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For a long time, travelling roughly on the flooded dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and concentrated on stopping herself vomiting. She was in childbirth, in extreme pain after her womb tore, but was now being jostled relentlessly in the ambulance that jumped along the dips and bumps of the road through the Chadian desert.

Most of the hundreds of thousands of Sudanese people who ran to Chad since 2023, barely getting by in this harsh landscape, are females. They stay in remote settlements in the desert with insufficient supplies, little employment and with healthcare often a life-threateningly long distance away.

The hospital Mohammed needed was in Metche, a different settlement more than two hours away.

“I repeatedly suffered from infections during my pregnancy and I had to go the health post multiple occasions – when I was there, the labour began. But I could not give birth normally because my womb had given way,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I remember was the agony; it was so unbearable I became delirious.”

Her maternal figure, Ashe Khamis Abdullah, 40, was terrified she would suffer the death of her offspring and descendant. But Mohammed was rushed straight into surgery when she reached the hospital and an critical surgical delivery saved her and her son, Muwais.

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

At the hospital, where they have delivered 824 babies in mostly emergency conditions this year, the medical staff are able to save many, but it is what affects the women who are fail to get to the hospital that concerns them.

In the couple of years since the domestic strife in Sudan erupted, the vast majority of the refugees who have arrived and stayed in Chad are women and children. In total, about over a million Sudanese are being sheltered in the eastern part of the country, four hundred thousand of whom ran from the earlier war in Darfur.

Chad has accepted the majority of the over four 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 stayed behind to be close to homes and land; some were slain, taken hostage or forced into fighting. Those of working age rapidly leave from Chad’s barren settlements to seek employment in the capital, N’Djamena, or elsewhere, in nearby Libya.

It results in women are left alone, without the means to sustain the children and the elderly left in their responsibility. To reduce density near the border, the Chadian government has transferred refugees to smaller camps such as Metche with usual resident counts of about a large community, but in distant locations with limited infrastructure and minimal chances.

Metche has a hospital set up by a medical aid organization, which began as a few tents but has grown to feature an operating theatre, but little else. There is a lack of jobs, families must travel long distances to find burning material, and each person must subsist with about minimal water of water a day – well under the suggested amount.

This remoteness means hospitals are treating women with issues in their pregnancy when it is almost too late. There is only a one medical transport to serve the area 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 observed instances where women in extreme agony have had to remain overnight for the ambulance to come.

Imagine being nine months pregnant, in labour, and travelling hours on a cart pulled by a donkey to get to a hospital

As well as being bumpy, the route passes through valleys that become inundated during the rainy season, completely preventing travel.

A surgeon at the hospital in Metche said each patient she treats is an critical situation, with some women having to make arduous trips to the hospital by walking or on a mule.

“Imagine being in the late stages of pregnancy, in childbirth, and travelling hours on a donkey cart to get to a hospital. The biggest factor is the wait but having to arrive under such circumstances also has an effect on the delivery,” says the surgeon.

Poor nutrition, which is increasing, also elevates the likelihood of complications in pregnancy, including the uterine ruptures that medical staff often encounter.

Mohammed has remained in hospital in the 60 days since her caesarean. Experiencing malnutrition, she developed an infection, while her son has been closely watched. The male guardian has gone to other towns in search of work, so Mohammed is totally dependent on her mother.

The nutritional care section has expanded to six tents and has cases exceeding capacity into other sections. Children lie under mosquito nets in sweltering heat in almost total quiet as medical staff work, mixing medications and measuring kids on a device constructed from a pail and cord.

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

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

“Every day, I see more children joining us in this shelter,” she says. “The food we’re eating 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 find employment, but here we’re reliant on what we’re provided.”

And what they are given is a small amount of grain, vegetable oil and salt, provided every two months. Such a basic diet offers little sustenance, and the little cash she is given acquires minimal items in the weekly food markets, where prices have become inflated.

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

Unable to get employment in Chad, her spouse has traveled to Libya in the desire to earning sufficient funds for them to follow. She stays with his family members, dividing up whatever meals they acquire.

Abubakar says she has already witnessed food supplies decreasing and there are worries 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 worst humanitarian disaster and the {scale of needs|extent