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For hours, jolting along the flooded dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and tried hard stopping herself throwing up. She was in labour, in extreme pain after her uterine wall split, but was now being tossed around in the ambulance that jumped along the uneven terrain 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 inhospitable environment, are women. They live in remote settlements in the desert with scarce resources, no work and with healthcare often a perilously remote away.

The hospital Mohammed needed was in Metche, another refugee camp more than 120 minutes away.

“I kept getting infections during my pregnancy and I had to go the clinic on numerous visits – when I was there, the labour began. But I could not give birth without intervention because my uterus had collapsed,” says Mohammed. “I had to endure a long delay for the ambulance but all I recall is the agony; it was so intense I became delirious.”

Her maternal figure, Ashe Khamis Abdullah, 40, worried she would be bereft of her offspring and descendant. But Mohammed was immediately taken for surgery when she arrived at the hospital and an critical surgical delivery saved her and her son, Muwais.

Chad previously recorded the world’s second-highest maternal fatality statistic before the current influx of refugees, but the conditions endured by the Sudanese put even more women in danger.

At the hospital, where they have delivered 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 internal conflict 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 accepted the majority of the 4.1 million people who have fled the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been forced out of their homes.

Many males have not left to be near homes and land; many were murdered, taken hostage or conscripted. Those of adult age rapidly leave from Chad’s desolate refugee camps to look for jobs in the main city, N’Djamena, or beyond, in neighbouring Libya.

It results in women are stranded, without the ability to provide for the children and the elderly left in their charge. To prevent congestion 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 isolated regions with limited infrastructure and few opportunities.

Metche has a hospital established by a medical aid organization, which began as a few tents but has expanded to include an procedure area, but little else. There is a lack of jobs, families must walk hours to find firewood, and each person must survive on about nine litres of water a day – much less than the suggested amount.

This isolation means hospitals are receiving women with problems in their pregnancy when it is almost too late. There is only a sole emergency vehicle to cover the route between the Metche hospital and the clinic near the Alacha encampment, where Mohammed is one of close to fifty thousand refugees. The medical team has observed instances where women in severe suffering have had to remain overnight for the ambulance to reach them.

Imagine being in the final trimester, in labour, and making a lengthy trip on a animal-drawn transport to get to a hospital

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

A surgeon at the hospital in Metche said all the situations she encounters is an emergency, with some women having to make arduous trips to the hospital by walking or on a mule.

“Imagine being nine months pregnant, in labour, and making a long trip on a cart pulled by a donkey to get to a medical center. The biggest factor is the delay but having to travel in this state also has an influence on the childbirth,” says the surgeon.

Malnutrition, which is growing, also increases the risk of complications in pregnancy, including the womb tears that medical staff often encounter.

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

The undernourishment unit has expanded to six tents and has individuals overflowing into other sections. Children lie under mosquito nets in extreme warmth in almost utter stillness as health workers work, mixing medications and measuring kids on a scale made from a bucket and rope.

In moderate instances children get packets of PlumpyNut, the uniquely designed peanut paste, but the critical situations need a regular intake of enriched milk. Mohammed’s baby is fed his through a medical device.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being nourished via a nose tube. The baby has been ill for the past year but Abubakar was only provided with painkillers without any diagnosis, until she made the trip from Alacha to Metche.

“Every day, I see further minors arriving in this shelter,” she says. “The food we’re eating is low-quality, there’s too little nourishment and it’s lacking in nutrients.

“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 given.”

And what they are given is a limited quantity of cereal, cooking oil and salt, provided every 60 days. Such a simple food lacks nutrition, and the meager funds she is given cannot buy much in the local bazaars, where values have increased.

Abubakar was moved to Alacha after coming from Sudan in 2023, having fled the armed group 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 hope of earning sufficient funds for them to come later. She lives with his family members, dividing up whatever meals they acquire.

Abubakar says she has already witnessed food supplies decreasing and there are worries that the sudden reductions in foreign support money by the US, UK and other European countries, could make things worse. Despite the war in Sudan having produced the 21st century’s gravest emergency and the {scale of needs|extent