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For an extended period, jolting along the flooded dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and concentrated on stopping herself being sick. She was in childbirth, in severe suffering after her womb tore, but was now being tossed around in the ambulance that bumped over 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, living hand to mouth in this inhospitable environment, are females. They live in remote settlements in the desert with limited water and food, little employment and with medical help often a dangerously far away.

The clinic Mohammed needed was in Metche, one more encampment more than 120 minutes away.

“I continuously experienced infections during my pregnancy and I had to go the medical tent seven times – when I was there, the delivery commenced. But I could not give birth without intervention because my uterine muscles failed,” says Mohammed. “I had to endure a long delay for the ambulance but all I can think of the agony; it was so unbearable I became delirious.”

Her mother, Ashe Khamis Abdullah, 40, was terrified she would lose both her offspring and descendant. But Mohammed was rushed straight into surgery when she got to the hospital and an urgent C-section rescued her and her son, Muwais.

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

At the hospital, where they have assisted in the arrival of 824 babies in often critical situations this year, the doctors are able to help plenty, but it is what happens to the women who are fail to get to the hospital that alarms the professionals.

In the couple of years since the civil war in Sudan began, 86% of the people who reached and stayed in Chad are women and children. In total, about over a million Sudanese are being hosted in the east of the country, 400,000 of whom ran from the past violence in Darfur.

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

Many males have remained to be close to homes and land; many were slain, captured or made to join the conflict. Those of adult age move on quickly from Chad’s isolated encampments to seek employment in the capital, N’Djamena, or elsewhere, in adjacent Libya.

It implies women are left alone, without the means to sustain the dependents left in their care. To prevent congestion near the border, the Chadian government has moved individuals to smaller camps such as Metche with average populations of about 50,000, but in isolated regions with few facilities and minimal chances.

Metche has a hospital built by a medical aid organization, which was initially a few tents but has developed to contain an surgical room, but few additional amenities. There is a lack of jobs, families must walk hours to find firewood, and each person must survive on about minimal water of water a day – far below the advised quantity.

This isolation means hospitals are receiving women with issues in their pregnancy dangerously late. There is only a single ambulance to cover the route between the Metche hospital and the health post near the camp at Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has encountered situations where women in extreme agony have had to wait an entire night for the ambulance to come.

Imagine being in the final trimester, in delivery, and making a lengthy trip on a donkey-drawn vehicle to get to a hospital

As well as being uneven, the route passes through valleys that fill with water during the monsoon, 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 long and difficult journeys to the hospital by walking or on a donkey.

“Imagine being in the late stages of pregnancy, in labour, and making a long trip on a donkey cart to get to a hospital. The main problem is the wait but having to come in these conditions also has an impact on the childbirth,” says the surgeon.

Undernourishment, which is increasing, also elevates the likelihood of problems in pregnancy, including the womb tears that medical staff frequently observe.

Mohammed has continued under care in the couple of months since her caesarean. Suffering from malnutrition, she developed an infection, while her son has been carefully monitored. The male guardian has travelled to other towns in search of work, so Mohammed is completely reliant on her mother.

The undernourishment unit has increased to six tents and has patients spilling over into other sections. Children lie under mosquito nets in oppressive temperatures in almost complete silence as doctors and nurses work, creating remedies and measuring kids on a instrument created using a pail and cord.

In moderate instances children get packets of PlumpyNut, the uniquely designed peanut paste, but the worst cases need a regular intake of fortified formula. Mohammed’s baby is given his nourishment through a injector.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being given nutrition by a nasogastric tube. The child has been unwell for the past year but Abubakar was consistently offered just painkillers without any identification, until she made the journey from Alacha to Metche.

“Every day, I see additional kids arriving in this structure,” she says. “The food we’re eating is inadequate, there’s not enough to eat and it’s deficient in vitamins.

“If we were at home, we could’ve coped better. You can go and grow crops, you can work to earn some money, but here we’re relying on what we’re given.”

And what they are given is a small amount of sorghum, vegetable oil and salt, provided every 60 days. Such a simple food lacks nutrition, and the small amount of money she is given acquires minimal items in the weekly food markets, where prices have become inflated.

Abubakar was moved to Alacha after coming from Sudan in 2023, having escaped the armed group Rapid Support Forces’ assault on her native town of El Geneina in June that year.

Unable to get employment in Chad, her husband has traveled to Libya in the hope of raising enough money for them to follow. She resides with his family members, sharing out whatever food they can get.

Abubakar says she has already seen 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 produced the 21st century’s gravest emergency and the {scale of needs|extent