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For a long time, travelling roughly on the soggy dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and concentrated on stopping herself vomiting. She was in childbirth, in agonizing discomfort 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 hundreds of thousands of Sudanese people who ran to Chad since 2023, barely getting by in this difficult terrain, are women. They stay in isolated camps in the desert with insufficient supplies, little employment and with medical help often a life-threateningly long distance away.

The hospital Mohammed needed was in Metche, a different settlement more than two hours away.

“I continuously experienced infections during my pregnancy and I had to go the medical tent on numerous visits – when I was there, the delivery commenced. But I wasn’t able to give birth normally because my uterine muscles failed,” says Mohammed. “I had to endure a long delay for the ambulance but all I recall is the agony; it was so bad I became delirious.”

Her parent, Ashe Khamis Abdullah, 40, was terrified she would lose both her daughter and baby grandson. But Mohammed was rushed straight into surgery when she reached the hospital and an emergency caesarean section preserved the lives of her and her son, Muwais.

Chad was known for the world’s second-highest maternal fatality statistic before the current influx of refugees, but the situations faced by the Sudanese expose further women in peril.

At the hospital, where they have birthed 824 babies in frequently urgent circumstances this year, the medics are able to rescue numerous, but it is what happens to the women who are not able to reach the hospital that worries the staff.

In the couple of years since the domestic strife in Sudan began, the vast majority of the refugees who have arrived and settled in Chad are women and children. In total, about one point two million Sudanese are being accommodated in the eastern region of the country, 400,000 of whom fled the earlier war in Darfur.

Chad has taken the lion’s share of the over four million people who have run from the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been displaced from their homes.

Many men have remained to be in proximity to homes and land; many were killed, captured or conscripted. Those of working age soon depart from Chad’s barren settlements to seek employment in the main city, N’Djamena, or elsewhere, in neighbouring Libya.

It results in women are left alone, without the resources to feed the children and the elderly left in their charge. To reduce density near the border, the Chadian government has relocated people to less crowded encampments such as Metche with average populations of about 50,000, but in isolated regions with limited infrastructure and few opportunities.

Metche has a hospital built by a medical aid organization, which began as a few tents but has expanded to include an procedure area, but few additional amenities. There is unemployment, families must walk hours to find burning material, and each person must get by with about a small amount of water a day – far below the suggested amount.

This remoteness means hospitals are treating women with complications in their pregnancy at a critical stage. There is only a sole emergency vehicle to travel the path between the Metche hospital and the health post near the settlement of 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 reach them.

Imagine being expecting a child, in childbirth, and journeying for a long time on a donkey-drawn vehicle to get to a hospital

As well as being bumpy, the path goes through valleys that become inundated during the wet period, completely preventing travel.

A surgeon at the hospital in Metche said each patient she treats is an critical situation, with some women having to make arduous trips to the hospital by foot or on a mule.

“Imagine being about to give birth, in delivery, and travelling hours on a donkey cart to get to a hospital. The primary issue is the wait but having to arrive under such circumstances also has an impact on the birth,” says the surgeon.

Poor nutrition, which is on the rise, also elevates the likelihood of complications in pregnancy, including the womb tears that medical staff see regularly.

Mohammed has remained in hospital in the two months since her C-section. Experiencing malnutrition, she contracted an illness, 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 undernourishment unit has grown to six tents and has cases exceeding capacity into other sections. Children are placed under mosquito nets in sweltering heat in almost complete silence as health workers work, preparing treatments and weighing children on a scale made from a bucket and rope.

In less severe situations children get sachets of PlumpyNut, the specifically created peanut paste, but the most severe instances need a daily dose 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 given nutrition by a nasogastric tube. The infant 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 coming in in this tent,” 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 adjusted our lives. You can go and grow crops, you can work to earn some money, but here we’re reliant on what we’re given.”

And what they are allocated is a meager portion of grain, edible oil and salt, provided every couple of months. Such a simple food offers little sustenance, and the meager funds she is given cannot buy much in the weekly food markets, where costs have risen.

Abubakar was moved to Alacha after reaching 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 partner has left for Libya in the desire to raising enough money for them to join him. She stays with his family members, sharing out whatever meals they acquire.

Abubakar says she has already observed food distributions being reduced and there are fears 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 created the 21st century’s most severe crisis and the {scale of needs|extent