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For an extended period, bouncing over the waterlogged dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and tried hard stopping herself being sick. She was in delivery, in extreme pain after her womb tore, but was now being tossed around in the ambulance that jumped along 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, barely getting by in this inhospitable environment, are females. They reside in isolated camps in the desert with insufficient supplies, few job opportunities and with healthcare often a perilously remote away.

The medical center Mohammed needed was in Metche, another refugee camp more than two hours away.

“I kept getting infections during my gestation and I had to go the health post on numerous visits – when I was there, the labour began. But I found it impossible to give birth without intervention because my uterus had collapsed,” says Mohammed. “I had to endure a long delay for the ambulance but all I remember was the pain; it was so bad I became confused.”

Her mother, Ashe Khamis Abdullah, 40, was terrified she would lose both 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 most severe maternal mortality rate 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 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 internal conflict in Sudan erupted, over four-fifths of the refugees who have arrived and remained in Chad are mothers and kids. 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 previous conflict in Darfur.

Chad has taken the lion’s share of the 4.1 million people who have run from the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been displaced from their homes.

Many men have stayed behind to be near homes and land; many were slain, captured or made to join the conflict. Those of adult age soon depart from Chad’s isolated encampments to look for jobs in the capital, N’Djamena, or beyond, in adjacent Libya.

It results in women are stranded, without the means to feed the children and the elderly left in their charge. To reduce density near the border, the Chadian government has relocated people to more compact settlements such as Metche with typical numbers of about fifty thousand, but in remote areas with limited infrastructure and few opportunities.

Metche has a hospital established by a medical aid organization, which was initially a few tents but has expanded to include an procedure area, but little else. There is unemployment, families must walk hours to find firewood, and each person must get by with about nine litres of water a day – far below the advised quantity.

This remoteness means hospitals are admitting women with complications in their pregnancy dangerously late. There is only a single ambulance to travel the path between the Metche hospital and the clinic near the Alacha encampment, where Mohammed is one of nearly 50,000 refugees. The medical team has observed instances where women in severe suffering have had to wait an entire night for the ambulance to reach them.

Imagine being nine months pregnant, in delivery, and journeying for a long time on a donkey-drawn vehicle to get to a medical facility

As well as being uneven, the path goes through valleys that flood during the monsoon, 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 long and difficult journeys to the hospital by foot or on a mule.

“Imagine being in the late stages of pregnancy, in childbirth, and journeying for an extended time on a donkey cart to get to a hospital. The main problem is the delay but having to arrive under such circumstances also has an effect on the delivery,” says the surgeon.

Poor nutrition, which is increasing, also raises the chance of problems in pregnancy, including the uterine ruptures that medical staff see regularly.

Mohammed has remained in hospital in the couple of months since her C-section. Afflicted by malnutrition, she developed an infection, while her son has been closely watched. The parent has journeyed to other towns in look for employment, so Mohammed is completely reliant on her mother.

The undernourishment unit has expanded to six tents and has cases exceeding capacity 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 instrument created using a container and string.

In mild cases children get small bags of PlumpyNut, the specially formulated peanut paste, but the worst cases need a daily dose of fortified formula. Mohammed’s baby is given his nourishment through a syringe.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being nourished via 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 journey from Alacha to Metche.

“Every day, I see further minors coming in in this tent,” she says. “The nutrition we receive is inadequate, 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 farm produce, you can find employment, but here we’re dependent on what we’re distributed.”

And what they are given is a meager portion of cereal, edible oil and salt, distributed every couple of months. Such a simple food lacks nutrition, and the small amount of money she is given purchases very little in the weekly food markets, where values have increased.

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

Failing to secure jobs in Chad, her husband has left for Libya in the desire to gathering adequate cash for them to join him. She resides with his relatives, sharing out whatever meals they acquire.

Abubakar says she has already observed food supplies decreasing and there are concerns that the sudden reductions in foreign support money by the US, UK and other European countries, could worsen the situation. Despite the war in Sudan having created the 21st century’s most severe crisis and the {scale of needs|extent