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For an extended period, jolting along the waterlogged dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and concentrated on stopping herself being sick. She was in labour, in agonizing discomfort after her womb tore, but was now being shaken violently in the ambulance that bumped over the uneven terrain of the road through the Chadian desert.

Most of the hundreds of thousands of Sudanese people who ran to Chad since 2023, surviving precariously in this inhospitable environment, are females. They stay in secluded encampments in the desert with limited water and food, no work and with treatment often a perilously remote away.

The clinic Mohammed needed was in Metche, one more encampment more than a considerable journey away.

“I continuously experienced infections during my term and I had to go the medical tent multiple occasions – when I was there, the labour began. But I found it impossible to give birth without intervention because my womb had given way,” says Mohammed. “I had to endure a long delay for the ambulance but all I recall is the agony; it was so unbearable I became confused.”

Her mother, Ashe Khamis Abdullah, 40, was terrified she would be bereft of her child and grandchild. But Mohammed was rushed straight into surgery when she arrived at the hospital and an urgent C-section saved her and her son, Muwais.

Chad was known for the world’s second most severe maternal mortality rate before the recent arrival of refugees, but the conditions endured by the Sudanese place additional women in danger.

At the hospital, where they have birthed 824 babies in often critical situations this year, the medics are able to rescue numerous, but it is what occurs with the women who are fail to get to the hospital that alarms the professionals.

In the couple of years since the internal conflict in Sudan started, the vast majority of the refugees who have arrived and settled in Chad are women and children. In total, about 1.2 million Sudanese are being hosted in the eastern region of the country, a large number of whom ran from the earlier war in Darfur.

Chad has hosted the bulk of the 4.1 million people who have fled the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been forced out of their homes.

Many adult men have stayed behind to be near homes and land; some were slain, abducted or made to join the conflict. Those of employable age soon depart from Chad’s barren settlements to find work in the main city, N’Djamena, or beyond, in adjacent Libya.

It means women are abandoned, without the ability to sustain the young and old left in their charge. To reduce density near the border, the Chadian government has relocated people to less crowded encampments such as Metche with usual resident counts of about fifty thousand, but in remote areas with limited infrastructure and few opportunities.

Metche has a hospital built by a medical aid organization, which started off as a few tents but has developed to contain an procedure area, but little else. There is unemployment, families must walk hours to find fuel, and each person must subsist with about minimal water of water a day – well under the recommended 20 litres.

This isolation means hospitals are receiving women with problems in their pregnancy when it is almost too late. There is only a one medical transport to serve the area between the Metche hospital and the medical tent near the Alacha encampment, where Mohammed is one of nearly 50,000 refugees. The medical team has encountered situations where women in extreme agony have had to wait an entire night for the ambulance to arrive.

Imagine being in the final trimester, in delivery, and travelling hours on a donkey-drawn vehicle to get to a hospital

As well as being rough, the road traverses valleys that become inundated during the rainy season, completely blocking travel.

A surgeon at the hospital in Metche said each patient she treats is an emergency, with some women having to make arduous trips to the hospital by foot or on a donkey.

“Imagine being nine months pregnant, in childbirth, and making a long trip on a animal-drawn vehicle to get to a hospital. The biggest factor is the wait but having to arrive under such circumstances also has an influence on the childbirth,” 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 surgical delivery. 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 entirely leaning on her mother.

The nutritional care section has expanded to six tents and has individuals overflowing into other sections. Children are placed under mosquito nets in oppressive temperatures in almost utter stillness as medical staff work, creating remedies and weighing children on a instrument created using a bucket and rope.

In less severe situations children get packets of PlumpyNut, the specially formulated peanut paste, but the most severe instances need a regular intake of enriched milk. Mohammed’s baby is administered his nutrition through a syringe.

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being fed through a nose tube. The infant has been sick for the past year but Abubakar was repeatedly given only painkillers without any medical assessment, until she made the trip from Alacha to Metche.

“Every day, I see additional kids joining us in this shelter,” she says. “The food we’re eating is low-quality, there’s not enough to eat and it’s lacking in nutrients.

“If we were at home, we could’ve adapted ourselves. You can go and cultivate plants, you can find employment, but here we’re relying on what we’re given.”

And what they are given is a meager portion of grain, vegetable oil and salt, provided every 60 days. Such a simple food offers little sustenance, and the small amount of money she is given acquires minimal items in the regular markets, where prices have become inflated.

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

Unable to get employment in Chad, her husband has traveled to Libya in the hope of raising enough money for them to join him. She stays with his relatives, dividing up whatever meals they acquire.

Abubakar says she has already witnessed food supplies decreasing and there are concerns that the abrupt cuts 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 most severe crisis and the {scale of needs|extent