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For an extended period, jolting along the waterlogged 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 delivery, in agonizing discomfort after her uterus ruptured, but was now being shaken violently in the ambulance that jumped along the uneven terrain of the road through the Chadian desert.

Most of the hundreds of thousands of Sudanese refugees who have fled to Chad since 2023, surviving precariously in this difficult terrain, are females. They stay in secluded encampments in the desert with scarce resources, little employment and with medical help often a perilously remote away.

The hospital Mohammed needed was in Metche, another refugee camp more than a considerable journey away.

“I continuously experienced infections during my term and I had to go the clinic on numerous visits – when I was there, the labour began. But I wasn’t able to give birth without intervention because my womb had given way,” says Mohammed. “I had to wait two hours for the ambulance but all I recall is the suffering; it was so bad I became confused.”

Her parent, Ashe Khamis Abdullah, 40, worried she would suffer the death of her offspring and descendant. But Mohammed was immediately taken for surgery when she got to the hospital and an critical surgical delivery preserved the lives of her and her son, Muwais.

Chad previously recorded the world’s second-highest maternal death rate before the recent arrival of refugees, but the circumstances suffered by the Sudanese expose further women in risk.

At the hospital, where they have assisted in the arrival of 824 babies in often critical situations 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 alarms the professionals.

In the couple of years since the domestic strife in Sudan started, 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 hosted in the eastern part of the country, four hundred thousand of whom fled the previous conflict in Darfur.

Chad has accepted the majority of the over four million people who have fled the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been displaced from their homes.

Many males have stayed behind to be near homes and land; others have been slain, taken hostage or conscripted. Those of adult age move on quickly from Chad’s isolated encampments to look for jobs in the capital, N’Djamena, or beyond, in neighbouring Libya.

It results in women are left alone, without the resources to sustain the dependents left in their charge. To prevent congestion near the border, the Chadian government has moved individuals to smaller camps such as Metche with average populations of about a large community, but in remote areas with limited infrastructure and minimal chances.

Metche has a hospital set up by a medical aid organization, which began as a few tents but has expanded to include an procedure area, but little else. There is unemployment, families must travel long distances to find fuel, and each person must survive on about minimal water of water a day – well under the recommended 20 litres.

This isolation means hospitals are receiving women with issues in their pregnancy at a critical stage. There is only a single ambulance to cover the route between the Metche hospital and the medical tent near the Alacha encampment, 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 expecting a child, in childbirth, and journeying for a long time on a animal-drawn transport to get to a medical facility

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

A surgeon at the hospital in Metche said each patient she treats is an crisis, with some women having to make long and difficult journeys to the hospital by walking or on a pack animal.

“Imagine being in the late stages of pregnancy, in childbirth, and journeying for an extended time on a donkey cart to get to a medical center. The main problem is the delay but having to arrive under such circumstances also has an impact on the birth,” says the surgeon.

Undernourishment, which is growing, also raises the chance of complications in pregnancy, including the womb tears that medical staff see regularly.

Mohammed has stayed at the medical facility in the couple of months since her caesarean. Experiencing malnutrition, she developed an infection, while her son has been carefully monitored. The parent has travelled to other towns in look for employment, so Mohammed is completely reliant on her mother.

The undernourishment unit has increased to six tents and has individuals overflowing into other sections. Children are placed under mosquito nets in sweltering heat in almost utter stillness as health workers work, creating remedies and measuring kids on a instrument created using a pail and cord.

In moderate instances children get small bags of PlumpyNut, the specially formulated peanut paste, but the critical situations need a daily dose of fortified formula. Mohammed’s baby is fed his through a syringe.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being fed through a nose tube. The child has been unwell for the past year but Abubakar was only provided with painkillers without any medical assessment, until she made the travel from Alacha to Metche.

“Every day, I see more children joining us in this shelter,” she says. “The meals we consume is poor, 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 get a job, but here we’re relying on what we’re distributed.”

And what they are allocated is a meager portion of grain, edible oil and salt, provided every couple of months. Such a minimal nutrition offers little sustenance, and the meager funds she is given purchases very little in the local bazaars, where prices have become inflated.

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

Finding no work in Chad, her spouse has left for Libya in the aspiration to raising enough money for them to follow. She stays with his relatives, dividing up whatever meals they acquire.

Abubakar says she has already observed food distributions being reduced and there are fears that the sudden reductions in international assistance funds by the US, UK and other European countries, could worsen the situation. Despite the war in Sudan having created the 21st century’s gravest emergency and the {scale of needs|extent