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For a long time, travelling roughly on the waterlogged dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and concentrated on stopping herself throwing up. She was in childbirth, in agonizing discomfort after her womb tore, but was now being tossed around in the ambulance that jumped along the uneven terrain 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 inhospitable environment, are women. They reside in secluded encampments in the desert with scarce resources, no work and with healthcare often a life-threateningly long distance away.

The clinic Mohammed needed was in Metche, one more encampment more than 120 minutes away.

“I repeatedly suffered from infections during my term and I had to go the health post multiple occasions – when I was there, the delivery commenced. But I could not give birth normally because my uterus had collapsed,” says Mohammed. “I had to wait two hours for the ambulance but all I remember was the pain; it was so intense I became confused.”

Her maternal figure, Ashe Khamis Abdullah, 40, feared she would lose both her daughter and baby grandson. But Mohammed was hurried into surgery when she got to the hospital and an urgent C-section rescued her and her son, Muwais.

Chad already had the world’s second most severe maternal death rate before the ongoing stream of refugees, but the conditions endured by the Sudanese place additional 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 help plenty, but it is what occurs with the women who are not able to reach the hospital that worries the staff.

In the 24 months since the domestic strife in Sudan started, the vast majority of the displaced persons who came and stayed in Chad are mothers and kids. In total, about 1.2 million Sudanese are being hosted in the eastern region of the country, four hundred thousand of whom escaped the previous conflict in Darfur.

Chad has accepted the majority 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 in proximity to homes and land; many were killed, taken hostage or forced into fighting. Those of adult age rapidly leave from Chad’s desolate refugee camps to look for jobs in the main city, N’Djamena, or elsewhere, in nearby Libya.

It means women are left alone, without the means to sustain the young and old left in their charge. 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 distant locations with few facilities and scarce prospects.

Metche has a hospital built 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 no work, families must travel long distances to find burning material, and each person must get by with about nine litres of water a day – far below the recommended 20 litres.

This remoteness means hospitals are receiving women with issues in their pregnancy at a critical stage. 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 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 come.

Imagine being expecting a child, in labour, and travelling hours on a cart pulled by a donkey to get to a medical facility

As well as being uneven, the path goes through valleys that flood during the wet period, 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 on foot or on a donkey.

“Imagine being about to give birth, in delivery, and travelling hours 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.

Undernourishment, which is increasing, also raises the chance of complications in pregnancy, including the womb tears that medical staff often encounter.

Mohammed has remained in hospital in the two months since her caesarean. Suffering from malnutrition, she contracted an illness, while her son has been closely watched. The male guardian has travelled to other towns in search of work, so Mohammed is entirely leaning on her mother.

The nutritional care section has increased to six tents and has individuals overflowing into other sections. Children are placed under mosquito nets in sweltering heat in almost utter stillness as health workers work, mixing medications and measuring kids on a device constructed from a pail and cord.

In moderate instances children get small bags of PlumpyNut, the uniquely designed peanut paste, but the critical situations need a consistent supply of enriched milk. Mohammed’s baby is administered his nutrition through a syringe.

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being given nutrition by a nasogastric tube. The child has been ill for the past year but Abubakar was repeatedly given only painkillers without any diagnosis, until she made the travel from Alacha to Metche.

“Every day, I see further minors arriving in this shelter,” she says. “The food we’re eating is poor, 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 farm produce, you can work to earn some money, but here we’re reliant on what we’re provided.”

And what they are given is a limited quantity of grain, cooking oil and salt, provided every 60 days. Such a basic diet offers little sustenance, and the small amount of money she is given cannot buy much in the regular markets, where prices have become inflated.

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

Finding no work in Chad, her husband has gone to Libya in the hope of earning sufficient funds for them to join him. She lives with his family members, dividing up whatever meals they acquire.

Abubakar says she has already seen food rations being cut and there are worries that the abrupt cuts in foreign support money 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