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For hours, travelling roughly on the waterlogged dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and concentrated on stopping herself throwing up. She was in delivery, in severe suffering after her womb tore, but was now being jostled relentlessly in the ambulance that bumped over the uneven terrain 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 inhospitable environment, are females. They reside in remote settlements in the desert with scarce resources, few job opportunities and with healthcare often a dangerously far away.

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

“I continuously experienced infections during my gestation and I had to go the clinic on numerous visits – 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 wait two hours for the ambulance but all I remember was the suffering; it was so bad I became confused.”

Her maternal figure, Ashe Khamis Abdullah, 40, worried she would lose both her offspring and descendant. But Mohammed was hurried into surgery when she reached the hospital and an critical surgical delivery preserved the lives of her and her son, Muwais.

Chad was known for the world’s second-highest maternal fatality statistic before the ongoing stream of refugees, but the circumstances suffered by the Sudanese expose further women in peril.

At the hospital, where they have assisted in the arrival of 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 cannot access the hospital that worries the staff.

In the 24 months since the civil war in Sudan erupted, over four-fifths of the refugees who have arrived and remained in Chad are females and minors. In total, about over a million Sudanese are being accommodated in the eastern part of the country, a large number of whom escaped the previous conflict in Darfur.

Chad has accepted the majority of the over four million 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 not left to be near homes and land; others have been murdered, taken hostage or forced into fighting. Those of employable age rapidly leave from Chad’s barren settlements to find work in the main city, N’Djamena, or beyond, in neighbouring Libya.

It results in women are stranded, without the resources to sustain the young and old left in their charge. To reduce density near the border, the Chadian government has moved individuals to smaller camps such as Metche with usual resident counts of about fifty thousand, but in isolated regions with no services and scarce prospects.

Metche has a hospital established by a medical aid organization, which began as a few tents but has grown to feature an procedure area, but few additional amenities. There is no work, families must walk hours to find burning material, and each person must subsist with about nine litres of water a day – much less than the suggested amount.

This seclusion means hospitals are treating women with issues in their pregnancy at a critical stage. There is only a single ambulance to cover the route between the Metche hospital and the medical tent near the camp at Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has observed instances where women in desperate pain have had to remain overnight for the ambulance to arrive.

Imagine being expecting a child, in childbirth, and travelling hours on a cart pulled by a donkey to get to a hospital

As well as being rough, the path goes through valleys that flood during the monsoon, completely cutting off travel.

A surgeon at the hospital in Metche said every case she sees is an emergency, with some women having to make long and difficult journeys to the hospital by on foot or on a pack animal.

“Imagine being in the late stages of pregnancy, in delivery, and making a long trip on a animal-drawn vehicle to get to a clinic. The main problem is the lag but having to come in these conditions also has an influence on the birth,” says the surgeon.

Malnutrition, which is increasing, also raises the chance of complications in pregnancy, including the uterine splits that medical staff see regularly.

Mohammed has continued under care in the 60 days since her C-section. Suffering from malnutrition, she contracted an illness, while her son has been carefully monitored. The parent has gone to other towns in seek jobs, so Mohammed is completely reliant on her mother.

The nutritional care section has grown to six tents and has individuals overflowing into other sections. Children rest beneath mosquito nets in extreme warmth in almost total quiet as medical staff work, creating remedies and assessing weights on a scale made from a pail and cord.

In mild cases children get small bags of PlumpyNut, the uniquely designed peanut paste, but the worst cases need a regular intake of enriched milk. Mohammed’s baby is given his nourishment through a syringe.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being fed through a nasogastric tube. The baby has been sick for the past year but Abubakar was only provided with painkillers without any medical assessment, until she made the trip from Alacha to Metche.

“Every day, I see more children joining us in this structure,” she says. “The food we’re eating is inadequate, there’s too little nourishment and it’s deficient in vitamins.

“If we were at home, we could’ve adapted ourselves. You can go and grow crops, you can get a job, 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 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 weekly food markets, where prices have become inflated.

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

Finding no work in Chad, her spouse has gone to Libya in the aspiration to gathering adequate cash for them to follow. She lives with his relatives, dividing up whatever meals they acquire.

Abubakar says she has already seen food supplies decreasing and there are fears that the abrupt cuts in international assistance funds by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having caused the 21st century’s gravest emergency and the {scale of needs|extent