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For hours, bouncing over the flooded dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and concentrated on stopping herself being sick. She was in delivery, in agonizing discomfort after her uterine wall split, but was now being tossed around in the ambulance that bumped over 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 limited water and food, few job opportunities and with medical help often a perilously remote away.

The hospital Mohammed needed was in Metche, a different settlement more than a considerable journey away.

“I kept getting infections during my term and I had to go the medical tent on numerous visits – when I was there, the delivery commenced. But I found it impossible 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 suffering; it was so bad I became confused.”

Her maternal figure, Ashe Khamis Abdullah, 40, worried she would lose both her offspring and descendant. But Mohammed was immediately taken for surgery when she got to the hospital and an urgent C-section rescued her and her son, Muwais.

Chad was known for the world’s second most severe maternal mortality rate before the recent arrival of refugees, but the situations faced by the Sudanese put even more women in danger.

At the hospital, where they have delivered 824 babies in mostly emergency conditions this year, the medics are able to help plenty, but it is what occurs with the women who are not able to reach the hospital that alarms the professionals.

In the 24 months since the internal conflict in Sudan erupted, the vast majority of the displaced persons who came and remained in Chad are women and children. In total, about one point two million Sudanese are being sheltered in the eastern region of the country, 400,000 of whom ran from the earlier war in Darfur.

Chad has accepted the majority of the over four million people who have fled the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been forced out of their homes.

Many males have stayed behind to be in proximity to homes and land; others have been murdered, abducted or conscripted. Those of working age soon depart from Chad’s barren settlements to find work in the capital, N’Djamena, or further, in adjacent Libya.

It implies women are left alone, without the resources to sustain the young and old left in their responsibility. To prevent congestion near the border, the Chadian government has moved individuals to less crowded encampments such as Metche with average populations of about fifty thousand, but in remote areas with no services and scarce prospects.

Metche has a hospital built by a medical aid organization, which began as a few tents but has expanded to include an surgical room, but few additional amenities. There is unemployment, families must walk hours to find burning material, and each person must subsist with about nine litres of water a day – well under the advised quantity.

This remoteness means hospitals are treating women with issues in their pregnancy dangerously late. There is only a one medical transport to cover the route between the Metche hospital and the clinic near the settlement of Alacha, where Mohammed is one of a large number of refugees. The medical team has encountered situations where women in severe suffering have had to remain overnight for the ambulance to arrive.

Imagine being nine months pregnant, in delivery, and journeying for a long time on a animal-drawn transport to get to a clinic

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

A surgeon at the hospital in Metche said all the situations she encounters is an critical situation, 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 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 travel in this state also has an impact on the childbirth,” says the surgeon.

Malnutrition, which is growing, also increases the risk of problems in pregnancy, including the womb tears that medical staff see regularly.

Mohammed has remained in hospital in the couple of months since her caesarean. Experiencing malnutrition, she contracted an illness, while her son has been carefully monitored. The father has gone to other towns in search of work, 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 lie under mosquito nets in sweltering heat in almost utter stillness as medical staff work, preparing treatments and measuring kids on a device constructed from a bucket and rope.

In moderate instances children get packets of PlumpyNut, the uniquely designed peanut paste, but the critical situations need a daily dose of fortified formula. Mohammed’s baby is administered his nutrition through a syringe.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being given nutrition by a nasal drip. The baby has been sick for the past year but Abubakar was only provided with painkillers without any diagnosis, until she made the journey from Alacha to Metche.

“Every day, I see additional kids joining us in this structure,” she says. “The nutrition we receive is inadequate, there’s too little nourishment 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 work to earn some money, but here we’re relying on what we’re distributed.”

And what they are provided is a meager portion of grain, vegetable oil and salt, distributed every couple of months. Such a basic diet offers little sustenance, and the little cash she is given purchases very little in the regular markets, where prices have become inflated.

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

Unable to get employment in Chad, her partner has gone to Libya in the aspiration to gathering adequate cash for them to join him. She stays with his relatives, distributing whatever nourishment they obtain.

Abubakar says she has already witnessed food rations being cut and there are worries that the sharp decreases in foreign support money by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having created the 21st century’s worst humanitarian disaster and the {scale of needs|extent