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For an extended period, bouncing over the soggy dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and tried hard stopping herself throwing up. She was in delivery, in agonizing discomfort after her womb tore, but was now being tossed around in the ambulance that lurched across the potholes and ridges of the road through the Chadian desert.

Most of the 878,000 Sudanese people who ran to Chad since 2023, living hand to mouth in this harsh landscape, are women. They stay in isolated camps in the desert with scarce resources, little employment and with treatment often a dangerously far away.

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

“I kept getting infections during my gestation and I had to go the clinic seven times – when I was there, the labour began. But I wasn’t able to give birth naturally because my uterine muscles failed,” says Mohammed. “I had to endure a long delay for the ambulance but all I recall is the suffering; it was so unbearable I became disoriented.”

Her maternal figure, Ashe Khamis Abdullah, 40, feared she would suffer the death of her child and grandchild. But Mohammed was immediately taken for surgery when she arrived at the hospital and an critical surgical delivery rescued her and her son, Muwais.

Chad already had the world’s second worst maternal death rate before the current influx of refugees, but the circumstances suffered by the Sudanese put even more women in peril.

At the hospital, where they have birthed 824 babies in often critical situations this year, the medics are able to save many, but it is what happens to the women who are not able to reach the hospital that worries the staff.

In the two years since the domestic strife in Sudan began, 86% of the displaced persons who came and stayed in Chad are mothers and kids. In total, about over a million Sudanese are being hosted in the east of the country, a large number of whom ran from the earlier war in Darfur.

Chad has accepted the majority of the millions of people who have run from the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been forced out of their homes.

Many males have stayed behind to be close to homes and land; others have been killed, abducted or forced into fighting. Those of adult age rapidly leave from Chad’s barren settlements to look for jobs in the capital, N’Djamena, or beyond, in adjacent Libya.

It implies women are left alone, without the resources to sustain the young and old left in their responsibility. To avoid overcrowding near the border, the Chadian government has moved individuals to less crowded encampments such as Metche with typical numbers of about 50,000, but in isolated regions with no services 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 procedure area, but little else. There is unemployment, 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 seclusion means hospitals are admitting women with issues in their pregnancy when it is almost too late. There is only a one medical transport to cover the route between the Metche hospital and the health post near the Alacha encampment, where Mohammed is one of close to fifty thousand refugees. The medical team has seen cases where women in desperate pain have had to endure a full night for the ambulance to arrive.

Imagine being nine months pregnant, in labour, and travelling hours on a animal-drawn transport to get to a hospital

As well as being uneven, the road traverses valleys that become inundated during the wet period, completely cutting off 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 on foot or on a donkey.

“Imagine being about to give birth, in labour, and travelling hours on a donkey cart to get to a hospital. The main problem is the lag but having to arrive under such circumstances also has an impact on the childbirth,” says the surgeon.

Undernourishment, which is growing, also elevates the likelihood of issues in pregnancy, including the uterine splits that medical staff often encounter.

Mohammed has continued under care in the two months since her C-section. Suffering from malnutrition, she contracted an illness, while her son has been regularly checked. The father has travelled to other towns in seek jobs, so Mohammed is entirely leaning on her mother.

The undernourishment unit has increased to six tents and has cases exceeding capacity into other sections. Children lie under mosquito nets in extreme warmth in almost utter stillness as health workers work, mixing medications and assessing weights on a device constructed from a bucket and rope.

In mild cases children get packets of PlumpyNut, the specially formulated peanut paste, but the critical situations need a regular intake of enriched milk. Mohammed’s baby is fed his through a injector.

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

“Every day, I see additional kids joining us in this shelter,” she says. “The meals we consume is poor, there’s insufficient food and it’s lacking in nutrients.

“If we were at home, we could’ve adjusted our lives. You can go and grow crops, you can get a job, but here we’re reliant on what we’re provided.”

And what they are allocated is a limited quantity of sorghum, cooking oil and salt, handed out every couple of months. Such a minimal nutrition is deficient in nutrients, and the small amount of money she is given acquires minimal items in the regular markets, where values have increased.

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

Unable to get employment in Chad, her spouse has gone to Libya in the hope of gathering adequate cash for them to come later. She resides with his relatives, sharing out whatever food they can get.

Abubakar says she has already seen food rations being cut and there are fears that the sharp decreases in foreign support money by the US, UK and other European countries, could worsen the situation. Despite the war in Sudan having produced the 21st century’s most severe crisis and the {scale of needs|extent