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For an extended period, travelling roughly on the flooded dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and focused on stopping herself vomiting. She was in labour, in extreme pain after her womb tore, but was now being jostled relentlessly in the ambulance that bumped over the dips and bumps of the road through the Chadian desert.

Most of the close to a million Sudanese refugees who have fled to Chad since 2023, barely getting by in this harsh landscape, are females. They stay 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, another refugee camp more than 120 minutes away.

“I repeatedly suffered from infections during my pregnancy and I had to go the medical tent multiple occasions – when I was there, the delivery commenced. But I found it impossible to give birth normally because my uterine muscles failed,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I recall is the agony; it was so intense I became delirious.”

Her parent, Ashe Khamis Abdullah, 40, was terrified she would be bereft of her offspring and descendant. But Mohammed was hurried into surgery when she reached the hospital and an critical surgical delivery rescued her and her son, Muwais.

Chad was known for the world’s second most severe maternal mortality rate before the current influx of refugees, but the conditions endured by the Sudanese place additional women in danger.

At the hospital, where they have assisted in the arrival of 824 babies in frequently urgent circumstances this year, the medical staff are able to save many, but it is what occurs with the women who are fail to get to the hospital that worries the staff.

In the 24 months since the civil war in Sudan started, 86% of the refugees who have arrived and settled in Chad are mothers and kids. In total, about one point two million Sudanese are being sheltered in the eastern part of the country, a large number of whom ran from the past violence in Darfur.

Chad has accepted the majority of the millions of people who have run from the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been forced out of their homes.

Many males have stayed behind to be close to homes and land; others have been murdered, captured or made to join the conflict. Those of working age rapidly leave from Chad’s barren settlements to find work in the capital, N’Djamena, or elsewhere, in adjacent Libya.

It means women are stranded, without the means to provide for the young and old left in their charge. To prevent congestion near the border, the Chadian government has relocated people to smaller camps such as Metche with typical numbers of about fifty thousand, but in remote areas with limited infrastructure and few opportunities.

Metche has a hospital built by a medical aid organization, which was initially a few tents but has grown to feature an procedure area, but not much more. There is a lack of jobs, families must travel long distances to find burning material, and each person must survive on about minimal water of water a day – well under the recommended 20 litres.

This remoteness means hospitals are admitting women with complications 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 health post near the settlement of Alacha, where Mohammed is one of close to fifty thousand 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 delivery, and travelling hours on a cart pulled by a donkey to get to a clinic

As well as being bumpy, the route passes through valleys that become inundated during the wet period, completely cutting off travel.

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

“Imagine being nine months pregnant, in childbirth, and journeying for an extended time on a animal-drawn vehicle to get to a hospital. The main problem is the delay but having to arrive under such circumstances also has an influence on the birth,” says the surgeon.

Malnutrition, which is on the rise, also increases the risk of issues in pregnancy, including the uterine splits that medical staff see regularly.

Mohammed has remained in hospital in the couple of months since her C-section. Experiencing malnutrition, she developed an infection, while her son has been regularly checked. The male guardian has journeyed to other towns in look for employment, so Mohammed is entirely leaning on her mother.

The nutritional care section has grown to six tents and has patients spilling over into other sections. Children rest beneath mosquito nets in extreme warmth in almost utter stillness as medical staff work, preparing treatments and weighing children on a scale made from a bucket and rope.

In mild cases children get small bags of PlumpyNut, the uniquely designed peanut paste, but the critical situations need a consistent supply of nutrient-rich liquid. Mohammed’s baby is fed his through a syringe.

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being nourished via a nasal drip. The child 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 more children arriving in this structure,” she says. “The nutrition we receive is poor, there’s too little nourishment and it’s lacking in nutrients.

“If we were at home, we could’ve adapted ourselves. You can go and farm produce, you can find employment, but here we’re reliant on what we’re distributed.”

And what they are given is a meager portion of grain, cooking oil and salt, distributed every two months. Such a minimal nutrition lacks nutrition, and the meager funds she is given purchases very little in the regular markets, where prices have become inflated.

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

Unable to get employment in Chad, her spouse has traveled to Libya in the aspiration to earning sufficient funds for them to join him. She resides with his family members, sharing out whatever meals they acquire.

Abubakar says she has already observed food rations being cut and there are concerns that the sharp decreases in overseas aid budgets by the US, UK and other European countries, could make things worse. Despite the war in Sudan having caused the 21st century’s worst humanitarian disaster and the {scale of needs|extent