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For a long time, travelling roughly on the soggy dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and focused on stopping herself being sick. She was in labour, in severe suffering after her womb tore, but was now being shaken violently in the ambulance that lurched across the uneven terrain of the road through the Chadian desert.

Most of the close to a million Sudanese displaced persons who escaped to Chad since 2023, surviving precariously in this inhospitable environment, are women. They stay in isolated camps in the desert with scarce resources, few job opportunities and with medical help often a dangerously far away.

The clinic Mohammed needed was in Metche, another refugee camp more than a considerable journey away.

“I repeatedly suffered from infections during my term and I had to go the health post multiple occasions – when I was there, the pregnancy started. But I could not give birth without intervention because my uterine muscles failed,” says Mohammed. “I had to endure a long delay for the ambulance but all I can think of the pain; it was so bad I became confused.”

Her maternal figure, Ashe Khamis Abdullah, 40, feared she would suffer the death of her daughter and baby grandson. But Mohammed was hurried into surgery when she reached the hospital and an critical surgical delivery saved her and her son, Muwais.

Chad previously recorded the world’s second-highest maternal mortality rate before the recent arrival of refugees, but the conditions endured by the Sudanese expose further women in risk.

At the hospital, where they have birthed 824 babies in often critical situations 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 concerns them.

In the 24 months since the civil war in Sudan began, 86% of the refugees who have arrived and settled in Chad are mothers and kids. In total, about over a million Sudanese are being hosted in the eastern part of the country, four hundred thousand of whom fled the previous conflict in Darfur.

Chad has taken the lion’s share of the 4.1 million people who have escaped the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been displaced from their homes.

Many males have remained to be in proximity to homes and land; many were killed, abducted or forced into fighting. Those of working age move on quickly from Chad’s desolate refugee camps to look for jobs in the capital, N’Djamena, or beyond, in neighbouring Libya.

It results in women are stranded, without the resources to provide for the dependents left in their charge. To prevent congestion near the border, the Chadian government has moved individuals to less crowded encampments such as Metche with usual resident counts of about 50,000, but in remote areas with limited infrastructure and few opportunities.

Metche has a hospital established by a medical aid organization, which started off as a few tents but has expanded to include an surgical room, but little else. There is no work, families must travel long distances to find fuel, and each person must subsist with about minimal water of water a day – far below the recommended 20 litres.

This isolation means hospitals are admitting women with complications in their pregnancy dangerously late. There is only a single ambulance to serve the area between the Metche hospital and the clinic near the Alacha encampment, where Mohammed is one of a large number of refugees. The medical team has seen cases where women in severe suffering have had to remain overnight for the ambulance to reach them.

Imagine being in the final trimester, in delivery, and making a lengthy trip on a animal-drawn transport to get to a medical facility

As well as being uneven, the road traverses valleys that become inundated during the wet period, completely preventing travel.

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

“Imagine being nine months pregnant, in childbirth, and making a long trip on a animal-drawn vehicle to get to a medical center. The primary issue is the wait but having to arrive under such circumstances also has an influence on the childbirth,” says the surgeon.

Malnutrition, which is on the rise, also increases the risk of complications in pregnancy, including the womb tears that medical staff often encounter.

Mohammed has remained in hospital in the 60 days since her caesarean. Experiencing malnutrition, she contracted an illness, while her son has been carefully monitored. The parent has travelled to other towns in seek jobs, 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 rest beneath mosquito nets in extreme warmth in almost complete silence as health workers work, preparing treatments and weighing children on a scale made from a pail and cord.

In moderate instances children get sachets of PlumpyNut, the specifically created peanut paste, but the most severe instances need a regular intake of fortified formula. Mohammed’s baby is fed his through a medical device.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being fed through a nasal drip. The baby has been unwell for the past year but Abubakar was consistently offered just painkillers without any diagnosis, until she made the trip from Alacha to Metche.

“Every day, I see further minors coming in in this structure,” she says. “The nutrition we receive is low-quality, there’s not enough to eat and it’s not nutritious.

“If we were at home, we could’ve adapted ourselves. You can go and farm produce, you can find employment, but here we’re dependent on what we’re provided.”

And what they are given is a limited quantity of cereal, cooking oil and salt, handed out every couple of months. Such a basic diet lacks nutrition, and the meager funds she is given cannot buy much in the weekly food markets, where prices have become inflated.

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

Failing to secure jobs in Chad, her spouse has left for Libya in the aspiration to earning sufficient funds for them to follow. She lives with his family members, distributing whatever nourishment they obtain.

Abubakar says she has already witnessed food rations being cut and there are fears that the sharp decreases in international assistance funds by the US, UK and other European countries, could make things worse. Despite the war in Sudan having created the 21st century’s worst humanitarian disaster and the {scale of needs|extent