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For a long time, bouncing over 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 extreme pain after her womb tore, but was now being tossed around in the ambulance that lurched across the potholes and ridges of the road through the Chadian desert.

Most of the 878,000 Sudanese displaced persons who escaped to Chad since 2023, barely getting by in this inhospitable environment, are females. They live in secluded encampments in the desert with scarce resources, no work and with medical help often a perilously remote away.

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

“I continuously experienced infections during my term and I had to go the health post on numerous visits – when I was there, the labour began. But I found it impossible to give birth normally because my womb had given way,” says Mohammed. “I had to endure a long delay for the ambulance but all I can think of the agony; it was so intense I became confused.”

Her parent, Ashe Khamis Abdullah, 40, feared she would lose both her daughter and baby grandson. But Mohammed was rushed straight into surgery when she arrived at the hospital and an critical surgical delivery preserved the lives of her and her son, Muwais.

Chad already had the world’s second-highest maternal death rate before the current influx of refugees, but the conditions endured by the Sudanese put even more women in danger.

At the hospital, where they have birthed 824 babies in often critical situations this year, the doctors are able to save many, but it is what occurs with the women who are cannot access the hospital that worries the staff.

In the 24 months since the internal conflict in Sudan erupted, the vast majority of the people who reached and stayed in Chad are females and minors. In total, about one point two million Sudanese are being hosted in the east of the country, four hundred thousand of whom escaped the earlier war in Darfur.

Chad has hosted the bulk 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 men have remained to be close to homes and land; many were killed, abducted or forced into fighting. Those of adult age soon depart from Chad’s isolated encampments to look for jobs in the main city, N’Djamena, or elsewhere, in neighbouring Libya.

It results in women are abandoned, without the resources to feed the dependents left in their responsibility. To reduce density near the border, the Chadian government has moved individuals to less crowded encampments such as Metche with usual resident counts of about fifty thousand, but in remote areas with few facilities and minimal chances.

Metche has a hospital established by a medical aid organization, which started off as a few tents but has developed to contain an operating theatre, but few additional amenities. There is no work, families must journey for extended periods to find burning material, and each person must get by with about nine litres of water a day – far below the recommended 20 litres.

This isolation means hospitals are receiving women with complications in their pregnancy dangerously late. There is only a single ambulance to cover the route between the Metche hospital and the medical tent near the camp at Alacha, where Mohammed is one of a large number of refugees. The medical team has observed instances where women in desperate pain have had to remain overnight for the ambulance to reach them.

Imagine being nine months pregnant, in delivery, and travelling hours on a animal-drawn transport to get to a medical facility

As well as being bumpy, the route passes through valleys that fill with water during the monsoon, completely preventing travel.

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

“Imagine being nine months pregnant, in childbirth, and making a long trip on a cart pulled by a donkey to get to a hospital. The primary issue is the lag but having to arrive under such circumstances also has an effect on the childbirth,” says the surgeon.

Malnutrition, which is growing, also raises the chance of complications in pregnancy, including the womb tears that medical staff frequently observe.

Mohammed has remained in hospital in the 60 days since her caesarean. Experiencing malnutrition, she developed an infection, while her son has been closely watched. The male guardian has travelled to other towns in seek jobs, so Mohammed is completely reliant on her mother.

The undernourishment unit has increased to six tents and has individuals overflowing into other sections. Children lie under mosquito nets in extreme warmth in almost complete silence as health workers work, preparing treatments and assessing weights on a device constructed from a bucket and rope.

In less severe situations children get packets of PlumpyNut, the specially formulated peanut paste, but the critical situations need a daily dose of enriched milk. Mohammed’s baby is given his nourishment through a medical device.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being given nutrition by a nasogastric tube. The child has been ill for the past year but Abubakar was repeatedly given only painkillers without any medical assessment, until she made the journey from Alacha to Metche.

“Every day, I see additional kids joining us in this tent,” she says. “The food we’re eating 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 relying on what we’re provided.”

And what they are provided is a small amount of grain, cooking oil and salt, provided every 60 days. Such a minimal nutrition offers little sustenance, and the small amount of money she is given purchases very little in the regular markets, where prices have become inflated.

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

Finding no work in Chad, her husband has gone to Libya in the desire to raising enough money for them to follow. She resides with his family members, 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 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