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For hours, jolting along the waterlogged dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and focused on stopping herself vomiting. She was in delivery, in agonizing discomfort after her womb tore, but was now being tossed around in the ambulance that bumped over the dips and bumps of the road through the Chadian desert.

Most of the 878,000 Sudanese people who ran to Chad since 2023, barely getting by in this difficult terrain, are women. They live in secluded encampments in the desert with scarce resources, no work and with medical help often a dangerously far away.

The hospital Mohammed needed was in Metche, one more encampment more than a considerable journey away.

“I kept getting infections during my gestation and I had to go the health post on numerous visits – 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 wait two hours for the ambulance but all I can think of the agony; it was so intense I became delirious.”

Her parent, Ashe Khamis Abdullah, 40, feared she would be bereft of her daughter and baby grandson. But Mohammed was immediately taken for 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 mortality rate before the current influx of refugees, but the situations faced by the Sudanese place additional women in peril.

At the hospital, where they have delivered 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 alarms the professionals.

In the 24 months since the civil war in Sudan erupted, the vast majority of the refugees who have arrived 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, 400,000 of whom fled the past violence in Darfur.

Chad has taken the lion’s share of the millions of people who have run from the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been displaced from their homes.

Many males have remained to be in proximity to homes and land; others have been murdered, taken hostage or conscripted. Those of working age rapidly leave from Chad’s desolate refugee camps to look for jobs in the main city, N’Djamena, or beyond, in nearby Libya.

It results in women are left alone, without the means to sustain the children and the elderly left in their charge. To avoid overcrowding near the border, the Chadian government has relocated people to more compact settlements such as Metche with typical numbers of about a large community, but in remote areas with few facilities and minimal chances.

Metche has a hospital set up by a medical aid organization, which was initially a few tents but has developed to contain an surgical room, but little else. There is a lack of jobs, families must journey for extended periods to find burning material, and each person must subsist with about a small amount of water a day – much less than the suggested amount.

This isolation means hospitals are admitting women with complications in their pregnancy when it is almost too late. There is only a one medical transport to cover the route between the Metche hospital and the clinic near the Alacha encampment, where Mohammed is one of nearly 50,000 refugees. The medical team has observed instances where women in extreme agony have had to remain overnight for the ambulance to arrive.

Imagine being expecting a child, in delivery, and travelling hours on a animal-drawn transport to get to a hospital

As well as being rough, the path goes through valleys that flood during the wet period, completely blocking travel.

A surgeon at the hospital in Metche said all the situations she encounters is an crisis, with some women having to make long and difficult journeys to the hospital by foot or on a mule.

“Imagine being in the late stages of pregnancy, in labour, and making a long trip on a animal-drawn vehicle to get to a medical center. The primary issue is the lag but having to come in these conditions also has an effect on the childbirth,” says the surgeon.

Malnutrition, which is increasing, also elevates the likelihood of complications in pregnancy, including the womb tears that medical staff often encounter.

Mohammed has stayed at the medical facility in the two months since her caesarean. Suffering from malnutrition, she got sick, while her son has been carefully monitored. The parent has travelled to other towns in seek jobs, so Mohammed is completely reliant on her mother.

The malnutrition ward has expanded to six tents and has cases exceeding capacity into other sections. Children are placed under mosquito nets in extreme warmth in almost complete silence as medical staff work, preparing treatments and measuring kids on a instrument created using a bucket and rope.

In mild cases children get sachets of PlumpyNut, the uniquely designed peanut paste, but the critical situations need a regular intake of fortified formula. Mohammed’s baby is administered his nutrition through a injector.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being nourished via a nasogastric tube. The baby has been sick for the past year but Abubakar was only provided with painkillers without any medical assessment, 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 poor, there’s insufficient food and it’s lacking in nutrients.

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

And what they are allocated is a limited quantity of sorghum, edible oil and salt, distributed every couple of months. Such a minimal nutrition offers little sustenance, and the small amount of money 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 run from 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 husband has gone to Libya in the hope of raising enough money for them to join him. She lives with his kin, sharing out whatever food they can get.

Abubakar says she has already seen food distributions being reduced and there are fears 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 produced the 21st century’s gravest emergency and the {scale of needs|extent