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For hours, bouncing over the waterlogged dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed gripped firmly 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 jostled relentlessly 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 displaced persons who escaped to Chad since 2023, living hand to mouth in this difficult terrain, are women. They live in secluded encampments in the desert with insufficient supplies, no work and with healthcare often a life-threateningly long distance away.

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

“I continuously experienced infections during my pregnancy and I had to go the medical tent seven times – when I was there, the delivery commenced. But I found it impossible to give birth normally because my uterine muscles failed,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I remember was the pain; it was so intense I became disoriented.”

Her mother, 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 emergency caesarean section preserved the lives of her and her son, Muwais.

Chad already had the world’s second most severe maternal fatality statistic before the recent arrival of refugees, but the situations faced by the Sudanese expose further women in danger.

At the hospital, where they have birthed 824 babies in mostly emergency conditions this year, the medics are able to rescue numerous, but it is what affects the women who are cannot access the hospital that worries the staff.

In the 24 months since the domestic strife in Sudan started, over four-fifths of the refugees who have arrived and remained 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 past violence in Darfur.

Chad has accepted the majority of the millions of people who have escaped the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been displaced from their homes.

Many males have remained to be near homes and land; some were killed, captured or made to join the conflict. Those of working age soon depart from Chad’s barren settlements to seek employment in the capital, N’Djamena, or further, in adjacent Libya.

It implies women are stranded, without the means to feed the children and the elderly left in their responsibility. To reduce density near the border, the Chadian government has moved individuals to more compact settlements such as Metche with usual resident counts of about fifty thousand, but in remote areas with limited infrastructure 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 operating theatre, but little else. There is no work, families must travel long distances to find firewood, and each person must subsist with about nine litres of water a day – well under the suggested amount.

This remoteness means hospitals are admitting women with problems in their pregnancy dangerously late. There is only a single ambulance to cover the route between the Metche hospital and the medical tent near the camp at Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has seen cases where women in extreme agony have had to remain overnight for the ambulance to reach them.

Imagine being in the final trimester, in childbirth, and journeying for a long time on a animal-drawn transport to get to a clinic

As well as being uneven, the path goes through valleys that flood during the rainy season, 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 arduous trips to the hospital by on foot or on a mule.

“Imagine being in the late stages of pregnancy, in delivery, and travelling hours on a cart pulled by a donkey to get to a hospital. The primary issue is the wait but having to come in these conditions also has an impact on the childbirth,” says the surgeon.

Undernourishment, which is on the rise, also elevates the likelihood of problems in pregnancy, including the uterine ruptures that medical staff frequently observe.

Mohammed has continued under care in the couple of months since her caesarean. Suffering from malnutrition, she got sick, while her son has been regularly checked. The male guardian has travelled to other towns in search of work, so Mohammed is entirely leaning on her mother.

The undernourishment unit has increased to six tents and has individuals overflowing into other sections. Children rest beneath mosquito nets in extreme warmth in almost complete silence as health workers work, preparing treatments and measuring kids on a device constructed from a pail and cord.

In mild cases children get packets of PlumpyNut, the specially formulated peanut paste, but the critical situations need a regular intake 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 nose tube. The infant has been unwell for the past year but Abubakar was repeatedly given only painkillers without any medical assessment, until she made the journey from Alacha to Metche.

“Every day, I see additional kids coming in in this tent,” she says. “The food we’re eating is inadequate, there’s insufficient food and it’s not nutritious.

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

And what they are provided is a small amount of cereal, cooking oil and salt, provided every 60 days. Such a basic diet is deficient in nutrients, and the little cash she is given cannot buy much in the regular markets, where costs have risen.

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

Failing to secure jobs in Chad, her partner has gone to Libya in the aspiration to gathering adequate cash for them to follow. She resides with his kin, dividing up whatever meals they acquire.

Abubakar says she has already witnessed food supplies decreasing and there are fears 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 created the 21st century’s worst humanitarian disaster and the {scale of needs|extent