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For hours, jolting along the soggy dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and concentrated on stopping herself being sick. She was in delivery, in agonizing discomfort after her uterine wall split, but was now being jostled relentlessly in the ambulance that lurched across the uneven terrain of the road through the Chadian desert.

Most of the 878,000 Sudanese people who ran to Chad since 2023, barely getting by in this inhospitable environment, are women. They live in isolated camps in the desert with limited water and food, few job opportunities and with treatment often a perilously remote away.

The clinic Mohammed needed was in Metche, one more encampment more than a considerable journey away.

“I continuously experienced infections during my pregnancy and I had to go the health post multiple occasions – when I was there, the delivery commenced. But I wasn’t able to give birth without intervention because my womb had given way,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I remember was the pain; it was so bad I became disoriented.”

Her mother, Ashe Khamis Abdullah, 40, was terrified she would suffer the death of her offspring and descendant. But Mohammed was immediately taken for surgery when she got to the hospital and an urgent C-section rescued her and her son, Muwais.

Chad was known for the world’s second-highest maternal fatality statistic before the recent arrival of refugees, but the situations faced by the Sudanese put even more women in danger.

At the hospital, where they have assisted in the arrival of 824 babies in mostly emergency conditions this year, the medical staff are able to help plenty, but it is what affects the women who are not able to reach the hospital that alarms the professionals.

In the two years since the domestic strife in Sudan started, over four-fifths of the people who reached and stayed in Chad are females and minors. In total, about one point two million Sudanese are being sheltered in the east of the country, a large number of whom escaped the earlier war 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 millions of Sudanese have been forced out of their homes.

Many males have not left to be close to homes and land; many were slain, captured or forced into fighting. Those of adult age soon depart from Chad’s isolated encampments to seek employment in the capital, N’Djamena, or beyond, in neighbouring Libya.

It implies women are left alone, without the means to feed the children and the elderly left in their charge. To prevent congestion near the border, the Chadian government has moved individuals to more compact settlements such as Metche with usual resident counts of about fifty thousand, but in distant locations with few facilities and scarce prospects.

Metche has a hospital established by a medical aid organization, which began as a few tents but has expanded to include an procedure area, but few additional amenities. There is a lack of jobs, families must walk hours to find burning material, and each person must subsist with about nine litres of water a day – far below the suggested amount.

This isolation means hospitals are treating women with issues in their pregnancy dangerously late. There is only a one medical transport 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 seen cases where women in extreme agony have had to remain overnight for the ambulance to come.

Imagine being in the final trimester, in delivery, and travelling hours on a donkey-drawn vehicle to get to a hospital

As well as being uneven, the road traverses valleys that flood during the wet period, completely cutting off travel.

A surgeon at the hospital in Metche said each patient she treats is an critical situation, with some women having to make challenging travels to the hospital by foot or on a donkey.

“Imagine being nine months pregnant, in labour, and travelling hours on a donkey cart to get to a medical center. The biggest factor is the lag but having to arrive under such circumstances also has an influence on the birth,” says the surgeon.

Poor nutrition, which is on the rise, also raises the chance of complications in pregnancy, including the uterine splits that medical staff see regularly.

Mohammed has continued under care in the two months since her caesarean. Afflicted by malnutrition, she developed an infection, while her son has been closely watched. The parent has gone to other towns in seek jobs, so Mohammed is totally dependent on her mother.

The nutritional care section has expanded to six tents and has patients spilling over into other sections. Children are placed under mosquito nets in extreme warmth in almost total quiet as health workers work, mixing medications and assessing weights on a scale made from a container and string.

In moderate instances children get sachets of PlumpyNut, the specifically created peanut paste, but the most severe instances need a consistent supply of enriched milk. Mohammed’s baby is administered his nutrition through a medical device.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being nourished via a nasogastric tube. The infant has been sick for the past year but Abubakar was only provided with painkillers without any medical assessment, until she made the travel from Alacha to Metche.

“Every day, I see further minors joining us in this shelter,” she says. “The meals we consume is inadequate, there’s not enough to eat and it’s lacking in nutrients.

“If we were at home, we could’ve adapted ourselves. You can go and farm produce, you can get a job, but here we’re relying on what we’re provided.”

And what they are provided is a small amount of sorghum, cooking oil and salt, distributed every two months. Such a basic diet is deficient in nutrients, and the small amount of money she is given cannot buy much in the local bazaars, where prices have become inflated.

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

Finding no work in Chad, her husband has gone to Libya in the aspiration to raising enough money for them to join him. She resides with his family members, sharing out whatever meals they acquire.

Abubakar says she has already witnessed food rations being cut and there are concerns that the sharp decreases in international assistance funds 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