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For an extended period, travelling roughly on the flooded dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and focused on stopping herself being sick. She was in childbirth, in agonizing discomfort after her uterus ruptured, but was now being tossed around in the ambulance that lurched across the uneven terrain of the road through the Chadian desert.

Most of the 878,000 Sudanese people who ran to Chad since 2023, barely getting by in this inhospitable environment, are females. They live in remote settlements in the desert with scarce resources, no work and with medical help often a dangerously far away.

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

“I repeatedly suffered from infections during my term and I had to go the clinic multiple occasions – when I was there, the delivery commenced. But I wasn’t able to give birth naturally because my uterine muscles failed,” says Mohammed. “I had to endure a long delay for the ambulance but all I recall is the agony; it was so bad I became confused.”

Her maternal figure, Ashe Khamis Abdullah, 40, worried she would suffer the death of her child and grandchild. But Mohammed was rushed straight into surgery when she arrived at the hospital and an critical surgical delivery rescued her and her son, Muwais.

Chad was known for the world’s second-highest maternal mortality rate before the recent arrival of refugees, but the circumstances suffered by the Sudanese place additional women in danger.

At the hospital, where they have delivered 824 babies in mostly emergency conditions this year, the medical staff are able to save many, but it is what occurs with the women who are fail to get to the hospital that concerns them.

In the two years since the civil war in Sudan erupted, over four-fifths of the displaced persons who came and settled in Chad are women and children. In total, about 1.2 million Sudanese are being sheltered in the east of the country, 400,000 of whom ran from the earlier war in Darfur.

Chad has accepted the majority of the over four million people who have fled the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been uprooted from their homes.

Many males have remained to be close to homes and land; many were slain, abducted or conscripted. Those of working age soon depart from Chad’s isolated encampments to look for jobs in the main city, N’Djamena, or beyond, in neighbouring Libya.

It results in women are stranded, without the ability to sustain the children and the elderly left in their care. To prevent congestion near the border, the Chadian government has moved individuals to more compact settlements such as Metche with average populations of about 50,000, but in distant locations with no services and few opportunities.

Metche has a hospital established by a medical aid organization, which started off as a few tents but has grown to feature an operating theatre, but little else. There is a lack of jobs, families must travel long distances to find burning material, and each person must survive on about nine litres of water a day – much less than the recommended 20 litres.

This remoteness means hospitals are treating women with complications in their pregnancy when it is almost too late. 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 nearly 50,000 refugees. The medical team has seen cases where women in desperate pain have had to endure a full night for the ambulance to come.

Imagine being nine months pregnant, in childbirth, and journeying for a long time on a animal-drawn transport to get to a medical facility

As well as being bumpy, the route passes through valleys that fill with water during the rainy season, completely preventing travel.

A surgeon at the hospital in Metche said each patient she treats is an critical situation, with some women having to make challenging travels to the hospital by foot or on a mule.

“Imagine being in the late stages of pregnancy, in labour, and making a long trip on a cart pulled by a donkey to get to a clinic. The primary issue is the delay but having to come in these conditions also has an effect on the delivery,” says the surgeon.

Malnutrition, which is growing, also elevates the likelihood of complications in pregnancy, including the uterine splits that medical staff frequently observe.

Mohammed has continued under care in the two months since her C-section. Afflicted by malnutrition, she contracted an illness, while her son has been carefully monitored. The male guardian has travelled to other towns in search of work, so Mohammed is entirely leaning on her mother.

The undernourishment unit has increased to six tents and has individuals overflowing into other sections. Children rest beneath mosquito nets in extreme warmth in almost total quiet as medical staff work, creating remedies and assessing weights on a device constructed from a container and string.

In less severe situations children get sachets of PlumpyNut, the specifically created peanut paste, but the most severe instances need a regular intake of nutrient-rich liquid. Mohammed’s baby is fed his through a medical device.

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

“Every day, I see additional kids joining us in this structure,” she says. “The meals we consume is low-quality, there’s insufficient food and it’s deficient in vitamins.

“If we were at home, we could’ve adjusted our lives. You can go and cultivate plants, you can work to earn some money, but here we’re relying on what we’re given.”

And what they are given is a meager portion of sorghum, cooking oil and salt, handed out every two months. Such a simple food lacks nutrition, and the meager funds she is given acquires minimal items in the local bazaars, where prices have become inflated.

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

Failing to secure jobs in Chad, her spouse has left for Libya in the hope of raising enough money for them to come later. She lives with his relatives, sharing out whatever food they can get.

Abubakar says she has already observed food rations being cut and there are worries that the sudden reductions in overseas aid budgets by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having produced the 21st century’s gravest emergency and the {scale of needs|extent