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For hours, jolting along the soggy dirt track to the medical facility, 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 womb tore, but was now being tossed around in the ambulance that lurched across the dips and bumps of the road through the Chadian desert.

Most of the close to a million Sudanese people who ran to Chad since 2023, living hand to mouth in this inhospitable environment, are women. They live in isolated camps in the desert with limited water and food, few job opportunities and with healthcare 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 repeatedly suffered from infections during my term and I had to go the medical tent multiple occasions – when I was there, the pregnancy started. But I could not give birth normally because my womb had given way,” says Mohammed. “I had to endure a long delay for the ambulance but all I remember was the agony; it was so bad I became confused.”

Her parent, Ashe Khamis Abdullah, 40, worried she would lose both her offspring and descendant. But Mohammed was immediately taken for surgery when she arrived at the hospital and an critical surgical delivery preserved the lives of her and her son, Muwais.

Chad previously recorded the world’s second most severe maternal fatality statistic before the current influx of refugees, but the situations faced by the Sudanese put even more women in risk.

At the hospital, where they have birthed 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 fail to get to the hospital that worries the staff.

In the couple of years since the domestic strife in Sudan started, over four-fifths of the people who reached and stayed in Chad are women and children. In total, about over a million Sudanese are being hosted in the east of the country, 400,000 of whom escaped the previous conflict in Darfur.

Chad has taken the lion’s share of the over four million people who have escaped the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been forced out of their homes.

Many males have stayed behind to be near homes and land; some were slain, captured or forced into fighting. Those of adult age move on quickly from Chad’s desolate refugee camps to look for jobs in the main city, N’Djamena, or elsewhere, in neighbouring Libya.

It implies women are abandoned, without the ability to feed the young and old left in their responsibility. To reduce density near the border, the Chadian government has relocated people to smaller camps such as Metche with typical numbers of about a large community, but in remote areas with few facilities and scarce prospects.

Metche has a hospital set up by a medical aid organization, which was initially a few tents but has developed to contain an operating theatre, but not much more. There is no work, families must journey for extended periods to find firewood, and each person must subsist with about a small amount of water a day – far below the recommended 20 litres.

This remoteness means hospitals are treating women with issues in their pregnancy dangerously late. There is only a one medical transport to travel the path between the Metche hospital and the clinic near the Alacha encampment, where Mohammed is one of close to fifty thousand refugees. The medical team has encountered situations where women in desperate pain have had to endure a full night for the ambulance to arrive.

Imagine being in the final trimester, in delivery, and journeying for a long time on a cart pulled by a donkey to get to a medical facility

As well as being bumpy, the path goes through valleys that fill with water during the wet period, 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 foot or on a pack animal.

“Imagine being in the late stages of pregnancy, in childbirth, and making a long trip on a cart pulled by a donkey to get to a hospital. The biggest factor is the delay but having to arrive under such circumstances also has an influence on the delivery,” says the surgeon.

Undernourishment, which is on the rise, also increases the risk of complications in pregnancy, including the uterine ruptures that medical staff frequently observe.

Mohammed has remained in hospital in the two months since her surgical delivery. Suffering from malnutrition, she contracted an illness, while her son has been carefully monitored. The father has travelled to other towns in seek jobs, so Mohammed is completely reliant on her mother.

The undernourishment unit has grown to six tents and has cases exceeding capacity into other sections. Children are placed under mosquito nets in oppressive temperatures in almost total quiet as health workers work, preparing treatments and assessing weights on a instrument created using a bucket and rope.

In moderate instances children get sachets of PlumpyNut, the specially formulated peanut paste, but the critical situations need a regular intake of nutrient-rich liquid. Mohammed’s baby is administered his nutrition through a medical device.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being given nutrition by a nose tube. The baby has been sick for the past year but Abubakar was only provided with painkillers without any medical assessment, until she made the travel from Alacha to Metche.

“Every day, I see additional kids coming in in this shelter,” she says. “The meals we consume is low-quality, there’s insufficient food and it’s lacking in nutrients.

“If we were at home, we could’ve coped better. You can go and cultivate plants, you can work to earn some money, but here we’re reliant on what we’re provided.”

And what they are given is a meager portion of cereal, edible oil and salt, distributed every couple of months. Such a basic diet offers little sustenance, and the small amount of money she is given cannot buy much in the weekly food markets, where prices have become inflated.

Abubakar was moved to Alacha after reaching from Sudan in 2023, having escaped the armed group Rapid Support Forces’ attack on her birthplace of El Geneina in June that year.

Finding no work in Chad, her spouse has traveled to Libya in the aspiration to gathering adequate cash for them to follow. She resides with his relatives, sharing out whatever meals they acquire.

Abubakar says she has already seen food rations being cut and there are concerns that the sudden reductions in international assistance funds by the US, UK and other European countries, could worsen the situation. Despite the war in Sudan having produced the 21st century’s gravest emergency and the {scale of needs|extent