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For a long time, travelling roughly on the flooded dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and concentrated on stopping herself throwing up. She was in delivery, in extreme pain after her uterine wall split, but was now being jostled relentlessly in the ambulance that jumped along 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 difficult terrain, are women. They live in isolated camps in the desert with scarce resources, no work and with healthcare often a life-threateningly long distance away.

The clinic Mohammed needed was in Metche, another refugee camp more than two hours away.

“I repeatedly suffered from infections during my pregnancy and I had to go the health post multiple occasions – when I was there, the delivery commenced. But I could not give birth normally because my womb had given way,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I can think of the pain; it was so bad I became delirious.”

Her maternal figure, Ashe Khamis Abdullah, 40, worried she would lose both her offspring and descendant. But Mohammed was hurried into surgery when she got to the hospital and an emergency caesarean section rescued her and her son, Muwais.

Chad was known for the world’s second worst maternal death rate before the ongoing stream of refugees, but the circumstances suffered by the Sudanese put even more women in peril.

At the hospital, where they have assisted in the arrival of 824 babies in mostly emergency conditions this year, the medics are able to rescue numerous, but it is what affects the women who are not able to reach the hospital that worries the staff.

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 females and minors. In total, about 1.2 million Sudanese are being sheltered in the eastern region of the country, a large number of whom escaped the past violence in Darfur.

Chad has taken the lion’s share of the 4.1 million people who have escaped the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been displaced from their homes.

Many males have not left to be near homes and land; many were killed, captured or forced into fighting. Those of employable age rapidly leave from Chad’s desolate refugee camps to find work in the main city, N’Djamena, or further, in adjacent Libya.

It means women are stranded, without the resources to sustain the young and old left in their care. To prevent congestion near the border, the Chadian government has relocated people to smaller camps such as Metche with usual resident counts of about fifty thousand, but in isolated regions with no services and minimal chances.

Metche has a hospital built by a medical aid organization, which began as a few tents but has developed to contain an surgical room, but little else. There is unemployment, families must walk hours to find burning material, and each person must get by with about minimal water of water a day – far below the advised quantity.

This seclusion means hospitals are treating women with issues in their pregnancy when it is almost too late. There is only a sole emergency vehicle to travel the path between the Metche hospital and the medical tent near the camp at Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has seen cases where women in desperate pain have had to remain overnight for the ambulance to come.

Imagine being expecting a child, in delivery, and making a lengthy trip on a cart pulled by a donkey to get to a hospital

As well as being uneven, the path goes through valleys that flood during the monsoon, completely cutting off travel.

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

“Imagine being about to give birth, in labour, and travelling hours on a donkey cart to get to a medical center. The biggest factor is the delay but having to arrive under such circumstances also has an impact on the delivery,” says the surgeon.

Malnutrition, which is on the rise, also increases the risk of complications in pregnancy, including the uterine ruptures that medical staff frequently observe.

Mohammed has stayed at the medical facility in the couple of months since her surgical delivery. Experiencing malnutrition, she developed an infection, while her son has been carefully monitored. The male guardian has journeyed to other towns in search of work, so Mohammed is completely reliant on her mother.

The nutritional care section has expanded to six tents and has individuals overflowing into other sections. Children lie under mosquito nets in sweltering heat in almost total quiet as health workers work, mixing medications and weighing children on a device constructed from a container and string.

In mild cases children get packets of PlumpyNut, the uniquely designed 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 11-month-old boy, Sufian Sulaiman, is being fed through a nose tube. The baby has been ill for the past year but Abubakar was repeatedly given only painkillers without any medical assessment, until she made the trip from Alacha to Metche.

“Every day, I see further minors coming in in this shelter,” she says. “The nutrition we receive is inadequate, there’s too little nourishment and it’s not nutritious.

“If we were at home, we could’ve adjusted our lives. You can go and grow crops, you can get a job, but here we’re relying on what we’re provided.”

And what they are provided is a limited quantity of sorghum, cooking oil and salt, handed out 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 regular markets, where prices have become inflated.

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

Unable to get employment in Chad, her husband has traveled to Libya in the hope of earning sufficient funds for them to follow. She stays with his family members, sharing out whatever nourishment they obtain.

Abubakar says she has already witnessed food supplies decreasing and there are concerns that the sudden reductions in overseas aid budgets by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having produced the 21st century’s most severe crisis and the {scale of needs|extent