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For a long time, bouncing over the waterlogged dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and tried hard stopping herself being sick. She was in labour, in severe suffering 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 close to a million Sudanese displaced persons who escaped to Chad since 2023, living hand to mouth in this harsh landscape, are women. They reside in secluded encampments in the desert with scarce resources, little employment and with medical help often a dangerously far away.

The clinic Mohammed needed was in Metche, another refugee camp more than two hours away.

“I kept getting infections during my gestation and I had to go the clinic seven times – when I was there, the delivery commenced. But I wasn’t able to give birth naturally because my uterus had collapsed,” says Mohammed. “I had to wait two hours for the ambulance but all I remember was the pain; it was so bad I became disoriented.”

Her mother, Ashe Khamis Abdullah, 40, was terrified she would be bereft of her daughter and baby grandson. But Mohammed was rushed straight into surgery when she got to the hospital and an emergency caesarean section preserved the lives of her and her son, Muwais.

Chad already had the world’s second worst maternal mortality rate before the current influx of refugees, but the conditions endured by the Sudanese expose further women in risk.

At the hospital, where they have assisted in the arrival of 824 babies in frequently urgent circumstances this year, the medical staff are able to save many, but it is what happens to the women who are fail to get to the hospital that alarms the professionals.

In the couple of years since the civil war in Sudan started, the vast majority of the displaced persons who came and remained in Chad are women and children. In total, about over a million Sudanese are being accommodated in the eastern region of the country, four hundred thousand of whom escaped the previous conflict in Darfur.

Chad has taken the lion’s share of the millions of people who have run from the war in Sudan; the remainder moved 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; some were murdered, abducted or forced into fighting. Those of employable age soon depart from Chad’s isolated encampments to seek employment in the capital, N’Djamena, or elsewhere, in adjacent Libya.

It results in women are stranded, without the resources to provide for the dependents left in their responsibility. To prevent congestion near the border, the Chadian government has transferred refugees to smaller camps such as Metche with typical numbers of about fifty thousand, but in isolated regions with limited infrastructure and few opportunities.

Metche has a hospital set up by a medical aid organization, which began as a few tents but has developed to contain an surgical room, but not much more. There is no work, families must journey for extended periods to find burning material, and each person must survive on about a small amount of water a day – much less than the recommended 20 litres.

This seclusion means hospitals are treating women with issues in their pregnancy dangerously late. There is only a sole emergency vehicle to serve the area between the Metche hospital and the medical tent near the settlement of Alacha, where Mohammed is one of nearly 50,000 refugees. The medical team has observed instances where women in severe suffering have had to remain overnight for the ambulance to come.

Imagine being in the final trimester, in delivery, and making a lengthy trip on a cart pulled by a donkey to get to a medical facility

As well as being rough, 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 arduous trips to the hospital by on foot or on a donkey.

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

Poor nutrition, which is growing, also elevates the likelihood of issues in pregnancy, including the uterine ruptures that medical staff see regularly.

Mohammed has stayed at the medical facility in the couple of 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 grown to six tents and has patients spilling over into other sections. Children are placed under mosquito nets in oppressive temperatures in almost utter stillness as medical staff work, mixing medications and weighing children on a scale made from a bucket and rope.

In mild cases children get sachets of PlumpyNut, the specially formulated peanut paste, but the critical situations need a consistent supply of nutrient-rich liquid. Mohammed’s baby is administered his nutrition through a medical device.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being nourished via a nasogastric tube. The infant has been unwell for the past year but Abubakar was only provided with painkillers without any identification, until she made the travel from Alacha to Metche.

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

“If we were at home, we could’ve adjusted our lives. You can go and cultivate plants, you can find employment, but here we’re dependent on what we’re distributed.”

And what they are provided is a limited quantity of sorghum, edible oil and salt, handed out every 60 days. Such a basic diet is deficient in nutrients, and the little cash she is given purchases very little in the weekly food markets, where prices have become inflated.

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

Unable to get employment in Chad, her spouse has gone to Libya in the aspiration to raising enough money for them to come later. She resides with his kin, dividing up whatever food they can get.

Abubakar says she has already witnessed food supplies decreasing and there are worries that the sharp decreases 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 worst humanitarian disaster and the {scale of needs|extent