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For an extended period, jolting along the waterlogged dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and concentrated on stopping herself being sick. She was in labour, in severe suffering after her uterine wall split, but was now being shaken violently in the ambulance that bumped over the dips and bumps 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 difficult terrain, are females. They live in secluded encampments in the desert with limited water and food, little employment and with medical help often a dangerously far away.

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

“I continuously experienced infections during my pregnancy and I had to go the health post seven times – when I was there, the delivery commenced. But I found it impossible to 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 unbearable I became disoriented.”

Her parent, Ashe Khamis Abdullah, 40, worried she would be bereft of her daughter and baby grandson. But Mohammed was immediately taken for surgery when she reached the hospital and an critical surgical delivery preserved the lives of her and her son, Muwais.

Chad was known for the world’s second worst maternal mortality rate before the current influx of refugees, but the circumstances suffered by the Sudanese put even more women in peril.

At the hospital, where they have assisted in the arrival of 824 babies in mostly emergency conditions this year, the medics are able to help plenty, but it is what affects the women who are fail to get to the hospital that alarms the professionals.

In the couple of years since the civil war in Sudan began, the vast majority of the displaced persons who came and remained in Chad are women and children. In total, about 1.2 million Sudanese are being sheltered in the east of the country, a large number of whom fled the earlier war in Darfur.

Chad has taken the lion’s share of the 4.1 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 uprooted from their homes.

Many males have stayed behind to be close to homes and land; others have been slain, abducted or forced into fighting. Those of employable age soon depart from Chad’s desolate refugee camps to look for jobs in the capital, N’Djamena, or elsewhere, in nearby Libya.

It implies women are left alone, without the ability to provide for the children and the elderly left in their care. To prevent congestion near the border, the Chadian government has relocated people to smaller camps such as Metche with usual resident counts of about a large community, but in isolated regions with no services and few opportunities.

Metche has a hospital built by a medical aid organization, which started off as a few tents but has grown to feature an operating theatre, but not much more. There is no work, families must journey for extended periods to find burning material, and each person must survive on about minimal water of water a day – well under the recommended 20 litres.

This remoteness means hospitals are receiving women with problems in their pregnancy when it is almost too late. There is only a single ambulance to cover the route between the Metche hospital and the health post near the settlement of Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has observed instances where women in severe suffering have had to endure a full night for the ambulance to arrive.

Imagine being expecting a child, in labour, and making a lengthy trip on a cart pulled by a donkey to get to a medical facility

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

A surgeon at the hospital in Metche said all the situations she encounters is an critical situation, with some women having to make challenging travels to the hospital by on foot or on a donkey.

“Imagine being nine months pregnant, in labour, and travelling hours on a donkey cart to get to a clinic. The primary issue is the delay but having to arrive under such circumstances also has an influence on the birth,” says the surgeon.

Malnutrition, which is on the rise, also increases the risk of problems in pregnancy, including the womb tears that medical staff see regularly.

Mohammed has remained in hospital in the 60 days since her caesarean. Experiencing malnutrition, she contracted an illness, while her son has been carefully monitored. The father has gone to other towns in search of work, so Mohammed is totally dependent on her mother.

The undernourishment unit has increased to six tents and has individuals overflowing into other sections. Children rest beneath mosquito nets in oppressive temperatures in almost utter stillness as health workers work, mixing medications and measuring kids on a instrument created using a container and string.

In less severe situations children get sachets of PlumpyNut, the uniquely designed 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 11-month-old boy, Sufian Sulaiman, is being given nutrition by a nasal drip. The infant has been ill for the past year but Abubakar was only provided with painkillers without any diagnosis, until she made the travel from Alacha to Metche.

“Every day, I see additional kids arriving in this tent,” she says. “The meals we consume is inadequate, there’s too little nourishment and it’s not nutritious.

“If we were at home, we could’ve adapted ourselves. 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 allocated is a small amount of cereal, vegetable oil and salt, distributed every 60 days. Such a simple food offers little sustenance, and the meager funds she is given purchases very little in the weekly food markets, where costs have risen.

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

Failing to secure jobs in Chad, her partner has left for Libya in the aspiration to earning sufficient funds for them to come later. She stays with his family members, dividing up whatever meals they acquire.

Abubakar says she has already observed food distributions being reduced and there are fears that the sharp decreases in overseas aid budgets by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having caused the 21st century’s gravest emergency and the {scale of needs|extent