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For hours, travelling roughly on the flooded dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and tried hard stopping herself being sick. She was in labour, in severe suffering after her uterine wall split, but was now being tossed around in the ambulance that jumped along the dips and bumps of the road through the Chadian desert.

Most of the close to a million Sudanese people who ran to Chad since 2023, barely getting by in this difficult terrain, are females. They stay in isolated camps in the desert with insufficient supplies, little employment and with treatment often a life-threateningly long distance away.

The medical center Mohammed needed was in Metche, one more encampment more than two hours away.

“I repeatedly suffered from infections during my gestation and I had to go the health post seven times – when I was there, the pregnancy started. But I wasn’t able to 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 mother, Ashe Khamis Abdullah, 40, feared she would suffer the death of her child and grandchild. But Mohammed was hurried into surgery when she got to 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 situations faced by the Sudanese put even more women in peril.

At the hospital, where they have delivered 824 babies in often critical situations this year, the medical staff are able to rescue numerous, but it is what occurs with the women who are cannot access the hospital that alarms the professionals.

In the couple of years since the domestic strife in Sudan began, over four-fifths of the people who reached and settled in Chad are women and children. In total, about one point two million Sudanese are being sheltered in the east of the country, 400,000 of whom ran from the past violence in Darfur.

Chad has taken the lion’s share of the over four million people who have fled the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been displaced from their homes.

Many men have not left to be near homes and land; many were killed, captured or conscripted. Those of employable age move on quickly from Chad’s barren settlements to look for jobs in the main city, N’Djamena, or beyond, in nearby Libya.

It implies women are abandoned, without the resources to feed the dependents left in their charge. To avoid overcrowding near the border, the Chadian government has relocated people to smaller camps such as Metche with average populations of about fifty thousand, but in distant locations with few facilities 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 surgical room, but not much more. There is unemployment, families must walk hours to find fuel, and each person must subsist with about minimal water of water a day – far below the suggested amount.

This remoteness means hospitals are admitting women with complications 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 medical tent near the settlement of Alacha, where Mohammed is one of a large number of refugees. The medical team has seen cases where women in extreme agony have had to endure a full night for the ambulance to come.

Imagine being expecting a child, in delivery, and journeying for a long time on a donkey-drawn vehicle to get to a hospital

As well as being rough, the road traverses 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 emergency, with some women having to make arduous trips to the hospital by foot or on a donkey.

“Imagine being about to give birth, in delivery, and journeying for an extended time on a donkey cart to get to a hospital. The main problem is the wait but having to travel in this state also has an influence on the birth,” says the surgeon.

Poor nutrition, which is growing, also increases the risk of problems in pregnancy, including the uterine splits that medical staff often encounter.

Mohammed has continued under care in the 60 days since her C-section. Suffering from malnutrition, she developed an infection, while her son has been carefully monitored. The parent has journeyed 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 patients spilling over into other sections. Children rest beneath mosquito nets in extreme warmth in almost complete silence as doctors and nurses work, preparing treatments and measuring kids on a instrument created using a container and string.

In less severe situations children get sachets of PlumpyNut, the specially formulated peanut paste, but the most severe instances need a daily dose of enriched milk. Mohammed’s baby is fed his through a syringe.

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being fed through a nasogastric tube. The infant has been unwell for the past year but Abubakar was consistently offered just painkillers without any identification, until she made the travel from Alacha to Metche.

“Every day, I see additional kids arriving in this tent,” she says. “The nutrition we receive is inadequate, there’s too little nourishment and it’s lacking in nutrients.

“If we were at home, we could’ve adjusted our lives. 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 limited quantity of cereal, edible oil and salt, provided every two months. Such a basic diet lacks nutrition, and the little cash she is given acquires minimal items in the local bazaars, where costs have risen.

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

Failing to secure jobs in Chad, her partner has traveled to Libya in the desire to earning sufficient funds for them to join him. She resides with his family members, dividing up whatever nourishment they obtain.

Abubakar says she has already witnessed food distributions being reduced and there are worries that the sudden reductions in foreign support money by the US, UK and other European countries, could make things worse. Despite the war in Sudan having created the 21st century’s gravest emergency and the {scale of needs|extent