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For an extended period, travelling roughly on the flooded dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and focused on stopping herself being sick. She was in childbirth, in severe suffering after her womb tore, but was now being jostled relentlessly in the ambulance that bumped over the uneven terrain of the road through the Chadian desert.

Most of the 878,000 Sudanese refugees who have fled to Chad since 2023, living hand to mouth in this difficult terrain, are women. They stay in secluded encampments in the desert with insufficient supplies, no work and with medical help often a life-threateningly long distance away.

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

“I kept getting infections during my pregnancy and I had to go the clinic multiple occasions – 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 recall is the suffering; it was so intense I became disoriented.”

Her maternal figure, Ashe Khamis Abdullah, 40, feared she would lose both her offspring and descendant. But Mohammed was hurried into surgery when she reached the hospital and an emergency caesarean section rescued her and her son, Muwais.

Chad was known for the world’s second most severe maternal death rate before the recent arrival of refugees, but the circumstances suffered by the Sudanese expose further women in danger.

At the hospital, where they have assisted in the arrival of 824 babies in often critical situations this year, the medical staff are able to save many, but it is what occurs with the women who are cannot access the hospital that alarms the professionals.

In the two years since the domestic strife in Sudan started, over four-fifths of the displaced persons who came and remained in Chad are mothers and kids. In total, about 1.2 million Sudanese are being hosted in the eastern part of the country, a large number of whom escaped the past violence in Darfur.

Chad has hosted the bulk of the millions of people who have escaped the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been uprooted from their homes.

Many males have remained to be in proximity to homes and land; others have been killed, taken hostage or conscripted. Those of adult age rapidly leave from Chad’s isolated encampments to find work in the main city, N’Djamena, or further, in neighbouring Libya.

It means women are abandoned, without the ability to provide for the dependents 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 isolated regions with limited infrastructure and scarce prospects.

Metche has a hospital established by a medical aid organization, which started off as a few tents but has developed to contain an procedure area, but little else. There is a lack of jobs, families must journey for extended periods to find fuel, and each person must subsist with about nine litres of water a day – well under the suggested amount.

This remoteness means hospitals are receiving women with issues in their pregnancy dangerously late. There is only a sole emergency vehicle to cover the route 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 observed instances where women in extreme agony have had to remain overnight for the ambulance to reach them.

Imagine being nine months pregnant, 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 flood during the monsoon, completely cutting off travel.

A surgeon at the hospital in Metche said each patient she treats is an crisis, with some women having to make long and difficult journeys to the hospital by walking or on a mule.

“Imagine being about to give birth, in labour, and making a long trip on a donkey cart to get to a clinic. The biggest factor is the delay but having to arrive under such circumstances also has an effect on the birth,” says the surgeon.

Malnutrition, which is on the rise, also elevates the likelihood of issues in pregnancy, including the womb tears that medical staff often encounter.

Mohammed has remained in hospital in the two months since her surgical delivery. Experiencing malnutrition, she developed an infection, 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 nutritional care section has expanded to six tents and has cases exceeding capacity into other sections. Children are placed under mosquito nets in sweltering heat in almost utter stillness as doctors and nurses work, creating remedies and measuring kids on a instrument created using a container and string.

In mild cases children get small bags of PlumpyNut, the uniquely designed peanut paste, but the worst cases need a regular intake of fortified formula. Mohammed’s baby is fed his through a syringe.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being fed through a nose tube. The baby has been unwell for the past year but Abubakar was consistently offered just painkillers without any medical assessment, until she made the trip from Alacha to Metche.

“Every day, I see further minors joining us in this structure,” 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 adjusted our lives. You can go and cultivate plants, you can get a job, but here we’re reliant on what we’re distributed.”

And what they are allocated is a meager portion of sorghum, vegetable oil and salt, handed out every couple of months. Such a basic diet is deficient in nutrients, and the meager funds she is given purchases very little in the regular markets, where prices have become inflated.

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

Failing to secure jobs in Chad, her partner has traveled to Libya in the aspiration to raising enough money for them to join him. She stays with his relatives, distributing whatever meals they acquire.

Abubakar says she has already witnessed food distributions being reduced and there are worries 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 caused the 21st century’s gravest emergency and the {scale of needs|extent