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For hours, bouncing over the waterlogged dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and tried hard stopping herself vomiting. She was in childbirth, in severe suffering after her womb tore, 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 hundreds of thousands of Sudanese displaced persons who escaped to Chad since 2023, barely getting by in this harsh landscape, are females. They live in secluded encampments in the desert with insufficient supplies, few job opportunities and with treatment often a perilously remote away.

The clinic Mohammed needed was in Metche, another refugee camp more than a considerable journey away.

“I repeatedly suffered from infections during my gestation and I had to go the medical tent multiple occasions – when I was there, the labour began. But I wasn’t able to give birth without intervention because my womb had given way,” says Mohammed. “I had to endure a long delay for the ambulance but all I recall is the suffering; it was so unbearable I became delirious.”

Her parent, Ashe Khamis Abdullah, 40, feared she would be bereft of her offspring and descendant. But Mohammed was rushed straight into surgery when she reached the hospital and an emergency caesarean section saved her and her son, Muwais.

Chad previously recorded the world’s second worst maternal mortality rate before the current influx of refugees, but the circumstances suffered by the Sudanese expose further women in danger.

At the hospital, where they have delivered 824 babies in frequently urgent circumstances this year, the medical staff are able to help plenty, but it is what happens to the women who are not able to reach the hospital that alarms the professionals.

In the two years since the domestic strife in Sudan started, the vast majority of the refugees who have arrived and settled in Chad are women and children. In total, about one point two million Sudanese are being accommodated in the east of the country, a large number of whom fled the previous conflict in Darfur.

Chad has accepted the majority of the 4.1 million people who have run from the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been forced out of their homes.

Many men have remained to be in proximity to homes and land; others have been killed, captured or forced into fighting. Those of employable age move on quickly from Chad’s barren settlements to find work in the main city, N’Djamena, or further, in adjacent Libya.

It implies women are left alone, without the means to sustain the dependents left in their care. To avoid overcrowding near the border, the Chadian government has transferred refugees to less crowded encampments such as Metche with usual resident counts of about fifty thousand, but in isolated regions with limited infrastructure and scarce prospects.

Metche has a hospital established by a medical aid organization, which was initially a few tents but has developed to contain an procedure area, but few additional amenities. There is no work, families must walk hours to find firewood, and each person must survive on about minimal water of water a day – well under the suggested amount.

This isolation means hospitals are receiving women with complications in their pregnancy at a critical stage. There is only a single ambulance to serve the area between the Metche hospital and the clinic near the settlement of Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has encountered situations where women in desperate pain have had to endure a full night for the ambulance to come.

Imagine being nine months pregnant, in labour, and travelling hours on a animal-drawn transport to get to a clinic

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

A surgeon at the hospital in Metche said all the situations she encounters is an emergency, with some women having to make long and difficult journeys to the hospital by walking or on a donkey.

“Imagine being about to give birth, in childbirth, and travelling hours on a cart pulled by a donkey to get to a hospital. The biggest factor is the delay but having to arrive under such circumstances also has an influence on the birth,” says the surgeon.

Malnutrition, which is increasing, also raises the chance of problems in pregnancy, including the uterine splits that medical staff often encounter.

Mohammed has continued under care in the two months since her C-section. Suffering from malnutrition, she developed an infection, while her son has been closely watched. The male guardian has journeyed to other towns in seek jobs, so Mohammed is totally dependent on her mother.

The undernourishment unit has expanded to six tents and has patients spilling over into other sections. Children are placed under mosquito nets in extreme warmth in almost total quiet as medical staff work, creating remedies and measuring kids on a scale made from a pail and cord.

In mild cases children get packets of PlumpyNut, the uniquely designed peanut paste, but the worst cases need a consistent supply of fortified formula. Mohammed’s baby is administered his nutrition through a medical device.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being fed through a nasogastric tube. The child has been unwell for the past year but Abubakar was only provided with painkillers without any medical assessment, until she made the journey from Alacha to Metche.

“Every day, I see further minors joining us in this tent,” 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 coped better. You can go and cultivate plants, you can work to earn some money, but here we’re dependent on what we’re distributed.”

And what they are given is a meager portion of cereal, vegetable oil and salt, provided every couple of months. Such a minimal nutrition offers little sustenance, and the little cash she is given cannot buy much in the local bazaars, where prices have become inflated.

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

Failing to secure jobs in Chad, her husband has gone to Libya in the desire to gathering adequate cash for them to come later. She resides with his family members, sharing out whatever meals they acquire.

Abubakar says she has already witnessed food supplies decreasing and there are concerns that the sudden reductions 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 most severe crisis and the {scale of needs|extent