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For hours, travelling roughly on the flooded dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and concentrated on stopping herself throwing up. She was in labour, in agonizing discomfort after her womb tore, but was now being shaken violently 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 displaced persons who escaped to Chad since 2023, living hand to mouth in this difficult terrain, are women. They live in remote settlements in the desert with scarce resources, few job opportunities and with medical help often a dangerously far away.

The clinic Mohammed needed was in Metche, a different settlement more than 120 minutes away.

“I kept getting infections during my term and I had to go the medical tent seven times – when I was there, the delivery commenced. But I could not give birth normally because my uterus had collapsed,” says Mohammed. “I had to wait two hours for the ambulance but all I remember was the suffering; it was so intense I became confused.”

Her maternal figure, Ashe Khamis Abdullah, 40, feared she would suffer the death of her offspring and descendant. 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 was known for the world’s second most severe maternal fatality statistic before the ongoing stream of refugees, but the circumstances suffered by the Sudanese expose further women in danger.

At the hospital, where they have assisted in the arrival of 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 alarms the professionals.

In the couple of years since the domestic strife in Sudan erupted, over four-fifths of the people who reached and remained 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 ran from the previous conflict in Darfur.

Chad has taken the lion’s share 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 uprooted from their homes.

Many men have remained to be near homes and land; many were slain, captured or made to join the conflict. Those of working age move on quickly from Chad’s isolated encampments to find work in the capital, N’Djamena, or elsewhere, in adjacent Libya.

It means women are stranded, without the ability to provide for the children and the elderly left in their charge. To avoid overcrowding near the border, the Chadian government has transferred refugees to more compact settlements such as Metche with usual resident counts of about a large community, but in isolated regions with no services and minimal chances.

Metche has a hospital established by a medical aid organization, which began as a few tents but has expanded to include an operating theatre, but little else. There is no work, families must journey for extended periods to find burning material, and each person must get by with about nine litres of water a day – far below the suggested amount.

This seclusion means hospitals are receiving women with issues in their pregnancy dangerously late. There is only a one medical transport to serve the area between the Metche hospital and the health post near the camp at Alacha, where Mohammed is one of nearly 50,000 refugees. The medical team has observed instances where women in desperate pain have had to remain overnight for the ambulance to arrive.

Imagine being expecting a child, in childbirth, and making a lengthy trip on a cart pulled by a donkey to get to a medical facility

As well as being bumpy, the road traverses valleys that flood during the rainy season, completely preventing travel.

A surgeon at the hospital in Metche said each patient she treats is an crisis, with some women having to make challenging travels to the hospital by walking or on a mule.

“Imagine being in the late stages of pregnancy, in labour, and travelling hours on a animal-drawn vehicle to get to a hospital. The main problem is the delay but having to travel in this state also has an influence on the delivery,” says the surgeon.

Malnutrition, which is on the rise, also raises the chance of issues in pregnancy, including the uterine ruptures that medical staff frequently observe.

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

The malnutrition ward has increased to six tents and has individuals overflowing into other sections. Children are placed under mosquito nets in sweltering heat in almost complete silence as health workers work, creating remedies and assessing weights on a scale made from a container and string.

In less severe situations children get packets of PlumpyNut, the specifically created peanut paste, but the critical situations need a daily dose of nutrient-rich liquid. Mohammed’s baby is administered his nutrition through a syringe.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being given nutrition by a nasal drip. The infant has been ill 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 joining us in this structure,” she says. “The nutrition we receive is low-quality, there’s insufficient food 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 provided.”

And what they are allocated is a meager portion of grain, edible oil and salt, distributed every couple of months. Such a simple food lacks nutrition, and the little cash 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 escaped the paramilitary Rapid Support Forces’ attack on her birthplace of El Geneina in June that year.

Finding no work in Chad, her spouse has left for Libya in the desire to gathering adequate cash for them to join him. She lives with his kin, dividing up whatever food they can get.

Abubakar says she has already observed food supplies decreasing and there are worries that the sudden reductions in foreign support money by the US, UK and other European countries, could worsen the situation. Despite the war in Sudan having caused the 21st century’s worst humanitarian disaster and the {scale of needs|extent