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For an extended period, travelling roughly on the flooded dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and tried hard stopping herself throwing up. She was in delivery, in severe suffering after her uterus ruptured, 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 878,000 Sudanese displaced persons who escaped to Chad since 2023, barely getting by in this inhospitable environment, are women. They stay in secluded encampments in the desert with limited water and food, few job opportunities and with treatment often a dangerously far away.

The medical center Mohammed needed was in Metche, one more encampment more than two hours away.

“I kept getting infections during my gestation and I had to go the health post seven times – when I was there, the pregnancy started. But I found it impossible to give birth naturally because my uterine muscles failed,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I recall is the pain; it was so intense I became confused.”

Her maternal figure, Ashe Khamis Abdullah, 40, worried she would suffer the death of her offspring and descendant. But Mohammed was rushed straight into surgery when she got to the hospital and an urgent C-section saved her and her son, Muwais.

Chad already had the world’s second-highest maternal fatality statistic before the current influx of refugees, but the conditions endured by the Sudanese put even more women in risk.

At the hospital, where they have assisted in the arrival of 824 babies in frequently urgent circumstances this year, the medical staff are able to help plenty, but it is what affects the women who are cannot access the hospital that worries the staff.

In the couple of years since the internal conflict in Sudan began, the vast majority of the people who reached and remained in Chad are females and minors. In total, about over a million Sudanese are being sheltered in the eastern part of the country, four hundred thousand of whom fled the previous conflict in Darfur.

Chad has hosted the bulk of the 4.1 million 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 displaced from their homes.

Many males have not left to be close to homes and land; many were slain, abducted or made to join the conflict. Those of adult age move on quickly from Chad’s barren settlements to find work in the main city, N’Djamena, or beyond, in nearby Libya.

It means women are left alone, without the resources to provide for the young and old left in their responsibility. To avoid overcrowding near the border, the Chadian government has transferred refugees to smaller camps such as Metche with usual resident counts of about a large community, but in isolated regions with few facilities and scarce prospects.

Metche has a hospital set up by a medical aid organization, which started off as a few tents but has grown to feature an procedure area, but few additional amenities. There is a lack of jobs, families must journey for extended periods to find fuel, and each person must subsist with about a small amount of water a day – much less than the advised quantity.

This seclusion means hospitals are treating women with complications in their pregnancy at a critical stage. There is only a one medical transport to cover the route between the Metche hospital and the medical tent near the settlement of 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 in the final trimester, in childbirth, and travelling hours on a donkey-drawn vehicle to get to a medical facility

As well as being bumpy, the path goes through valleys that become inundated during the rainy season, completely preventing travel.

A surgeon at the hospital in Metche said every case she sees is an emergency, with some women having to make long and difficult journeys to the hospital by on foot or on a mule.

“Imagine being in the late stages of pregnancy, in labour, and journeying for an extended time on a animal-drawn vehicle to get to a clinic. The primary issue is the lag but having to come in these conditions also has an influence on the childbirth,” says the surgeon.

Poor nutrition, which is increasing, also increases the risk of issues in pregnancy, including the womb tears that medical staff often encounter.

Mohammed has continued under care in the 60 days since her C-section. Experiencing malnutrition, she got sick, while her son has been carefully monitored. The male guardian has journeyed to other towns in look for employment, so Mohammed is entirely leaning on her mother.

The malnutrition ward has increased to six tents and has cases exceeding capacity into other sections. Children rest beneath mosquito nets in oppressive temperatures in almost utter stillness as health workers work, creating remedies and weighing children on a device constructed from a pail and cord.

In moderate instances children get packets of PlumpyNut, the uniquely designed peanut paste, but the worst cases need a regular intake of fortified formula. Mohammed’s baby is given his nourishment through a injector.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being given nutrition by a nose tube. The baby has been unwell for the past year but Abubakar was consistently offered just painkillers without any diagnosis, until she made the trip from Alacha to Metche.

“Every day, I see additional kids coming in in this tent,” she says. “The meals we consume is inadequate, there’s too little nourishment and it’s not nutritious.

“If we were at home, we could’ve adapted ourselves. You can go and cultivate plants, you can get a job, but here we’re relying on what we’re provided.”

And what they are provided is a limited quantity of grain, edible oil and salt, handed out every couple of months. Such a minimal nutrition lacks nutrition, and the small amount of money she is given purchases very little in the weekly food markets, where prices have become inflated.

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

Unable to get employment in Chad, her partner has left for Libya in the aspiration to earning sufficient funds for them to join him. She stays with his kin, sharing out whatever food they can get.

Abubakar says she has already observed food distributions being reduced and there are fears that the abrupt cuts in overseas aid budgets by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having created the 21st century’s most severe crisis and the {scale of needs|extent