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For a long time, bouncing over the waterlogged dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and tried hard stopping herself throwing up. She was in labour, in severe suffering after her uterine wall split, but was now being tossed around in the ambulance that lurched across the uneven terrain of the road through the Chadian desert.

Most of the close to a million Sudanese refugees who have fled to Chad since 2023, surviving precariously in this difficult terrain, are females. They live in secluded encampments in the desert with insufficient supplies, no work and with treatment often a perilously remote away.

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

“I continuously experienced infections during my gestation and I had to go the health post on numerous visits – when I was there, the delivery commenced. But I wasn’t able to give birth without intervention because my womb had given way,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I can think of the suffering; it was so bad I became disoriented.”

Her maternal figure, Ashe Khamis Abdullah, 40, worried she would lose both her daughter and baby grandson. But Mohammed was rushed straight into surgery when she reached the hospital and an urgent C-section preserved the lives of her and her son, Muwais.

Chad was known for the world’s second-highest maternal mortality rate before the recent arrival of refugees, but the situations faced by the Sudanese put even more women in risk.

At the hospital, where they have assisted in the arrival of 824 babies in often critical situations this year, the medics are able to rescue numerous, but it is what happens to the women who are cannot access the hospital that alarms the professionals.

In the two years since the domestic strife 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 sheltered in the eastern region of the country, 400,000 of whom fled the previous conflict in Darfur.

Chad has accepted the majority of the millions of people who have run from the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been displaced from their homes.

Many adult men have remained to be near homes and land; many were killed, abducted or made to join the conflict. Those of adult age rapidly leave from Chad’s isolated encampments to seek employment in the main city, N’Djamena, or elsewhere, in neighbouring Libya.

It implies women are left alone, without the resources to provide for the children and the elderly left in their care. To prevent congestion near the border, the Chadian government has moved individuals to less crowded encampments such as Metche with typical numbers of about 50,000, but in remote areas with no services and scarce prospects.

Metche has a hospital built by a medical aid organization, which was initially a few tents but has grown to feature an operating theatre, but few additional amenities. There is no work, families must walk hours to find fuel, and each person must subsist with about minimal water of water a day – much less than the suggested amount.

This seclusion means hospitals are receiving women with issues in their pregnancy at a critical stage. 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 close to fifty thousand refugees. The medical team has seen cases where women in extreme agony have had to endure a full night for the ambulance to arrive.

Imagine being in the final trimester, in childbirth, and making a lengthy trip on a cart pulled by a donkey to get to a medical facility

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

A surgeon at the hospital in Metche said each patient she treats is an critical situation, with some women having to make challenging travels to the hospital by walking or on a donkey.

“Imagine being nine months pregnant, in delivery, and journeying for an extended time on a animal-drawn vehicle to get to a clinic. The primary issue is the wait but having to arrive under such circumstances also has an influence on the birth,” says the surgeon.

Malnutrition, which is growing, also elevates the likelihood of issues in pregnancy, including the uterine ruptures that medical staff see regularly.

Mohammed has continued under care in the couple of months since her C-section. Afflicted by malnutrition, she contracted an illness, while her son has been regularly checked. The male guardian has journeyed to other towns in search of work, so Mohammed is totally dependent on her mother.

The malnutrition ward has expanded to six tents and has patients spilling over into other sections. Children are placed under mosquito nets in sweltering heat in almost complete silence as health workers work, creating remedies and measuring kids on a device constructed from a pail and cord.

In less severe situations children get sachets of PlumpyNut, the specifically created peanut paste, but the critical situations need a daily dose of fortified formula. Mohammed’s baby is administered his nutrition through a syringe.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being fed through a nasogastric tube. The infant has been ill for the past year but Abubakar was consistently offered just painkillers without any identification, until she made the journey from Alacha to Metche.

“Every day, I see additional kids coming in in this tent,” she says. “The food we’re eating is low-quality, there’s insufficient food and it’s deficient in vitamins.

“If we were at home, we could’ve coped better. You can go and farm produce, you can find employment, but here we’re dependent on what we’re provided.”

And what they are given is a small amount of sorghum, vegetable oil and salt, provided every couple of months. Such a minimal nutrition offers little sustenance, and the meager funds she is given acquires minimal items in the weekly food markets, where costs have risen.

Abubakar was transferred to Alacha after arriving from Sudan in 2023, having run from the militia Rapid Support Forces’ assault on her home city of El Geneina in June that year.

Unable to get employment in Chad, her husband has gone to Libya in the aspiration to gathering adequate cash for them to follow. She stays with his kin, sharing out whatever food they can get.

Abubakar says she has already observed food supplies decreasing and there are worries that the sharp decreases in overseas aid budgets by the US, UK and other European countries, could make things worse. Despite the war in Sudan having created the 21st century’s most severe crisis and the {scale of needs|extent