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For hours, jolting along the waterlogged dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and concentrated on stopping herself vomiting. She was in delivery, in agonizing discomfort after her uterine wall split, but was now being tossed around 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 difficult terrain, are females. They stay in secluded encampments in the desert with limited water and food, no work and with treatment often a perilously remote away.

The medical center Mohammed needed was in Metche, a different settlement more than two hours away.

“I kept getting infections during my pregnancy and I had to go the health post on numerous visits – when I was there, the pregnancy started. But I could not give birth normally because my uterus had collapsed,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I remember was the suffering; it was so intense I became confused.”

Her mother, Ashe Khamis Abdullah, 40, feared she would lose both her offspring and descendant. But Mohammed was hurried into surgery when she arrived at the hospital and an emergency caesarean section saved her and her son, Muwais.

Chad was known for the world’s second-highest maternal death rate before the current influx of refugees, but the circumstances suffered by the Sudanese place additional women in risk.

At the hospital, where they have assisted in the arrival of 824 babies in mostly emergency conditions this year, the medics are able to help plenty, but it is what affects the women who are fail to get to the hospital that alarms the professionals.

In the couple of years since the domestic strife in Sudan started, over four-fifths of the refugees who have arrived and remained in Chad are women and children. In total, about one point two million Sudanese are being hosted in the eastern region of the country, a large number of whom ran from the earlier war in Darfur.

Chad has taken the lion’s share of the millions of people who have escaped the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been forced out of their homes.

Many men have not left to be near homes and land; some were slain, captured or made to join the conflict. Those of working age rapidly leave from Chad’s desolate refugee camps to find work in the capital, N’Djamena, or elsewhere, in neighbouring Libya.

It implies women are left alone, without the ability to feed the young and old left in their care. To reduce density near the border, the Chadian government has moved individuals to more compact settlements such as Metche with average populations of about a large community, but in distant locations with limited infrastructure and minimal chances.

Metche has a hospital established by a medical aid organization, which started off as a few tents but has expanded to include an procedure area, but not much more. There is no work, families must walk hours to find firewood, and each person must subsist with about nine litres of water a day – much less than the suggested amount.

This seclusion means hospitals are treating women with complications in their pregnancy when it is almost too late. There is only a single ambulance to cover the route between the Metche hospital and the health post near the settlement of Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has seen cases where women in severe suffering have had to remain overnight for the ambulance to reach them.

Imagine being in the final trimester, in delivery, and travelling hours on a cart pulled by a donkey to get to a hospital

As well as being uneven, the path goes through valleys that fill with water during the rainy season, completely cutting off travel.

A surgeon at the hospital in Metche said all the situations she encounters is an critical situation, with some women having to make challenging travels to the hospital by walking or on a pack animal.

“Imagine being about to give birth, in childbirth, and making a long trip on a animal-drawn vehicle to get to a medical center. The primary issue is the lag but having to travel in this state also has an influence on the birth,” says the surgeon.

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

Mohammed has continued under care in the two months since her C-section. Experiencing malnutrition, she got sick, while her son has been closely watched. The parent has travelled to other towns in search of work, so Mohammed is completely reliant on her mother.

The malnutrition ward has increased to six tents and has individuals overflowing into other sections. Children lie under mosquito nets in sweltering heat in almost utter stillness as medical staff work, preparing treatments and weighing children on a scale made from a pail and cord.

In mild cases children get sachets of PlumpyNut, the specifically created peanut paste, but the worst cases need a regular intake of enriched milk. Mohammed’s baby is fed his through a injector.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being fed through a nasal drip. The infant has been sick for the past year but Abubakar was consistently offered just painkillers without any identification, until she made the trip from Alacha to Metche.

“Every day, I see more children coming in in this structure,” she says. “The meals we consume is poor, there’s not enough to eat and it’s not nutritious.

“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 limited quantity of grain, edible oil and salt, distributed every 60 days. Such a minimal nutrition offers little sustenance, and the small amount of money she is given purchases very little in the local bazaars, where values have increased.

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

Unable to get employment in Chad, her spouse has gone to Libya in the hope of gathering adequate cash for them to come later. She resides with his family members, distributing whatever meals they acquire.

Abubakar says she has already observed food rations being cut and there are fears that the sharp decreases 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