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For a long time, travelling roughly on the flooded dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and tried hard stopping herself vomiting. She was in childbirth, in agonizing discomfort after her womb tore, but was now being shaken violently in the ambulance that jumped along the dips and bumps of the road through the Chadian desert.

Most of the hundreds of thousands of Sudanese displaced persons who escaped to Chad since 2023, living hand to mouth in this harsh landscape, are women. They live in isolated camps in the desert with scarce resources, few job opportunities and with treatment often a dangerously far away.

The hospital Mohammed needed was in Metche, a different settlement more than a considerable journey away.

“I repeatedly suffered from infections during my gestation and I had to go the health post seven times – when I was there, the labour began. But I wasn’t able to give birth naturally because my uterine muscles failed,” says Mohammed. “I had to wait two hours for the ambulance but all I remember was the pain; it was so unbearable I became confused.”

Her parent, Ashe Khamis Abdullah, 40, worried she would suffer the death of her child and grandchild. But Mohammed was hurried into surgery when she got to the hospital and an critical surgical delivery preserved the lives of her and her son, Muwais.

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

At the hospital, where they have delivered 824 babies in frequently urgent circumstances this year, the doctors are able to rescue numerous, but it is what happens to the women who are not able to reach the hospital that concerns them.

In the couple of years since the civil war in Sudan began, the vast majority of the refugees who have arrived and stayed in Chad are mothers and kids. In total, about 1.2 million Sudanese are being sheltered in the eastern part of the country, a large number of whom ran from the previous conflict in Darfur.

Chad has hosted the bulk of the over four million people who have escaped the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been uprooted from their homes.

Many males have stayed behind to be close to homes and land; many were slain, abducted or conscripted. Those of working age move on quickly from Chad’s barren settlements to seek employment in the main city, N’Djamena, or elsewhere, in nearby Libya.

It results in women are abandoned, without the ability to sustain the children and the elderly left in their responsibility. To prevent congestion near the border, the Chadian government has transferred refugees to less crowded encampments such as Metche with usual resident counts of about 50,000, but in isolated regions with few facilities 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 surgical room, but few additional amenities. There is no work, families must journey for extended periods to find burning material, 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 treating women with problems in their pregnancy when it is almost too 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 nearly 50,000 refugees. The medical team has seen cases where women in severe suffering have had to remain overnight 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 rough, the road traverses valleys that become inundated during the monsoon, completely blocking travel.

A surgeon at the hospital in Metche said each patient she treats is an emergency, with some women having to make long and difficult journeys to the hospital by foot or on a pack animal.

“Imagine being in the late stages of pregnancy, in labour, and journeying for an extended time on a animal-drawn vehicle to get to a clinic. The main problem is the lag but having to come in these conditions also has an influence on the delivery,” says the surgeon.

Malnutrition, which is increasing, also increases the risk of complications in pregnancy, including the uterine splits that medical staff often encounter.

Mohammed has remained in hospital in the two months since her surgical delivery. Suffering from malnutrition, she got sick, while her son has been regularly checked. The father has gone to other towns in look for employment, so Mohammed is completely reliant on her mother.

The malnutrition ward has increased to six tents and has patients spilling over into other sections. Children lie under mosquito nets in sweltering heat in almost total quiet as medical staff work, creating remedies and weighing children on a scale made from a pail and cord.

In moderate instances children get sachets of PlumpyNut, the specially formulated peanut paste, but the worst cases need a daily dose of fortified formula. Mohammed’s baby is fed his through a medical device.

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

“Every day, I see more children joining us in this tent,” she says. “The meals we consume is low-quality, there’s not enough to eat and it’s deficient in vitamins.

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

And what they are given is a meager portion of grain, cooking oil and salt, distributed every couple of months. Such a basic diet lacks nutrition, and the meager funds she is given cannot buy much in the regular markets, where prices have become inflated.

Abubakar was transferred to Alacha after arriving from Sudan in 2023, having fled the militia Rapid Support Forces’ raid on her home city of El Geneina in June that year.

Unable to get employment in Chad, her partner has left for Libya in the hope of raising enough money for them to join him. She resides with his kin, distributing whatever nourishment they obtain.

Abubakar says she has already seen food supplies decreasing and there are concerns that the abrupt cuts in overseas aid budgets by the US, UK and other European countries, could worsen the situation. Despite the war in Sudan having caused the 21st century’s gravest emergency and the {scale of needs|extent