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For hours, bouncing over the waterlogged dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and tried hard stopping herself vomiting. She was in labour, in severe suffering after her womb tore, but was now being jostled relentlessly in the ambulance that lurched across the dips and bumps of the road through the Chadian desert.

Most of the close to a million Sudanese refugees who have fled to Chad since 2023, surviving precariously in this inhospitable environment, are females. They reside in secluded encampments in the desert with scarce resources, little employment and with medical help often a perilously remote away.

The clinic Mohammed needed was in Metche, another refugee camp more than two hours away.

“I continuously experienced infections during my term and I had to go the medical tent seven times – when I was there, the pregnancy started. But I could not give birth normally because my uterus had collapsed,” says Mohammed. “I had to endure a long delay for the ambulance but all I can think of the suffering; it was so intense I became disoriented.”

Her parent, Ashe Khamis Abdullah, 40, worried she would lose both her offspring and descendant. But Mohammed was rushed straight into surgery when she arrived at the hospital and an emergency caesarean section saved her and her son, Muwais.

Chad was known for the world’s second worst maternal mortality rate before the ongoing stream of refugees, but the conditions endured by the Sudanese expose further women in danger.

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 affects the women who are not able to reach the hospital that worries the staff.

In the 24 months since the civil war in Sudan erupted, over four-fifths of the people who reached and settled in Chad are mothers and kids. In total, about one point two million Sudanese are being sheltered in the eastern part of the country, a large number of whom escaped the earlier war in Darfur.

Chad has accepted the majority of the 4.1 million people who have fled the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been uprooted from their homes.

Many males have remained to be near homes and land; many were murdered, captured or conscripted. Those of adult age move on quickly from Chad’s barren settlements to find work in the capital, N’Djamena, or further, in adjacent Libya.

It means women are left alone, without the means to provide for the young and old left in their responsibility. To avoid overcrowding 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 built by a medical aid organization, which started off as a few tents but has developed to contain an operating theatre, but little else. There is unemployment, families must travel long distances to find burning material, and each person must get by with about minimal water of water a day – much less than the advised quantity.

This seclusion means hospitals are receiving women with issues in their pregnancy when it is almost too late. There is only a one medical transport to travel the path between the Metche hospital and the clinic near the camp at Alacha, where Mohammed is one of a large number of refugees. The medical team has seen cases where women in severe suffering have had to wait an entire night for the ambulance to reach them.

Imagine being nine months pregnant, in labour, and travelling hours on a donkey-drawn vehicle to get to a medical facility

As well as being uneven, the route passes through valleys that flood during the rainy season, completely cutting off travel.

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

“Imagine being nine months pregnant, in childbirth, and journeying for an extended time on a donkey cart to get to a hospital. The primary issue is the lag but having to arrive under such circumstances also has an influence on the delivery,” says the surgeon.

Malnutrition, which is on the rise, also raises the chance of issues in pregnancy, including the uterine ruptures that medical staff frequently observe.

Mohammed has stayed at the medical facility in the 60 days since her surgical delivery. Afflicted by malnutrition, she got sick, while her son has been regularly checked. The father has travelled to other towns in search of work, so Mohammed is completely reliant on her mother.

The undernourishment unit has grown to six tents and has cases exceeding capacity into other sections. Children lie under mosquito nets in sweltering heat in almost complete silence as medical staff work, creating remedies and measuring kids on a instrument created using a bucket and rope.

In mild cases children get small bags of PlumpyNut, the specially formulated peanut paste, but the critical situations need a daily dose of enriched milk. Mohammed’s baby is administered his nutrition through a injector.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being nourished via a nose tube. The infant has been unwell for the past year but Abubakar was only provided with painkillers without any identification, until she made the trip from Alacha to Metche.

“Every day, I see further minors coming in in this structure,” she says. “The meals we consume is poor, there’s not enough to eat and it’s deficient in vitamins.

“If we were at home, we could’ve adapted ourselves. You can go and farm produce, you can find employment, but here we’re reliant on what we’re provided.”

And what they are provided is a small amount of sorghum, edible oil and salt, distributed every couple of months. Such a minimal nutrition is deficient in nutrients, and the little cash she is given cannot buy much in the regular markets, where prices have become inflated.

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

Finding no work in Chad, her husband has left for Libya in the hope of gathering adequate cash for them to follow. She stays with his kin, dividing up whatever nourishment they obtain.

Abubakar says she has already seen food rations being cut and there are worries that the abrupt cuts 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 gravest emergency and the {scale of needs|extent