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For an extended period, bouncing over the soggy dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and focused on stopping herself throwing up. She was in delivery, in extreme pain after her uterine wall split, 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 displaced persons who escaped to Chad since 2023, barely getting by in this harsh landscape, are females. They stay in isolated camps in the desert with limited water and food, few job opportunities and with medical help often a life-threateningly long distance away.

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

“I repeatedly suffered from infections during my pregnancy and I had to go the clinic 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 wait two hours for the ambulance but all I recall is the agony; it was so intense I became confused.”

Her parent, Ashe Khamis Abdullah, 40, feared she would lose both her child and grandchild. But Mohammed was hurried into surgery when she arrived at the hospital and an emergency caesarean section saved her and her son, Muwais.

Chad was known for the world’s second-highest maternal fatality statistic before the current influx of refugees, but the situations faced by the Sudanese expose further women in danger.

At the hospital, where they have delivered 824 babies in frequently urgent circumstances this year, the doctors are able to help plenty, but it is what affects the women who are fail to get to the hospital that worries the staff.

In the 24 months since the civil war in Sudan erupted, the vast majority of the displaced persons who came and settled in Chad are women and children. In total, about over a million Sudanese are being accommodated in the eastern part of the country, a large number of whom fled the previous conflict in Darfur.

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

Many adult men have stayed behind to be near homes and land; many were murdered, taken hostage or conscripted. Those of employable age move on quickly from Chad’s isolated encampments to look for jobs in the main city, N’Djamena, or elsewhere, in nearby Libya.

It implies women are abandoned, without the ability to provide for the children and the elderly left in their responsibility. To avoid overcrowding near the border, the Chadian government has relocated people to smaller camps such as Metche with typical numbers of about 50,000, but in distant locations with no services and few opportunities.

Metche has a hospital established by a medical aid organization, which began as a few tents but has developed to contain an procedure area, but few additional amenities. There is no work, families must walk hours to find firewood, and each person must survive on about a small amount of water a day – much less than the recommended 20 litres.

This seclusion means hospitals are treating women with issues in their pregnancy at a critical stage. There is only a one medical transport to serve the area between the Metche hospital and the clinic near the Alacha encampment, where Mohammed is one of close to fifty thousand refugees. The medical team has seen cases where women in desperate pain have had to wait an entire night for the ambulance to reach them.

Imagine being nine months pregnant, in delivery, and travelling hours on a donkey-drawn vehicle to get to a hospital

As well as being uneven, the path goes through valleys that become inundated during the monsoon, completely preventing travel.

A surgeon at the hospital in Metche said all the situations she encounters is an crisis, with some women having to make challenging travels to the hospital by on foot or on a mule.

“Imagine being in the late stages of pregnancy, in childbirth, and making a long trip on a animal-drawn vehicle to get to a clinic. The main problem is the wait but having to arrive under such circumstances also has an impact on the birth,” says the surgeon.

Poor nutrition, which is increasing, also raises the chance of issues in pregnancy, including the womb tears that medical staff frequently observe.

Mohammed has stayed at the medical facility in the 60 days since her surgical delivery. Afflicted by malnutrition, she contracted an illness, while her son has been carefully monitored. The male guardian has journeyed to other towns in search of work, so Mohammed is completely reliant on her mother.

The undernourishment unit has increased to six tents and has patients spilling over into other sections. Children lie under mosquito nets in extreme warmth in almost complete silence as doctors and nurses work, mixing medications and measuring kids on a instrument created using a pail and cord.

In mild cases children get sachets of PlumpyNut, the uniquely designed peanut paste, but the critical situations need a regular intake of fortified formula. Mohammed’s baby is given his nourishment through a medical device.

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

“Every day, I see further minors arriving in this shelter,” she says. “The nutrition we receive is inadequate, there’s not enough to eat 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 work to earn some money, but here we’re dependent on what we’re provided.”

And what they are given is a small amount of cereal, vegetable oil and salt, provided every 60 days. Such a simple food lacks nutrition, and the little cash she is given cannot buy much in the local bazaars, where values have increased.

Abubakar was transferred to Alacha after arriving from Sudan in 2023, having run from the paramilitary Rapid Support Forces’ assault on her birthplace of El Geneina in June that year.

Failing to secure jobs in Chad, her partner has left for Libya in the hope of raising enough money for them to come later. She resides with his family members, distributing whatever nourishment they obtain.

Abubakar says she has already observed food rations being cut and there are concerns that the sharp decreases in overseas aid budgets by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having created the 21st century’s gravest emergency and the {scale of needs|extent