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For an extended period, travelling roughly on the soggy dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and tried hard stopping herself throwing up. She was in delivery, 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 hundreds of thousands of Sudanese refugees who have fled to Chad since 2023, living hand to mouth in this harsh landscape, are women. They reside in isolated camps in the desert with scarce resources, few job opportunities and with treatment often a perilously remote away.

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

“I continuously experienced infections during my term and I had to go the clinic on numerous visits – when I was there, the pregnancy started. But I wasn’t able to give birth normally because my womb had given way,” says Mohammed. “I had to wait two hours for the ambulance but all I can think of the suffering; it was so bad I became disoriented.”

Her mother, Ashe Khamis Abdullah, 40, was terrified she would be bereft of her offspring and descendant. But Mohammed was immediately taken for 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 ongoing stream of refugees, but the conditions endured by the Sudanese place additional women in peril.

At the hospital, where they have delivered 824 babies in often critical situations this year, the medics are able to save many, but it is what happens to the women who are fail to get to the hospital that concerns them.

In the 24 months since the internal conflict in Sudan erupted, 86% of the people who reached and stayed in Chad are mothers and kids. In total, about over a million Sudanese are being accommodated in the east of the country, a large number of whom fled the previous conflict in Darfur.

Chad has accepted the majority of the over four million people who have fled the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been forced out of their homes.

Many adult men have remained to be in proximity to homes and land; many were slain, taken hostage or forced into fighting. Those of working age rapidly leave from Chad’s isolated encampments to seek employment in the capital, N’Djamena, or further, in nearby Libya.

It means women are left alone, without the resources to sustain the children and the elderly left in their care. To prevent congestion near the border, the Chadian government has transferred refugees to more compact settlements such as Metche with typical numbers of about fifty thousand, but in remote areas with limited infrastructure and minimal chances.

Metche has a hospital established by a medical aid organization, which began as a few tents but has expanded to include an operating theatre, but not much more. There is a lack of jobs, families must travel long distances to find fuel, and each person must survive on about minimal water of water a day – far below the advised quantity.

This isolation means hospitals are admitting women with problems in their pregnancy dangerously late. There is only a sole emergency vehicle to cover the route between the Metche hospital and the health post near the camp at Alacha, where Mohammed is one of nearly 50,000 refugees. The medical team has encountered situations where women in severe suffering have had to wait an entire night for the ambulance to come.

Imagine being in the final trimester, in delivery, and making a lengthy trip 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 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 challenging travels to the hospital by foot or on a mule.

“Imagine being in the late stages of pregnancy, in delivery, and journeying for an extended time on a cart pulled by a donkey to get to a clinic. The primary issue is the lag but having to arrive under such circumstances also has an effect on the delivery,” says the surgeon.

Malnutrition, which is increasing, also increases the risk of complications in pregnancy, including the womb tears that medical staff see regularly.

Mohammed has stayed at the medical facility in the two months since her caesarean. Suffering from malnutrition, she got sick, while her son has been closely watched. The father has travelled 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 individuals overflowing into other sections. Children rest beneath mosquito nets in extreme warmth in almost total quiet as health workers work, mixing medications and weighing children on a scale made from a container and string.

In less severe situations children get sachets of PlumpyNut, the specially formulated peanut paste, but the worst cases need a regular intake of fortified formula. Mohammed’s baby is administered his nutrition through a injector.

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being nourished via a nose tube. The baby has been unwell for the past year but Abubakar was only provided with painkillers without any medical assessment, until she made the journey from Alacha to Metche.

“Every day, I see more children joining us in this shelter,” she says. “The meals we consume is low-quality, there’s insufficient food and it’s not nutritious.

“If we were at home, we could’ve coped better. You can go and cultivate plants, you can get a job, but here we’re dependent on what we’re given.”

And what they are allocated is a meager portion of grain, vegetable oil and salt, provided every 60 days. Such a simple food is deficient in nutrients, and the meager funds she is given acquires minimal items in the regular markets, where costs have risen.

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

Finding no work in Chad, her partner has traveled to Libya in the aspiration to raising enough money for them to come later. She resides with his kin, dividing up whatever nourishment they obtain.

Abubakar says she has already observed food rations being cut and there are worries that the sharp decreases in international assistance funds 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