, little employment and with medical help often a dangerously far away.

The medical center Mohammed needed was in Metche, a different settlement more than a considerable journey away.

“I kept getting infections during my pregnancy and I had to go the health post on numerous visits – when I was there, the pregnancy started. But I could not give birth naturally because my uterus had collapsed,” says Mohammed. “I had to wait two hours for the ambulance but all I remember was the suffering; it was so bad I became delirious.”

Her maternal figure, Ashe Khamis Abdullah, 40, feared she would lose both her child and grandchild. But Mohammed was hurried into surgery when she arrived at the hospital and an critical surgical delivery saved her and her son, Muwais.

Chad already had the world’s second-highest maternal death rate before the recent arrival of refugees, but the situations faced by the Sudanese expose further women in peril.

At the hospital, where they have delivered 824 babies in mostly emergency conditions this year, the medics are able to save many, but it is what affects the women who are not able to reach the hospital that worries the staff.

In the 24 months since the internal conflict in Sudan started, the vast majority of the displaced persons who came and stayed in Chad are women and children. In total, about over a million Sudanese are being hosted in the east of the country, four hundred thousand of whom escaped the earlier war in Darfur.

Chad has taken the lion’s share of the over four million people who have fled the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been displaced from their homes.

Many men have stayed behind to be close to homes and land; others have been slain, abducted or conscripted. Those of adult age move on quickly from Chad’s desolate refugee camps to look for jobs in the capital, N’Djamena, or further, in nearby Libya.

It means women are left alone, without the resources to feed the dependents left in their charge. To reduce density near the border, the Chadian government has transferred refugees to smaller camps such as Metche with usual resident counts of about a large community, but in remote areas with limited infrastructure and minimal chances.

Metche has a hospital established by a medical aid organization, which was initially a few tents but has expanded to include an procedure area, but little else. There is no work, families must walk hours to find fuel, and each person must subsist with about a small amount of water a day – well under the suggested amount.

This seclusion means hospitals are treating women with issues in their pregnancy dangerously late. There is only a single ambulance to cover the route between the Metche hospital and the health post near the camp at Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has encountered situations where women in severe suffering have had to endure a full night for the ambulance to come.

Imagine being in the final trimester, in labour, and journeying for a long time on a cart pulled by a donkey to get to a clinic

As well as being bumpy, the road traverses valleys that fill with water during the monsoon, completely blocking travel.

A surgeon at the hospital in Metche said each patient she treats is an critical situation, with some women having to make long and difficult journeys to the hospital by foot or on a pack animal.

“Imagine being in the late stages of pregnancy, in childbirth, and making a long trip on a animal-drawn vehicle to get to a clinic. The main problem is the lag but having to arrive under such circumstances also has an effect on the delivery,” says the surgeon.

Undernourishment, which is increasing, also elevates the likelihood of issues in pregnancy, including the uterine splits that medical staff see regularly.

Mohammed has stayed at the medical facility in the couple of months since her surgical delivery. Experiencing malnutrition, she developed an infection, while her son has been carefully monitored. The father has travelled to other towns in look for employment, so Mohammed is entirely leaning on her mother.

The nutritional care section has expanded to six tents and has patients spilling over into other sections. Children rest beneath mosquito nets in oppressive temperatures in almost total quiet as doctors and nurses work, mixing medications and assessing weights on a device constructed from a bucket and rope.

In less severe situations children get sachets of PlumpyNut, the specially formulated peanut paste, but the most severe instances need a consistent supply of nutrient-rich liquid. Mohammed’s baby is fed his through a syringe.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being given nutrition by a nasal drip. The infant has been unwell for the past year but Abubakar was consistently offered just painkillers without any diagnosis, until she made the travel from Alacha to Metche.

“Every day, I see more children coming in in this shelter,” she says. “The food we’re eating is low-quality, there’s not enough to eat and it’s deficient in vitamins.

“If we were at home, we could’ve adjusted our lives. You can go and grow crops, you can get a job, but here we’re relying on what we’re provided.”

And what they are provided is a meager portion of grain, edible oil and salt, provided every two months. Such a minimal nutrition offers little sustenance, and the small amount of money she is given acquires minimal items in the weekly food markets, where prices have become inflated.

Abubakar was moved to Alacha after arriving from Sudan in 2023, having fled the paramilitary Rapid Support Forces’ attack on her home city of El Geneina in June that year.

Finding no work in Chad, her partner has left for Libya in the aspiration to earning sufficient funds for them to come later. She lives with his relatives, distributing whatever nourishment they obtain.

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