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For a long time, bouncing over the soggy dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and focused on stopping herself being sick. She was in delivery, in severe suffering after her uterus ruptured, but was now being jostled relentlessly in the ambulance that jumped along the uneven terrain of the road through the Chadian desert.

Most of the 878,000 Sudanese refugees who have fled to Chad since 2023, surviving precariously in this inhospitable environment, are women. They stay in secluded encampments in the desert with scarce resources, few job opportunities and with healthcare often a perilously remote away.

The clinic Mohammed needed was in Metche, another refugee camp more than a considerable journey away.

“I kept getting infections during my pregnancy and I had to go the medical tent seven times – when I was there, the pregnancy started. But I wasn’t able to give birth normally because my uterine muscles failed,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I recall is the suffering; it was so bad I became confused.”

Her maternal figure, Ashe Khamis Abdullah, 40, worried she would be bereft of her daughter and baby grandson. But Mohammed was immediately taken for surgery when she arrived at the hospital and an emergency caesarean section rescued her and her son, Muwais.

Chad previously recorded the world’s second most severe maternal fatality statistic before the ongoing stream of refugees, but the circumstances suffered 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 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 domestic strife in Sudan began, 86% of the refugees who have arrived and stayed in Chad are females and minors. In total, about over a million Sudanese are being sheltered in the eastern region of the country, four hundred thousand of whom ran from the past violence in Darfur.

Chad has accepted the majority 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 11.8 million Sudanese have been displaced from their homes.

Many males have not left to be close to homes and land; many were killed, abducted or made to join the conflict. Those of employable age rapidly leave from Chad’s desolate refugee camps to find work in the main city, N’Djamena, or beyond, in neighbouring Libya.

It means women are left alone, without the ability to sustain the children and the elderly left in their responsibility. To reduce density near the border, the Chadian government has relocated people to more compact settlements such as Metche with usual resident counts of about fifty thousand, but in distant locations with no services and scarce prospects.

Metche has a hospital established by a medical aid organization, which started off as a few tents but has grown to feature an operating theatre, but few additional amenities. There is no work, families must travel long distances to find firewood, and each person must survive on about a small amount of water a day – much less than the advised quantity.

This seclusion means hospitals are receiving women with complications 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 settlement of Alacha, where Mohammed is one of close to fifty thousand 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 travelling hours on a donkey-drawn vehicle to get to a hospital

As well as being bumpy, the route passes through valleys that fill with water during the wet period, 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 pack animal.

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

Malnutrition, which is growing, also increases the risk of issues in pregnancy, including the uterine ruptures that medical staff see regularly.

Mohammed has remained in hospital in the two months since her caesarean. Afflicted by malnutrition, she got sick, while her son has been carefully monitored. The male guardian has travelled to other towns in seek jobs, 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 are placed under mosquito nets in oppressive temperatures in almost total quiet as health workers work, creating remedies and weighing children on a device constructed from a container and string.

In moderate instances children get small bags of PlumpyNut, the specifically created peanut paste, but the most severe instances need a regular intake of nutrient-rich liquid. Mohammed’s baby is given his nourishment through a injector.

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

“Every day, I see more children coming in in this structure,” she says. “The food we’re eating is inadequate, there’s not enough to eat and it’s not nutritious.

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

And what they are provided is a limited quantity of grain, edible oil and salt, distributed every two months. Such a simple food is deficient in nutrients, and the little cash she is given cannot buy much in the regular markets, where prices have become inflated.

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

Finding no work in Chad, her partner has left for Libya in the aspiration to earning sufficient funds for them to join him. She resides with his kin, dividing up whatever food they can get.

Abubakar says she has already witnessed food supplies decreasing and there are worries that the sudden reductions in overseas aid budgets by the US, UK and other European countries, could make things worse. Despite the war in Sudan having caused the 21st century’s gravest emergency and the {scale of needs|extent