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For hours, jolting along the soggy dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and focused on stopping herself being sick. She was in labour, in extreme pain after her uterus ruptured, but was now being tossed around in the ambulance that lurched across the dips and bumps of the road through the Chadian desert.

Most of the 878,000 Sudanese refugees who have fled to Chad since 2023, barely getting by in this difficult terrain, are females. They live in isolated camps in the desert with limited water and food, few job opportunities and with treatment often a life-threateningly long distance away.

The clinic Mohammed needed was in Metche, one more encampment more than a considerable journey away.

“I repeatedly suffered from infections during my term and I had to go the medical tent seven times – when I was there, the pregnancy started. But I found it impossible to give birth without intervention because my uterine muscles failed,” says Mohammed. “I had to endure a long delay for the ambulance but all I recall is the agony; it was so bad I became confused.”

Her parent, Ashe Khamis Abdullah, 40, was terrified she would suffer the death of her child and grandchild. But Mohammed was immediately taken for surgery when she got to the hospital and an emergency caesarean section preserved the lives of her and her son, Muwais.

Chad was known for the world’s second worst maternal mortality rate before the ongoing stream of refugees, but the conditions endured by the Sudanese place additional women in danger.

At the hospital, where they have birthed 824 babies in frequently urgent circumstances this year, the doctors are able to help plenty, but it is what affects the women who are not able to reach the hospital that concerns them.

In the two years since the internal conflict in Sudan erupted, the vast majority of the displaced persons who came and settled in Chad are females and minors. In total, about one point two million Sudanese are being accommodated in the eastern part of the country, four hundred thousand of whom ran from the earlier war in Darfur.

Chad has accepted the majority of the over four million people who have run from the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of millions of Sudanese have been uprooted from their homes.

Many men have stayed behind to be in proximity to homes and land; some were murdered, taken hostage or forced into fighting. Those of working age move on quickly from Chad’s isolated encampments to find work in the capital, N’Djamena, or elsewhere, in neighbouring Libya.

It means women are stranded, without the means to provide for the young and old left in their responsibility. To prevent congestion near the border, the Chadian government has transferred refugees to more compact settlements such as Metche with usual resident counts of about fifty thousand, but in distant locations with limited infrastructure and few opportunities.

Metche has a hospital built by a medical aid organization, which started off as a few tents but has grown to feature an procedure area, but few additional amenities. There is a lack of jobs, families must walk hours to find firewood, and each person must subsist with about minimal water of water a day – well under the suggested amount.

This remoteness means hospitals are receiving women with problems in their pregnancy at a critical stage. There is only a one medical transport to cover the route between the Metche hospital and the health post near the settlement of Alacha, where Mohammed is one of a large number of refugees. The medical team has encountered situations where women in desperate pain have had to endure a full night for the ambulance to come.

Imagine being expecting a child, in labour, and travelling hours on a animal-drawn transport to get to a clinic

As well as being uneven, the path goes through valleys that fill with water during the monsoon, completely preventing travel.

A surgeon at the hospital in Metche said every case she sees is an emergency, with some women having to make challenging travels to the hospital by foot or on a pack animal.

“Imagine being nine months pregnant, in childbirth, and travelling hours on a cart pulled by a donkey to get to a clinic. The primary issue is the wait but having to come in these conditions also has an influence on the childbirth,” says the surgeon.

Undernourishment, which is growing, also raises the chance of issues in pregnancy, including the uterine splits that medical staff often encounter.

Mohammed has remained in hospital in the two months since her surgical delivery. Suffering from malnutrition, she developed an infection, while her son has been regularly checked. The male guardian has gone to other towns in look for employment, so Mohammed is totally dependent on her mother.

The malnutrition ward has grown to six tents and has individuals overflowing into other sections. Children lie under mosquito nets in extreme warmth in almost total quiet as health workers work, preparing treatments and measuring kids on a instrument created using a container and string.

In less severe situations children get packets of PlumpyNut, the specially formulated peanut paste, but the worst cases need a daily dose of nutrient-rich liquid. Mohammed’s baby is given his nourishment through a medical device.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being fed through a nasal drip. The child has been ill for the past year but Abubakar was repeatedly given only painkillers without any diagnosis, until she made the travel from Alacha to Metche.

“Every day, I see further minors arriving in this shelter,” she says. “The food we’re eating is poor, there’s too little nourishment and it’s lacking in nutrients.

“If we were at home, we could’ve adjusted our lives. You can go and grow crops, you can work to earn some money, but here we’re relying on what we’re given.”

And what they are provided is a limited quantity of cereal, cooking oil and salt, provided every two months. Such a basic diet lacks nutrition, and the meager funds she is given cannot buy much in the weekly food markets, where costs have risen.

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

Unable to get employment in Chad, her spouse has traveled to Libya in the aspiration to gathering adequate cash for them to join him. She resides with his family members, sharing out 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 make things worse. Despite the war in Sudan having produced the 21st century’s most severe crisis and the {scale of needs|extent