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For a long time, jolting along the waterlogged dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and concentrated on stopping herself vomiting. She was in labour, in extreme pain after her uterine wall split, 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 close to a million Sudanese people who ran to Chad since 2023, barely getting by in this harsh landscape, are women. They reside in secluded encampments in the desert with scarce resources, 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 term and I had to go the medical tent seven times – when I was there, the delivery commenced. But I found it impossible to give birth naturally because my uterine muscles failed,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I recall is the suffering; it was so intense I became delirious.”

Her parent, Ashe Khamis Abdullah, 40, was terrified she would lose both her child and grandchild. But Mohammed was rushed straight into surgery when she got to the hospital and an emergency caesarean section rescued her and her son, Muwais.

Chad was known for the world’s second most severe maternal mortality rate before the recent arrival of refugees, but the circumstances suffered by the Sudanese put even more women in danger.

At the hospital, where they have birthed 824 babies in mostly emergency conditions this year, the medical staff are able to help plenty, but it is what occurs with the women who are fail to get to the hospital that worries the staff.

In the 24 months since the domestic strife in Sudan started, the vast majority of the refugees who have arrived and settled in Chad are women and children. In total, about 1.2 million Sudanese are being sheltered in the eastern region of the country, 400,000 of whom escaped the earlier war in Darfur.

Chad has accepted the majority of the millions of people who have fled the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been displaced from their homes.

Many adult men have remained to be close to homes and land; many were slain, captured or conscripted. Those of adult age soon depart from Chad’s barren settlements to seek employment in the main city, N’Djamena, or beyond, in adjacent Libya.

It means women are abandoned, without the resources to feed the children and the elderly left in their charge. To avoid overcrowding near the border, the Chadian government has relocated people to less crowded encampments such as Metche with usual resident counts of about a large community, but in remote areas with few facilities and scarce prospects.

Metche has a hospital built by a medical aid organization, which started off as a few tents but has grown to feature an procedure area, but few additional amenities. There is unemployment, families must travel long distances to find burning material, and each person must survive on about a small amount of water a day – far below the advised quantity.

This seclusion means hospitals are receiving women with issues in their pregnancy dangerously late. There is only a single ambulance to travel the path between the Metche hospital and the medical tent near the settlement of Alacha, where Mohammed is one of a large number of refugees. The medical team has seen cases where women in severe suffering have had to wait an entire night for the ambulance to come.

Imagine being in the final trimester, 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 path goes through valleys that become inundated 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 long and difficult journeys to the hospital by walking or on a donkey.

“Imagine being nine months pregnant, in childbirth, and travelling hours on a animal-drawn vehicle to get to a clinic. The main problem is the wait but having to arrive under such circumstances also has an effect on the childbirth,” says the surgeon.

Poor nutrition, which is growing, also raises the chance of problems in pregnancy, including the womb tears that medical staff frequently observe.

Mohammed has stayed at the medical facility in the couple of months since her surgical delivery. Suffering from malnutrition, she contracted an illness, while her son has been carefully monitored. The father has journeyed to other towns in seek jobs, so Mohammed is completely reliant on her mother.

The nutritional care section has increased to six tents and has individuals overflowing into other sections. Children are placed under mosquito nets in extreme warmth in almost complete silence as health workers work, mixing medications and assessing weights on a instrument created using a pail and cord.

In moderate instances children get packets of PlumpyNut, the specifically created peanut paste, but the most severe instances need a regular intake of fortified formula. Mohammed’s baby is administered his nutrition through a medical device.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being given nutrition by a nose tube. The infant has been ill for the past year but Abubakar was only provided with painkillers without any identification, until she made the journey from Alacha to Metche.

“Every day, I see more children arriving in this tent,” she says. “The nutrition we receive is poor, there’s insufficient food and it’s deficient in vitamins.

“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 small amount of cereal, vegetable oil and salt, provided every couple of months. Such a basic diet offers little sustenance, and the little cash she is given purchases very little in the regular markets, where prices have become inflated.

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

Failing to secure jobs in Chad, her spouse has traveled to Libya in the aspiration to gathering adequate cash for them to join him. She lives with his relatives, distributing whatever meals they acquire.

Abubakar says she has already observed food distributions being reduced and there are fears that the abrupt cuts in international assistance funds by the US, UK and other European countries, could make things worse. Despite the war in Sudan having created the 21st century’s most severe crisis and the {scale of needs|extent