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For an extended period, travelling roughly on the waterlogged dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and focused on stopping herself vomiting. She was in childbirth, in severe suffering after her womb tore, but was now being shaken violently in the ambulance that bumped over the potholes and ridges of the road through the Chadian desert.

Most of the 878,000 Sudanese refugees who have fled to Chad since 2023, barely getting by in this harsh landscape, are females. They live in isolated camps in the desert with limited water and food, few job opportunities and with treatment often a life-threateningly long distance away.

The medical center Mohammed needed was in Metche, one more encampment more than a considerable journey away.

“I repeatedly suffered from infections during my pregnancy and I had to go the medical tent on numerous visits – when I was there, the delivery commenced. But I could not give birth naturally because my womb had given way,” says Mohammed. “I had to endure a long delay for the ambulance but all I can think of the agony; it was so intense I became disoriented.”

Her parent, 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 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 situations faced by the Sudanese put even more women in peril.

At the hospital, where they have assisted in the arrival of 824 babies in frequently urgent circumstances 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 24 months since the internal conflict in Sudan began, the vast majority of the displaced persons who came and settled in Chad are females and minors. In total, about 1.2 million Sudanese are being hosted in the east of the country, four hundred thousand of whom fled the previous conflict in Darfur.

Chad has hosted the bulk of the millions of people who have fled the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been forced out of their homes.

Many men have stayed behind to be in proximity to homes and land; many were murdered, captured or conscripted. Those of employable age rapidly leave from Chad’s barren settlements to look for jobs in the main city, N’Djamena, or further, in nearby Libya.

It results in women are abandoned, without the means to feed the young and old left in their responsibility. To prevent congestion near the border, the Chadian government has moved individuals to less crowded encampments such as Metche with typical numbers of about fifty thousand, but in remote areas with few facilities and minimal chances.

Metche has a hospital built by a medical aid organization, which started off as a few tents but has grown to feature an surgical room, but not much more. There is unemployment, families must journey for extended periods to find firewood, and each person must survive on about nine litres of water a day – far below the recommended 20 litres.

This seclusion means hospitals are treating women with issues in their pregnancy dangerously late. There is only a single ambulance to serve the area between the Metche hospital and the medical tent near the Alacha encampment, where Mohammed is one of a large number of refugees. The medical team has observed instances where women in severe suffering have had to endure a full night for the ambulance to come.

Imagine being nine months pregnant, in delivery, and journeying for a long time on a cart pulled by a donkey to get to a clinic

As well as being rough, the route passes through valleys that fill with water during the monsoon, completely cutting off travel.

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

“Imagine being in the late stages of pregnancy, in delivery, and journeying for an extended time on a cart pulled by a donkey to get to a hospital. The main problem is the wait but having to travel in this state also has an impact on the childbirth,” says the surgeon.

Malnutrition, which is on the rise, also raises the chance of complications in pregnancy, including the womb tears that medical staff frequently observe.

Mohammed has continued under care in the 60 days since her caesarean. Afflicted by malnutrition, she got sick, while her son has been carefully monitored. The parent has journeyed to other towns in look for employment, so Mohammed is entirely leaning on her mother.

The nutritional care section has expanded to six tents and has individuals overflowing into other sections. Children rest beneath mosquito nets in extreme warmth in almost total quiet as health workers work, creating remedies and weighing children on a scale made from a pail and cord.

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

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being fed through a nose tube. The infant has been sick for the past year but Abubakar was repeatedly given only painkillers without any identification, until she made the travel from Alacha to Metche.

“Every day, I see additional kids joining us in this shelter,” she says. “The food we’re eating is inadequate, there’s insufficient food and it’s not nutritious.

“If we were at home, we could’ve adapted ourselves. You can go and cultivate plants, you can work to earn some money, but here we’re dependent on what we’re distributed.”

And what they are allocated is a small amount of cereal, cooking oil and salt, handed out every 60 days. Such a minimal nutrition lacks nutrition, and the little cash she is given purchases very little in the weekly food markets, where values have increased.

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

Failing to secure jobs in Chad, her partner has left for Libya in the hope of earning sufficient funds for them to come later. She resides with his kin, dividing up whatever meals they acquire.

Abubakar says she has already witnessed food supplies decreasing and there are concerns that the sharp decreases in foreign support money by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having produced the 21st century’s most severe crisis and the {scale of needs|extent