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For an extended period, jolting along the soggy dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and concentrated on stopping herself vomiting. She was in labour, in extreme pain after her uterus ruptured, but was now being tossed around in the ambulance that bumped over the potholes and ridges of the road through the Chadian desert.

Most of the 878,000 Sudanese displaced persons who escaped to Chad since 2023, living hand to mouth in this difficult terrain, are females. They live in isolated camps in the desert with insufficient supplies, little employment and with treatment often a dangerously far away.

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

“I kept getting infections during my term and I had to go the medical tent multiple occasions – 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 endure a long delay for the ambulance but all I recall is the pain; it was so intense I became disoriented.”

Her mother, Ashe Khamis Abdullah, 40, was terrified she would suffer the death of her daughter and baby grandson. But Mohammed was hurried into surgery when she arrived at the hospital and an emergency caesarean section saved her and her son, Muwais.

Chad was known for the world’s second most severe maternal fatality statistic before the recent arrival of refugees, but the situations faced by the Sudanese expose further women in risk.

At the hospital, where they have delivered 824 babies in often critical situations this year, the medics are able to save many, 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, 86% of the people who reached and stayed in Chad are women and children. In total, about over a million Sudanese are being sheltered in the eastern part of the country, a large number of whom ran from the earlier war in Darfur.

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

Many adult men have remained to be in proximity to homes and land; some were killed, taken hostage or conscripted. Those of adult age move on quickly from Chad’s barren settlements to find work in the capital, N’Djamena, or elsewhere, in nearby Libya.

It means women are abandoned, without the ability to feed the young and old left in their responsibility. To reduce density near the border, the Chadian government has relocated people to smaller camps such as Metche with average populations of about a large community, 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 not much more. There is unemployment, families must walk hours to find fuel, and each person must survive on about a small amount of water a day – far below the suggested amount.

This isolation means hospitals are admitting 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 camp at Alacha, where Mohammed is one of a large number of refugees. The medical team has seen cases where women in extreme agony have had to wait an entire night for the ambulance to come.

Imagine being in the final trimester, in childbirth, and making a lengthy trip on a cart pulled by a donkey to get to a medical facility

As well as being uneven, the road traverses valleys that become inundated during the rainy season, completely preventing travel.

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

“Imagine being about to give birth, in childbirth, and making a long trip on a animal-drawn vehicle to get to a medical center. The main problem is the wait but having to come in these conditions also has an influence on the birth,” says the surgeon.

Poor nutrition, which is on the rise, also raises the chance of issues in pregnancy, including the uterine splits that medical staff often encounter.

Mohammed has continued under care in the couple of 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 entirely leaning on her mother.

The malnutrition ward has expanded to six tents and has individuals overflowing into other sections. Children lie under mosquito nets in oppressive temperatures in almost complete silence as doctors and nurses work, creating remedies and weighing children on a device constructed from a pail and cord.

In less severe situations children get small bags of PlumpyNut, the uniquely designed peanut paste, but the most severe instances need a regular intake of nutrient-rich liquid. Mohammed’s baby is fed his through a syringe.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being fed through a nose tube. The infant has been sick for the past year but Abubakar was repeatedly given only painkillers without any diagnosis, until she made the travel from Alacha to Metche.

“Every day, I see additional kids arriving in this structure,” she says. “The food we’re eating is inadequate, there’s too little nourishment and it’s not nutritious.

“If we were at home, we could’ve adapted ourselves. You can go and cultivate plants, you can work to earn some money, but here we’re relying on what we’re distributed.”

And what they are given is a small amount of grain, vegetable oil and salt, distributed every couple of months. Such a minimal nutrition offers little sustenance, and the small amount of money she is given cannot buy much in the regular markets, where costs have risen.

Abubakar was transferred to Alacha after arriving from Sudan in 2023, having escaped the armed group Rapid Support Forces’ raid on her native town of El Geneina in June that year.

Unable to get employment in Chad, her husband has gone to Libya in the hope of raising enough money for them to follow. She lives with his family members, sharing out whatever food they can get.

Abubakar says she has already seen 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 worsen the situation. Despite the war in Sudan having created the 21st century’s most severe crisis and the {scale of needs|extent