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For a long time, jolting along the waterlogged dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and concentrated on stopping herself being sick. She was in labour, in agonizing discomfort after her womb tore, but was now being shaken violently in the ambulance that jumped along the dips and bumps of the road through the Chadian desert.

Most of the 878,000 Sudanese refugees who have fled to Chad since 2023, barely getting by in this difficult terrain, are women. They reside in secluded encampments in the desert with limited water and food, few job opportunities and with healthcare often a perilously remote away.

The hospital Mohammed needed was in Metche, one more encampment more than two hours away.

“I kept getting infections during my pregnancy 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 normally because my uterus had collapsed,” says Mohammed. “I had to endure a long delay for the ambulance but all I can think of the pain; it was so intense I became delirious.”

Her mother, Ashe Khamis Abdullah, 40, worried she would suffer the death of her child and grandchild. But Mohammed was immediately taken for surgery when she reached the hospital and an urgent C-section preserved the lives of her and her son, Muwais.

Chad previously recorded the world’s second-highest maternal mortality rate before the recent arrival of refugees, but the circumstances suffered by the Sudanese put even more women in peril.

At the hospital, where they have delivered 824 babies in often critical situations 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 concerns them.

In the two years since the civil war in Sudan started, over four-fifths of the displaced persons who came and settled in Chad are females and minors. In total, about 1.2 million Sudanese are being sheltered in the eastern part of the country, 400,000 of whom escaped the past violence 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 displaced from their homes.

Many adult men have remained to be near homes and land; some were killed, abducted or conscripted. Those of employable age move on quickly from Chad’s barren settlements to look for jobs in the main city, N’Djamena, or elsewhere, in neighbouring Libya.

It results in women are left alone, without the means to sustain the dependents left in their charge. To avoid overcrowding near the border, the Chadian government has transferred refugees to less crowded encampments such as Metche with average populations of about a large community, but in distant locations with few facilities and minimal chances.

Metche has a hospital established by a medical aid organization, which started off as a few tents but has developed to contain an operating theatre, but few additional amenities. There is a lack of jobs, families must travel long distances to find firewood, and each person must subsist with about nine litres of water a day – far below the advised quantity.

This remoteness means hospitals are receiving women with issues in their pregnancy dangerously late. There is only a one medical transport to cover the route between the Metche hospital and the medical tent near the camp at Alacha, where Mohammed is one of a large number of refugees. The medical team has seen cases where women in severe suffering have had to endure a full night for the ambulance to reach them.

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

As well as being rough, the route passes through valleys that flood during the monsoon, completely preventing travel.

A surgeon at the hospital in Metche said all the situations she encounters is an crisis, with some women having to make long and difficult journeys to the hospital by foot or on a pack animal.

“Imagine being about to give birth, in delivery, and making a long trip on a animal-drawn vehicle to get to a hospital. The primary issue is the wait but having to come in these conditions also has an impact on the childbirth,” says the surgeon.

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

Mohammed has stayed at the medical facility in the couple of months since her surgical delivery. Experiencing malnutrition, she contracted an illness, while her son has been carefully monitored. The male guardian has travelled to other towns in look for employment, so Mohammed is entirely leaning on her mother.

The malnutrition ward has grown to six tents and has individuals overflowing into other sections. Children lie under mosquito nets in sweltering heat in almost utter stillness as doctors and nurses work, mixing medications and assessing weights on a scale made from a container and string.

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

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being nourished via a nose tube. The infant has been unwell for the past year but Abubakar was consistently offered just painkillers without any identification, until she made the trip from Alacha to Metche.

“Every day, I see additional kids arriving in this shelter,” she says. “The meals we consume is low-quality, there’s too little nourishment and it’s not nutritious.

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

And what they are provided is a meager portion of grain, edible oil and salt, handed out every couple of months. Such a minimal nutrition lacks nutrition, 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 coming from Sudan in 2023, having run from the militia Rapid Support Forces’ attack on her native town of El Geneina in June that year.

Finding no work in Chad, her spouse has traveled to Libya in the hope of gathering adequate cash for them to come later. She resides with his relatives, dividing up whatever food they can get.

Abubakar says she has already observed food rations being cut and there are worries that the sharp decreases in foreign support money by the US, UK and other European countries, could make things worse. Despite the war in Sudan having caused the 21st century’s gravest emergency and the {scale of needs|extent