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For an extended period, jolting along the soggy dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and tried hard stopping herself vomiting. She was in delivery, 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 close to a million Sudanese refugees who have fled to Chad since 2023, living hand to mouth in this difficult terrain, are females. They live in remote settlements in the desert with insufficient supplies, few job opportunities and with healthcare often a life-threateningly long distance away.

The clinic Mohammed needed was in Metche, a different settlement 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 could not give birth without intervention because my uterus had collapsed,” says Mohammed. “I had to endure a long delay for the ambulance but all I remember was the pain; it was so unbearable I became confused.”

Her parent, Ashe Khamis Abdullah, 40, feared she would lose both her daughter and baby grandson. But Mohammed was hurried into surgery when she arrived at the hospital and an urgent C-section rescued her and her son, Muwais.

Chad previously recorded the world’s second-highest maternal fatality statistic before the current influx of refugees, but the conditions endured by the Sudanese put even more women in peril.

At the hospital, where they have birthed 824 babies in frequently urgent circumstances this year, the medics are able to save many, but it is what occurs with the women who are cannot access the hospital that concerns them.

In the couple of years since the civil war in Sudan began, over four-fifths of the refugees who have arrived and settled in Chad are women and children. In total, about 1.2 million Sudanese are being sheltered in the east of the country, four hundred thousand of whom fled the past violence in Darfur.

Chad has hosted the bulk of the over four million people who have escaped the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been forced out of their homes.

Many men have not left to be in proximity to homes and land; others have been slain, abducted or forced into fighting. Those of adult age soon depart from Chad’s isolated encampments to seek employment in the main city, N’Djamena, or elsewhere, in neighbouring Libya.

It results in women are left alone, without the means to feed the young and old left in their charge. To avoid overcrowding near the border, the Chadian government has transferred refugees to smaller camps such as Metche with average populations of about fifty thousand, but in isolated regions with limited infrastructure 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 few additional amenities. There is unemployment, families must travel long distances to find fuel, and each person must survive on about minimal water of water a day – much less than the advised quantity.

This seclusion means hospitals are treating women with complications in their pregnancy dangerously late. There is only a single ambulance to cover the route between the Metche hospital and the health post near the Alacha encampment, where Mohammed is one of close to fifty thousand refugees. The medical team has seen cases where women in extreme agony have had to wait an entire night for the ambulance to reach them.

Imagine being nine months pregnant, in childbirth, and making a lengthy trip on a donkey-drawn vehicle to get to a medical facility

As well as being uneven, the road traverses valleys that fill with water during the rainy season, completely cutting off travel.

A surgeon at the hospital in Metche said every case she sees is an critical situation, with some women having to make arduous trips to the hospital by on foot or on a mule.

“Imagine being about to give birth, in labour, and travelling hours on a cart pulled by a donkey to get to a hospital. The primary issue is the lag but having to come in these conditions also has an influence on the childbirth,” says the surgeon.

Malnutrition, which is growing, also increases the risk of issues in pregnancy, including the uterine splits that medical staff see regularly.

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

The undernourishment unit has increased to six tents and has individuals overflowing into other sections. Children rest beneath mosquito nets in extreme warmth in almost complete silence as health workers work, mixing medications and measuring kids on a instrument created using a pail and cord.

In moderate instances children get packets of PlumpyNut, the specially formulated 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 infant son, Sufian Sulaiman, is being fed through a nasogastric tube. The baby has been ill for the past year but Abubakar was consistently offered just painkillers without any diagnosis, until she made the journey from Alacha to Metche.

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

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

And what they are given is a small amount of grain, cooking oil and salt, distributed every two months. Such a simple food offers little sustenance, and the meager funds she is given cannot buy much in the local bazaars, where prices have become inflated.

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

Unable to get employment in Chad, her partner has left for Libya in the hope of gathering adequate cash for them to join him. She lives with his family members, dividing up whatever food they can get.

Abubakar says she has already witnessed food rations being cut and there are worries that the abrupt cuts in foreign support money by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having caused the 21st century’s most severe crisis and the {scale of needs|extent