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For an extended period, bouncing over the waterlogged dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and focused on stopping herself being sick. She was in delivery, in agonizing discomfort after her uterine wall split, but was now being shaken violently in the ambulance that bumped over the uneven terrain of the road through the Chadian desert.

Most of the hundreds of thousands of Sudanese displaced persons who escaped to Chad since 2023, barely getting by in this harsh landscape, are women. They live in isolated camps in the desert with scarce resources, no work and with healthcare often a life-threateningly long distance away.

The medical center Mohammed needed was in Metche, a different settlement more than 120 minutes away.

“I repeatedly suffered from infections during my gestation and I had to go the clinic on numerous visits – when I was there, the delivery commenced. But I wasn’t able to give birth normally because my uterine muscles failed,” says Mohammed. “I had to endure a long delay for the ambulance but all I can think of the suffering; it was so bad I became confused.”

Her mother, Ashe Khamis Abdullah, 40, feared she would lose both her daughter and baby grandson. But Mohammed was rushed straight into surgery when she arrived at the hospital and an urgent C-section rescued her and her son, Muwais.

Chad already had the world’s second most severe maternal fatality statistic before the recent arrival of refugees, but the circumstances suffered by the Sudanese expose further women in danger.

At the hospital, where they have delivered 824 babies in mostly emergency conditions this year, the medical staff are able to rescue numerous, but it is what affects the women who are cannot access the hospital that alarms the professionals.

In the two years since the domestic strife in Sudan started, 86% of the people who reached and remained in Chad are mothers and kids. In total, about 1.2 million Sudanese are being hosted in the eastern part of the country, four hundred thousand of whom ran from the earlier war in Darfur.

Chad has hosted the bulk of the 4.1 million people who have run from the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been displaced from their homes.

Many males have not left to be in proximity to homes and land; many were slain, taken hostage or made to join the conflict. Those of working age rapidly leave from Chad’s desolate refugee camps to seek employment in the capital, N’Djamena, or beyond, in neighbouring Libya.

It implies women are left alone, without the resources to provide for the children and the elderly left in their responsibility. To avoid overcrowding near the border, the Chadian government has moved individuals to smaller camps such as Metche with usual resident counts of about 50,000, but in isolated regions with limited infrastructure and minimal chances.

Metche has a hospital built by a medical aid organization, which began as a few tents but has grown to feature an operating theatre, but little else. There is no work, families must travel long distances to find burning material, and each person must survive on about nine litres of water a day – much less than the suggested amount.

This seclusion means hospitals are admitting women with problems 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 camp at Alacha, 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 delivery, and making a lengthy trip on a animal-drawn transport to get to a medical facility

As well as being bumpy, the road traverses valleys that become inundated during the monsoon, completely preventing travel.

A surgeon at the hospital in Metche said every case she sees is an critical situation, with some women having to make challenging travels to the hospital by walking or on a pack animal.

“Imagine being about to give birth, in childbirth, and travelling hours on a donkey cart to get to a hospital. The biggest factor is the lag but having to come in these conditions also has an impact on the birth,” says the surgeon.

Undernourishment, which is increasing, also elevates the likelihood of problems in pregnancy, including the uterine ruptures that medical staff see regularly.

Mohammed has continued under care in the 60 days since her C-section. Afflicted by malnutrition, she developed an infection, while her son has been regularly checked. The male guardian has travelled to other towns in look for employment, so Mohammed is entirely leaning on her mother.

The undernourishment unit has grown to six tents and has individuals overflowing into other sections. Children rest beneath mosquito nets in extreme warmth in almost utter stillness as doctors and nurses work, preparing treatments and assessing weights on a device constructed from a pail and cord.

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

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being fed through a nose tube. The child has been unwell for the past year but Abubakar was repeatedly given only painkillers without any diagnosis, until she made the trip from Alacha to Metche.

“Every day, I see more children arriving in this tent,” she says. “The nutrition we receive is low-quality, there’s insufficient food and it’s not nutritious.

“If we were at home, we could’ve coped better. You can go and cultivate plants, you can find employment, but here we’re relying on what we’re given.”

And what they are given is a limited quantity of sorghum, cooking oil and salt, provided every two months. Such a simple food lacks nutrition, and the meager funds she is given purchases very little in the weekly food markets, where costs have risen.

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

Failing to secure jobs in Chad, her partner has traveled to Libya in the hope of gathering adequate cash for them to come later. She resides with his kin, sharing out whatever nourishment they obtain.

Abubakar says she has already seen food distributions being reduced and there are fears that the sudden reductions in overseas aid budgets by the US, UK and other European countries, could make things worse. Despite the war in Sudan having caused the 21st century’s gravest emergency and the {scale of needs|extent