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For a long time, bouncing over the soggy dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and tried hard stopping herself throwing up. She was in childbirth, in agonizing discomfort after her uterus ruptured, but was now being shaken violently in the ambulance that lurched across the uneven terrain of the road through the Chadian desert.

Most of the 878,000 Sudanese refugees who have fled to Chad since 2023, barely getting by in this harsh landscape, are females. They live in isolated camps in the desert with scarce resources, no work and with treatment often a life-threateningly long distance away.

The hospital Mohammed needed was in Metche, another refugee camp more than 120 minutes away.

“I continuously experienced infections during my gestation and I had to go the health post seven times – when I was there, the pregnancy started. But I wasn’t able to give birth normally because my uterus had collapsed,” says Mohammed. “I had to wait two hours for the ambulance but all I recall is the agony; it was so bad I became disoriented.”

Her maternal figure, Ashe Khamis Abdullah, 40, feared she would be bereft of her child and grandchild. But Mohammed was hurried into surgery when she got to the hospital and an urgent C-section preserved the lives of her and her son, Muwais.

Chad already had the world’s second worst maternal death rate 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 frequently urgent circumstances this year, the doctors are able to rescue numerous, but it is what affects the women who are cannot access the hospital that concerns them.

In the two years since the domestic strife in Sudan started, over four-fifths of the displaced persons who came and settled in Chad are women and children. In total, about one point two million Sudanese are being accommodated in the eastern part of the country, four hundred thousand of whom escaped the past violence in Darfur.

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

Many men have remained to be close to homes and land; some were killed, taken hostage or made to join the conflict. Those of working age move on quickly from Chad’s barren settlements to look for jobs in the main city, N’Djamena, or further, in adjacent Libya.

It implies women are abandoned, without the ability to sustain the children and the elderly left in their care. To prevent congestion near the border, the Chadian government has moved individuals to more compact settlements such as Metche with average populations of about a large community, but in isolated regions with limited infrastructure and few opportunities.

Metche has a hospital established by a medical aid organization, which started off as a few tents but has developed to contain an procedure area, but few additional amenities. There is no work, families must travel long distances to find fuel, and each person must survive on about minimal water of water a day – much less than the advised quantity.

This seclusion means hospitals are treating women with problems in their pregnancy dangerously late. There is only a single ambulance to travel the path between the Metche hospital and the medical tent near the camp at Alacha, where Mohammed is one of nearly 50,000 refugees. The medical team has observed instances where women in severe suffering have had to remain overnight for the ambulance to reach them.

Imagine being expecting a child, in labour, and journeying for a long time on a cart pulled by a donkey to get to a clinic

As well as being uneven, the path goes through valleys that become inundated during the rainy season, completely cutting off travel.

A surgeon at the hospital in Metche said all the situations she encounters is an critical situation, with some women having to make long and difficult journeys to the hospital by foot or on a donkey.

“Imagine being in the late stages of pregnancy, in childbirth, and travelling hours on a animal-drawn vehicle to get to a medical center. The main problem is the wait but having to travel in this state also has an effect on the childbirth,” says the surgeon.

Poor nutrition, which is growing, also increases the risk of problems in pregnancy, including the uterine splits that medical staff often encounter.

Mohammed has continued under care in the 60 days since her surgical delivery. Afflicted by malnutrition, she got sick, while her son has been closely watched. The father has gone 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 patients spilling over into other sections. Children lie under mosquito nets in extreme warmth in almost utter stillness as health workers work, mixing medications and weighing children on a instrument created using a container and string.

In moderate instances children get packets of PlumpyNut, the specially formulated peanut paste, but the most severe instances need a regular intake of fortified formula. Mohammed’s baby is administered his nutrition through a injector.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being given nutrition by a nasogastric tube. The child has been ill for the past year but Abubakar was repeatedly given only painkillers without any medical assessment, until she made the travel from Alacha to Metche.

“Every day, I see additional kids arriving in this tent,” she says. “The meals we consume is low-quality, there’s insufficient food and it’s lacking in nutrients.

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

And what they are given is a small amount of cereal, vegetable oil and salt, handed out every two months. Such a minimal nutrition is deficient in nutrients, and the small amount of money she is given purchases very little in the local bazaars, where prices have become inflated.

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

Finding no work in Chad, her spouse has traveled to Libya in the desire to gathering adequate cash for them to join him. She stays with his kin, dividing up whatever meals they acquire.

Abubakar says she has already observed food rations being cut and there are worries that the abrupt cuts in foreign support money by the US, UK and other European countries, could worsen the situation. Despite the war in Sudan having produced the 21st century’s most severe crisis and the {scale of needs|extent