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For a long time, travelling roughly on the waterlogged dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and focused on stopping herself being sick. She was in labour, in extreme pain after her uterus ruptured, but was now being jostled relentlessly in the ambulance that bumped over the potholes and ridges of the road through the Chadian desert.

Most of the close to a million Sudanese displaced persons who escaped to Chad since 2023, surviving precariously in this inhospitable environment, are women. They live in isolated camps in the desert with scarce resources, little employment and with healthcare often a perilously remote away.

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

“I continuously experienced infections during my pregnancy and I had to go the health post on numerous visits – when I was there, the delivery commenced. But I wasn’t able to give birth without intervention because my uterine muscles failed,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I remember was the suffering; it was so bad I became delirious.”

Her mother, Ashe Khamis Abdullah, 40, was terrified she would lose both her offspring and descendant. But Mohammed was immediately taken for surgery when she arrived at the hospital and an critical surgical delivery saved her and her son, Muwais.

Chad already had the world’s second-highest maternal fatality statistic before the recent arrival of refugees, but the conditions endured by the Sudanese place additional women in risk.

At the hospital, where they have birthed 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 fail to get to the hospital that worries the staff.

In the couple of years since the domestic strife in Sudan started, the vast majority of the displaced persons who came and remained in Chad are women and children. In total, about over a million Sudanese are being hosted in the east of the country, four hundred thousand of whom fled the previous conflict in Darfur.

Chad has hosted the bulk of the millions of 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 forced out of their homes.

Many adult men have not left to be close to homes and land; some were slain, captured or conscripted. Those of employable age soon depart from Chad’s barren settlements to seek employment in the main city, N’Djamena, or beyond, in neighbouring Libya.

It implies women are left alone, without the ability to feed the children and the elderly left in their charge. To reduce density near the border, the Chadian government has relocated people to smaller camps such as Metche with usual resident counts of about a large community, but in remote areas with limited infrastructure and minimal chances.

Metche has a hospital built by a medical aid organization, which was initially a few tents but has expanded to include an surgical room, but not much more. There is a lack of jobs, families must travel long distances to find fuel, and each person must get by with about a small amount of water a day – well under the advised quantity.

This seclusion means hospitals are treating women with complications in their pregnancy when it is almost too late. There is only a single ambulance to serve the area between the Metche hospital and the clinic 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 endure a full night for the ambulance to come.

Imagine being expecting a child, in labour, and travelling hours on a donkey-drawn vehicle to get to a medical facility

As well as being bumpy, the road traverses valleys that flood during the rainy season, completely preventing travel.

A surgeon at the hospital in Metche said every case she sees is an emergency, with some women having to make challenging travels to the hospital by foot or on a donkey.

“Imagine being about to give birth, in delivery, and travelling hours on a donkey cart to get to a clinic. The main problem is the wait but having to travel in this state also has an effect on the childbirth,” says the surgeon.

Undernourishment, which is increasing, also elevates the likelihood of issues in pregnancy, including the uterine splits that medical staff see regularly.

Mohammed has continued under care in the 60 days since her caesarean. Experiencing malnutrition, she got sick, while her son has been closely watched. The parent has travelled to other towns in search of work, so Mohammed is totally dependent on her mother.

The undernourishment unit has expanded to six tents and has patients spilling over into other sections. Children rest beneath mosquito nets in extreme warmth in almost utter stillness as health workers work, creating remedies and weighing children on a instrument created using a pail and cord.

In less severe situations children get packets of PlumpyNut, the specifically created peanut paste, but the critical situations need a regular intake 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 nasal drip. The baby has been unwell for the past year but Abubakar was consistently offered just painkillers without any medical assessment, until she made the travel from Alacha to Metche.

“Every day, I see additional kids joining us in this structure,” she says. “The meals we consume is low-quality, there’s insufficient food and it’s deficient in vitamins.

“If we were at home, we could’ve coped better. You can go and farm produce, you can get a job, 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, handed out every two months. Such a simple food is deficient in nutrients, and the little cash she is given acquires minimal items in the regular markets, where costs have risen.

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

Unable to get employment in Chad, her partner has left for Libya in the desire to gathering adequate cash for them to follow. She stays with his family members, sharing out whatever meals they acquire.

Abubakar says she has already witnessed food distributions being reduced and there are fears that the abrupt cuts in foreign support money by the US, UK and other European countries, could make things worse. Despite the war in Sudan having produced the 21st century’s most severe crisis and the {scale of needs|extent