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For a long time, travelling roughly on the soggy dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and focused on stopping herself being sick. She was in childbirth, in extreme pain after her uterus ruptured, but was now being jostled relentlessly in the ambulance that jumped along the potholes and ridges of the road through the Chadian desert.

Most of the 878,000 Sudanese displaced persons who escaped to Chad since 2023, barely getting by in this harsh landscape, are women. They reside in secluded encampments in the desert with scarce resources, no work and with medical help often a perilously remote away.

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

“I kept getting infections during my gestation and I had to go the medical tent on numerous visits – when I was there, the delivery commenced. But I wasn’t able to give birth naturally because my uterus had collapsed,” says Mohammed. “I had to endure a long delay for the ambulance but all I remember was the suffering; it was so bad I became disoriented.”

Her maternal figure, Ashe Khamis Abdullah, 40, was terrified she would be bereft of her child and grandchild. But Mohammed was immediately taken for surgery when she arrived at the hospital and an emergency caesarean section rescued her and her son, Muwais.

Chad previously recorded the world’s second most severe maternal mortality rate before the recent arrival of refugees, but the situations faced by the Sudanese place additional women in peril.

At the hospital, where they have assisted in the arrival of 824 babies in mostly emergency conditions this year, the medical staff are able to save many, but it is what occurs with the women who are not able to reach the hospital that worries the staff.

In the two years since the internal conflict in Sudan started, 86% of the refugees who have arrived and stayed in Chad are females and minors. 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 hosted the bulk 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 adult men have stayed behind to be in proximity to homes and land; others have been murdered, captured or forced into fighting. Those of adult age soon depart from Chad’s isolated encampments to find work in the capital, N’Djamena, or further, in nearby Libya.

It results in women are left alone, without the ability to feed the young and old left in their charge. To avoid overcrowding near the border, the Chadian government has transferred refugees to smaller camps such as Metche with typical numbers of about fifty thousand, but in remote areas with no services and scarce prospects.

Metche has a hospital set up by a medical aid organization, which was initially a few tents but has expanded to include an operating theatre, but few additional amenities. There is unemployment, families must walk hours to find firewood, and each person must get by with about a small amount of water a day – far below the recommended 20 litres.

This seclusion means hospitals are admitting women with complications in their pregnancy dangerously late. There is only a single ambulance to cover the route between the Metche hospital and the medical tent near the camp at Alacha, where Mohammed is one of nearly 50,000 refugees. The medical team has observed instances where women in severe suffering have had to remain overnight for the ambulance to come.

Imagine being nine months pregnant, in labour, and making a lengthy trip on a cart pulled by a donkey to get to a hospital

As well as being uneven, the road traverses valleys that fill with water during the wet period, completely blocking travel.

A surgeon at the hospital in Metche said every case she sees is an critical situation, with some women having to make long and difficult journeys to the hospital by on foot or on a donkey.

“Imagine being in the late stages of pregnancy, in childbirth, and travelling hours on a donkey cart to get to a hospital. The biggest factor is the lag but having to arrive under such circumstances also has an influence on the delivery,” says the surgeon.

Malnutrition, which is growing, also elevates the likelihood of complications in pregnancy, including the uterine ruptures that medical staff frequently observe.

Mohammed has continued under care in the 60 days since her C-section. Suffering from malnutrition, she got sick, while her son has been carefully monitored. The male guardian has travelled to other towns in search of work, so Mohammed is entirely leaning on her mother.

The undernourishment unit has increased to six tents and has individuals overflowing into other sections. Children lie under mosquito nets in oppressive temperatures in almost complete silence as medical staff work, preparing treatments and assessing weights on a instrument created using a pail and cord.

In moderate instances children get sachets of PlumpyNut, the specially formulated peanut paste, but the most severe instances need a daily dose of fortified formula. Mohammed’s baby is fed his through a injector.

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 repeatedly given only painkillers without any identification, until she made the travel from Alacha to Metche.

“Every day, I see additional kids arriving in this structure,” she says. “The meals we consume is low-quality, there’s insufficient food and it’s not nutritious.

“If we were at home, we could’ve adapted ourselves. You can go and farm produce, you can find employment, but here we’re reliant on what we’re distributed.”

And what they are provided is a small amount of cereal, cooking oil and salt, distributed every two months. Such a minimal nutrition lacks nutrition, and the meager funds she is given acquires minimal items in the regular markets, where costs have risen.

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

Failing to secure jobs in Chad, her spouse has left for Libya in the hope of earning sufficient funds for them to join him. She stays with his family members, dividing up whatever meals they acquire.

Abubakar says she has already observed food supplies decreasing and there are concerns that the abrupt cuts in international assistance funds by the US, UK and other European countries, could make things worse. Despite the war in Sudan having created the 21st century’s gravest emergency and the {scale of needs|extent