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For an extended period, bouncing over the flooded dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and concentrated on stopping herself throwing up. She was in delivery, in extreme pain after her uterine wall split, but was now being tossed around in the ambulance that lurched across the uneven terrain of the road through the Chadian desert.

Most of the close to a million Sudanese displaced persons who escaped to Chad since 2023, living hand to mouth in this harsh landscape, are females. They live in secluded encampments in the desert with limited water and food, few job opportunities and with healthcare often a perilously remote away.

The medical center Mohammed needed was in Metche, one more encampment more than 120 minutes away.

“I kept getting infections during my gestation and I had to go the medical tent seven times – when I was there, the delivery commenced. But I wasn’t able to give birth normally because my uterus had collapsed,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I can think of the pain; it was so intense I became delirious.”

Her mother, Ashe Khamis Abdullah, 40, was terrified she would suffer the death of her daughter and baby grandson. But Mohammed was immediately taken for surgery when she reached the hospital and an critical surgical delivery rescued her and her son, Muwais.

Chad was known for the world’s second most severe maternal death rate before the recent arrival of refugees, but the situations faced by the Sudanese put even more women in danger.

At the hospital, where they have birthed 824 babies in frequently urgent circumstances this year, the medics are able to rescue numerous, but it is what happens to the women who are not able to reach the hospital that worries the staff.

In the couple of 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 one point two million Sudanese are being accommodated in the east of the country, four hundred thousand of whom escaped the past violence in Darfur.

Chad has taken the lion’s share of the 4.1 million people who have fled 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 adult men have stayed behind to be near homes and land; many were slain, taken hostage or forced into fighting. Those of adult age move on quickly from Chad’s barren settlements to find work in the main city, N’Djamena, or further, in adjacent Libya.

It implies women are abandoned, without the resources to feed the dependents left in their responsibility. To prevent congestion 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 distant locations with limited infrastructure and scarce prospects.

Metche has a hospital set up by a medical aid organization, which began as a few tents but has expanded to include an procedure area, but little else. There is no work, families must journey for extended periods to find firewood, and each person must survive on about nine litres of water a day – far below the recommended 20 litres.

This isolation means hospitals are receiving women with complications in their pregnancy dangerously late. There is only a one medical transport to travel the path between the Metche hospital and the medical tent near the Alacha encampment, where Mohammed is one of close to fifty thousand refugees. The medical team has encountered situations 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 making a lengthy trip on a cart pulled by a donkey to get to a clinic

As well as being bumpy, the path goes through valleys that become inundated during the wet period, completely cutting off travel.

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

“Imagine being nine months pregnant, in labour, and journeying for an extended time on a cart pulled by a donkey to get to a medical center. The primary issue is the delay but having to arrive under such circumstances also has an effect on the childbirth,” says the surgeon.

Poor nutrition, which is growing, also elevates the likelihood of complications in pregnancy, including the uterine splits that medical staff see regularly.

Mohammed has continued under care in the couple of months since her surgical delivery. Afflicted by malnutrition, she developed an infection, while her son has been regularly checked. The male guardian has travelled to other towns in search of work, so Mohammed is totally dependent on her mother.

The malnutrition ward has expanded to six tents and has patients spilling over into other sections. Children rest beneath mosquito nets in extreme warmth in almost complete silence as health workers work, creating remedies and weighing children on a instrument created using a pail and cord.

In mild cases children get packets of PlumpyNut, the specifically created peanut paste, but the most severe instances need a regular intake of enriched milk. Mohammed’s baby is fed his through a medical device.

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

“Every day, I see further minors coming in in this structure,” she says. “The food we’re eating is low-quality, there’s insufficient food and it’s lacking in nutrients.

“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 given.”

And what they are provided is a limited quantity of sorghum, cooking oil and salt, handed out every couple of months. Such a basic diet offers little sustenance, and the little cash she is given cannot buy much in the weekly food markets, where values have increased.

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

Finding no work in Chad, her spouse has left for Libya in the aspiration to earning sufficient funds for them to follow. She lives with his family members, sharing out whatever meals they acquire.

Abubakar says she has already witnessed food rations being cut and there are fears that the abrupt cuts in international assistance funds by the US, UK and other European countries, could make things worse. Despite the war in Sudan having produced the 21st century’s worst humanitarian disaster and the {scale of needs|extent