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For an extended period, travelling roughly on the waterlogged dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and focused on stopping herself vomiting. She was in labour, in agonizing discomfort 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 hundreds of thousands of Sudanese refugees who have fled to Chad since 2023, surviving precariously in this inhospitable environment, are females. They live in remote settlements in the desert with limited water and food, no work and with medical help often a perilously remote away.

The medical center Mohammed needed was in Metche, another refugee camp more than 120 minutes away.

“I kept getting infections during my term and I had to go the medical tent seven times – when I was there, the pregnancy started. But I wasn’t able to give birth normally because my uterine muscles failed,” says Mohammed. “I had to remain for 120 minutes for the ambulance but all I can think of the agony; it was so bad I became disoriented.”

Her maternal figure, Ashe Khamis Abdullah, 40, feared she would lose both her child and grandchild. But Mohammed was immediately taken for surgery when she arrived at the hospital and an emergency caesarean section rescued her and her son, Muwais.

Chad previously recorded the world’s second-highest maternal fatality statistic before the ongoing stream of refugees, but the conditions endured by the Sudanese place additional women in risk.

At the hospital, where they have assisted in the arrival of 824 babies in mostly emergency conditions this year, the medical staff are able to help plenty, but it is what occurs with the women who are fail to get to the hospital that alarms the professionals.

In the two years since the internal conflict in Sudan began, over four-fifths of the people who reached and settled in Chad are mothers and kids. In total, about over a million Sudanese are being sheltered in the eastern region of the country, a large number of whom fled the past violence in Darfur.

Chad has accepted the majority of the over four million people who have escaped the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been uprooted from their homes.

Many males have stayed behind to be in proximity to homes and land; others have been murdered, captured or forced into fighting. Those of working age move on quickly from Chad’s barren settlements to find work in the capital, N’Djamena, or further, in neighbouring Libya.

It implies women are abandoned, without the means to provide for the dependents left in their charge. To avoid overcrowding near the border, the Chadian government has relocated people to less crowded encampments such as Metche with average populations of about 50,000, but in isolated regions with few facilities and scarce prospects.

Metche has a hospital set up by a medical aid organization, which was initially a few tents but has grown to feature an surgical room, but few additional amenities. There is a lack of jobs, families must walk hours to find firewood, and each person must get by with about nine litres 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 single ambulance to cover the route between the Metche hospital and the health post near the camp at Alacha, where Mohammed is one of a large number of refugees. The medical team has seen cases where women in desperate pain have had to wait an entire night for the ambulance to reach them.

Imagine being in the final trimester, in childbirth, and making a lengthy trip on a cart pulled by a donkey to get to a clinic

As well as being bumpy, the road traverses valleys that fill with water during the rainy season, 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 on foot or on a pack animal.

“Imagine being nine months pregnant, in childbirth, and travelling hours on a cart pulled by a donkey to get to a medical center. The biggest factor is the lag but having to come in these conditions also has an effect on the childbirth,” says the surgeon.

Malnutrition, which is growing, also raises the chance of issues 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 parent has travelled to other towns in seek jobs, so Mohammed is entirely leaning on her mother.

The malnutrition ward has increased to six tents and has cases exceeding capacity into other sections. Children are placed under mosquito nets in oppressive temperatures in almost utter stillness as medical staff work, mixing medications and measuring kids on a device constructed from a bucket and rope.

In mild cases children get packets of PlumpyNut, the specifically created peanut paste, but the most severe instances need a consistent supply of nutrient-rich liquid. Mohammed’s baby is administered his nutrition through a syringe.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being nourished via a nasal drip. The baby has been sick 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 arriving in this shelter,” she says. “The nutrition we receive is inadequate, there’s insufficient food and it’s deficient in vitamins.

“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 dependent on what we’re given.”

And what they are allocated is a meager portion of grain, vegetable oil and salt, handed out every two months. Such a minimal nutrition lacks nutrition, and the meager funds she is given purchases very little in the weekly food markets, where prices have become inflated.

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

Failing to secure jobs in Chad, her husband has left for Libya in the hope of earning sufficient funds for them to join him. She stays with his family members, dividing up whatever nourishment they obtain.

Abubakar says she has already seen food distributions being reduced and there are concerns that the sharp decreases in overseas aid budgets by the US, UK and other European countries, could worsen the situation. Despite the war in Sudan having produced the 21st century’s gravest emergency and the {scale of needs|extent