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For a long time, jolting along the waterlogged dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and concentrated on stopping herself vomiting. She was in childbirth, in agonizing discomfort after her womb tore, but was now being shaken violently in the ambulance that bumped over the potholes and ridges of the road through the Chadian desert.

Most of the 878,000 Sudanese refugees who have fled to Chad since 2023, surviving precariously in this inhospitable environment, are women. They stay in isolated camps in the desert with scarce resources, no work and with healthcare often a dangerously far away.

The clinic 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 health post seven times – when I was there, the delivery commenced. But I found it impossible to give birth without intervention because my uterus had collapsed,” says Mohammed. “I had to wait two hours for the ambulance but all I can think of the suffering; it was so unbearable I became confused.”

Her mother, Ashe Khamis Abdullah, 40, was terrified she would be bereft of her offspring and descendant. But Mohammed was immediately taken for surgery when she arrived at the hospital and an emergency caesarean section saved her and her son, Muwais.

Chad already had the world’s second worst maternal fatality statistic before the current influx of refugees, but the conditions endured by the Sudanese expose further women in danger.

At the hospital, where they have delivered 824 babies in mostly emergency conditions this year, the medical staff are able to help plenty, but it is what affects the women who are not able to reach the hospital that worries the staff.

In the 24 months since the internal conflict in Sudan started, 86% of the displaced persons who came and stayed in Chad are mothers and kids. In total, about one point two million Sudanese are being sheltered in the east of the country, a large number of whom fled the previous conflict in Darfur.

Chad has hosted the bulk of the 4.1 million people who have fled the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been uprooted from their homes.

Many adult men have remained to be near homes and land; others have been murdered, taken hostage or conscripted. Those of employable age move on quickly from Chad’s desolate refugee camps to find work in the main city, N’Djamena, or beyond, in nearby Libya.

It results in women are left alone, without the resources to feed the children and the elderly left in their charge. To avoid overcrowding near the border, the Chadian government has transferred refugees to more compact settlements such as Metche with typical numbers of about fifty thousand, but in remote areas with limited infrastructure and minimal chances.

Metche has a hospital set up by a medical aid organization, which was initially a few tents but has developed to contain an procedure area, but not much more. There is unemployment, families must travel long distances to find firewood, and each person must get by with about minimal water of water a day – much less than the suggested amount.

This isolation means hospitals are receiving women with problems in their pregnancy dangerously late. There is only a single ambulance to cover the route between the Metche hospital and the health post near the camp at Alacha, where Mohammed is one of a large number of refugees. The medical team has encountered situations where women in desperate pain have had to wait an entire night for the ambulance to arrive.

Imagine being expecting a child, in childbirth, and journeying for a long time on a cart pulled by a donkey to get to a hospital

As well as being rough, the route passes through valleys that become inundated during the rainy season, completely cutting off travel.

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

“Imagine being nine months pregnant, in childbirth, and making a long trip on a donkey cart to get to a hospital. The main problem is the wait but having to arrive under such circumstances also has an impact on the birth,” says the surgeon.

Undernourishment, which is on the rise, also increases the risk of issues in pregnancy, including the womb tears that medical staff frequently observe.

Mohammed has continued under care in the two months since her caesarean. Experiencing malnutrition, she developed an infection, while her son has been regularly checked. The father has travelled to other towns in seek jobs, so Mohammed is completely reliant on her mother.

The malnutrition ward has expanded to six tents and has patients spilling over into other sections. Children rest beneath mosquito nets in sweltering heat in almost total quiet as health workers work, mixing medications and assessing weights on a device constructed from a container and string.

In mild cases children get sachets of PlumpyNut, the uniquely designed peanut paste, but the critical situations need a consistent supply of enriched milk. Mohammed’s baby is fed his through a injector.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being nourished via a nasal drip. The baby has been sick 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 further minors joining us in this structure,” she says. “The nutrition we receive is low-quality, there’s insufficient food and it’s not nutritious.

“If we were at home, we could’ve adjusted our lives. You can go and farm produce, you can work to earn some money, but here we’re reliant on what we’re distributed.”

And what they are given is a limited quantity of sorghum, cooking oil and salt, distributed every two months. Such a minimal nutrition lacks nutrition, and the meager funds she is given purchases very little in the regular markets, where values have increased.

Abubakar was transferred to Alacha after coming from Sudan in 2023, having escaped 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 traveled to Libya in the aspiration to raising enough money for them to follow. She resides with his relatives, sharing out whatever nourishment they obtain.

Abubakar says she has already observed food distributions being reduced and there are fears that the abrupt cuts in foreign support money 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