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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 concentrated on stopping herself throwing up. She was in childbirth, in extreme pain after her uterus ruptured, but was now being tossed around in the ambulance that jumped along the uneven terrain of the road through the Chadian desert.

Most of the hundreds of thousands of Sudanese refugees who have fled to Chad since 2023, living hand to mouth in this harsh landscape, are females. They reside in remote settlements in the desert with scarce resources, little employment and with healthcare often a dangerously far away.

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

“I repeatedly suffered from infections during my pregnancy and I had to go the clinic seven times – when I was there, the labour began. But I could not give birth without intervention because my womb had given way,” says Mohammed. “I had to wait two hours for the ambulance but all I recall is the agony; it was so intense I became confused.”

Her maternal figure, Ashe Khamis Abdullah, 40, feared she would be bereft of her offspring and descendant. But Mohammed was rushed straight into surgery when she arrived at the hospital and an critical surgical delivery saved her and her son, Muwais.

Chad previously recorded the world’s second worst maternal death rate before the ongoing stream 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 frequently urgent circumstances this year, the medical staff are able to rescue numerous, but it is what happens to 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 refugees who have arrived and remained in Chad are mothers and kids. In total, about over a million Sudanese are being accommodated in the eastern part of the country, four hundred thousand of whom escaped the earlier war in Darfur.

Chad has hosted the bulk of the 4.1 million people who have run from the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been forced out of their homes.

Many adult men have remained to be in proximity to homes and land; others have been killed, taken hostage or made to join the conflict. Those of adult age soon depart from Chad’s desolate refugee camps to seek employment in the main city, N’Djamena, or elsewhere, in adjacent Libya.

It implies women are left alone, without the means to feed the dependents left in their responsibility. To avoid overcrowding near the border, the Chadian government has moved individuals to smaller camps such as Metche with typical numbers of about a large community, but in isolated regions with few facilities and minimal chances.

Metche has a hospital established by a medical aid organization, which was initially a few tents but has grown to feature an procedure area, but little else. There is unemployment, families must travel long distances to find fuel, and each person must survive on about a small amount of water a day – much less than the suggested amount.

This seclusion means hospitals are receiving women with problems in their pregnancy at a critical stage. There is only a sole emergency vehicle to serve the area between the Metche hospital and the clinic near the settlement of Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has seen cases where women in extreme agony have had to remain overnight for the ambulance to come.

Imagine being in the final trimester, in childbirth, and travelling hours on a donkey-drawn vehicle to get to a medical facility

As well as being rough, the path goes through valleys that flood during the rainy season, completely cutting off travel.

A surgeon at the hospital in Metche said all the situations she encounters is an crisis, with some women having to make challenging travels to the hospital by walking or on a mule.

“Imagine being in the late stages of pregnancy, in childbirth, and making a long trip on a donkey cart to get to a medical center. The primary issue is the wait but having to travel in this state also has an influence on the delivery,” says the surgeon.

Poor nutrition, which is on the rise, also raises the chance of problems in pregnancy, including the uterine ruptures that medical staff often encounter.

Mohammed has stayed at the medical facility in the couple of months since her surgical delivery. Afflicted by malnutrition, she got sick, while her son has been closely watched. The male guardian has gone 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 rest beneath mosquito nets in sweltering heat in almost utter stillness as health workers work, creating remedies and measuring kids on a instrument created using a container and string.

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

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

“Every day, I see further minors coming in in this tent,” she says. “The food we’re eating is inadequate, 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 cultivate plants, you can get a job, but here we’re relying on what we’re distributed.”

And what they are given is a small amount of cereal, cooking oil and salt, handed out every 60 days. Such a simple food lacks nutrition, and the little cash she is given acquires minimal items in the local bazaars, where values have increased.

Abubakar was transferred to Alacha after reaching from Sudan in 2023, having fled the armed group Rapid Support Forces’ raid on her birthplace of El Geneina in June that year.

Unable to get employment in Chad, her spouse has left for Libya in the desire to gathering adequate cash for them to follow. She lives with his family members, distributing whatever food they can get.

Abubakar says she has already observed food rations being cut and there are worries that the abrupt cuts in international assistance funds by the US, UK and other European countries, could worsen the situation. Despite the war in Sudan having caused the 21st century’s gravest emergency and the {scale of needs|extent