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For a long time, travelling roughly on the waterlogged dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and concentrated on stopping herself throwing up. She was in delivery, in extreme pain after her uterine wall split, but was now being tossed around 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 secluded encampments in the desert with limited water and food, few job opportunities and with treatment often a perilously remote away.

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

“I repeatedly suffered from infections during my gestation and I had to go the clinic on numerous visits – when I was there, the delivery commenced. But I could not give birth naturally because my womb had given way,” says Mohammed. “I had to wait two hours for the ambulance but all I remember was the suffering; it was so intense I became delirious.”

Her parent, Ashe Khamis Abdullah, 40, feared she would be bereft of her offspring and descendant. But Mohammed was rushed straight into surgery when she got to the hospital and an emergency caesarean section saved her and her son, Muwais.

Chad previously recorded the world’s second worst maternal mortality rate before the recent arrival of refugees, but the circumstances suffered by the Sudanese expose further women in danger.

At the hospital, where they have assisted in the arrival of 824 babies in frequently urgent circumstances this year, the medics are able to help plenty, but it is what occurs with the women who are fail to get to the hospital that concerns them.

In the two years since the internal conflict in Sudan started, 86% of the displaced persons who came and remained in Chad are females and minors. In total, about 1.2 million Sudanese are being sheltered in the eastern part of the country, 400,000 of whom ran from the past violence in Darfur.

Chad has accepted the majority of the 4.1 million people who have run from the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been displaced from their homes.

Many males have remained to be close to homes and land; many were slain, abducted or forced into fighting. Those of adult age move on quickly from Chad’s desolate refugee camps to find work in the capital, N’Djamena, or further, in adjacent Libya.

It results in women are stranded, without the means to provide for the children and the elderly left in their charge. To avoid overcrowding near the border, the Chadian government has transferred refugees to less crowded encampments such as Metche with typical numbers of about a large community, but in remote areas with no services and minimal chances.

Metche has a hospital set up by a medical aid organization, which was initially a few tents but has expanded to include an operating theatre, but little else. There is no work, families must travel long distances to find fuel, and each person must survive on about a small amount of water a day – much less than the suggested amount.

This isolation means hospitals are admitting women with problems in their pregnancy when it is almost too late. There is only a single ambulance to travel the path between the Metche hospital and the health post near the camp at Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has seen cases where women in desperate pain have had to endure a full night for the ambulance to reach them.

Imagine being nine months pregnant, in childbirth, and travelling hours on a animal-drawn transport to get to a hospital

As well as being uneven, the road traverses valleys that flood 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 arduous trips to the hospital by foot or on a mule.

“Imagine being nine months pregnant, in childbirth, and making a long trip on a cart pulled by a donkey to get to a medical center. The biggest factor is the wait but having to arrive under such circumstances also has an impact on the delivery,” says the surgeon.

Malnutrition, which is on the rise, also elevates the likelihood of problems in pregnancy, including the uterine ruptures that medical staff see regularly.

Mohammed has remained in hospital in the couple of months since her caesarean. Experiencing malnutrition, she contracted an illness, while her son has been closely watched. The father has gone to other towns in search of work, so Mohammed is entirely leaning on her mother.

The nutritional care section has increased to six tents and has individuals overflowing into other sections. Children lie under mosquito nets in oppressive temperatures in almost complete silence as medical staff work, creating remedies and assessing weights on a scale made from a container and string.

In mild cases children get sachets of PlumpyNut, the uniquely designed peanut paste, but the most severe instances need a daily dose of fortified formula. Mohammed’s baby is given his nourishment through a syringe.

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being nourished via a nose tube. The baby has been unwell for the past year but Abubakar was only provided with painkillers without any identification, until she made the travel from Alacha to Metche.

“Every day, I see additional kids coming in in this shelter,” she says. “The meals we consume is poor, there’s not enough to eat and it’s not nutritious.

“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 relying on what we’re given.”

And what they are allocated is a meager portion of cereal, vegetable oil and salt, handed out every couple of months. Such a simple food is deficient in nutrients, and the meager funds she is given acquires minimal items in the local bazaars, where prices have become inflated.

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

Unable to get employment in Chad, her spouse has gone to Libya in the desire to raising enough money for them to follow. She lives with his family members, distributing whatever food they can get.

Abubakar says she has already observed food rations being cut and there are fears that the abrupt cuts in international assistance funds by the US, UK and other European countries, could make things worse. Despite the war in Sudan having caused the 21st century’s most severe crisis and the {scale of needs|extent