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For hours, bouncing over the flooded dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed clung desperately to her seat and focused on stopping herself vomiting. She was in childbirth, in severe suffering after her womb tore, but was now being tossed around in the ambulance that jumped along the uneven terrain of the road through the Chadian desert.

Most of the close to a million Sudanese refugees who have fled to Chad since 2023, barely getting by in this harsh landscape, are females. They stay in secluded encampments in the desert with limited water and food, little employment and with medical help often a perilously remote away.

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

“I continuously experienced infections during my gestation and I had to go the health post on numerous visits – when I was there, the pregnancy started. 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 remember was the pain; it was so intense I became disoriented.”

Her parent, Ashe Khamis Abdullah, 40, worried she would lose both her child and grandchild. But Mohammed was immediately taken for surgery when she got to the hospital and an critical surgical delivery saved her and her son, Muwais.

Chad already had the world’s second most severe maternal death rate before the recent arrival of refugees, but the conditions endured by the Sudanese put even more women in danger.

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 rescue numerous, but it is what affects the women who are cannot access the hospital that worries the staff.

In the 24 months since the civil war in Sudan erupted, the vast majority of the displaced persons who came and remained in Chad are mothers and kids. In total, about over a million Sudanese are being sheltered in the eastern region of the country, 400,000 of whom escaped the previous conflict in Darfur.

Chad has accepted the majority of the over four million people who have fled the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of 11.8 million Sudanese have been displaced from their homes.

Many men have not left to be close to homes and land; others have been murdered, taken hostage or conscripted. Those of employable age rapidly leave from Chad’s barren settlements to seek employment in the main city, N’Djamena, or further, in adjacent Libya.

It means women are stranded, without the ability to feed the children and the elderly left in their responsibility. To reduce density near the border, the Chadian government has relocated people to more compact settlements such as Metche with average populations of about 50,000, but in distant locations with few facilities and scarce prospects.

Metche has a hospital built by a medical aid organization, which began as a few tents but has grown to feature an operating theatre, but not much more. There is a lack of jobs, families must walk hours to find fuel, and each person must survive on about a small amount of water a day – well under the suggested amount.

This remoteness means hospitals are receiving women with issues in their pregnancy dangerously late. There is only a sole emergency vehicle 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 encountered situations where women in desperate pain have had to wait an entire night for the ambulance to come.

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 road traverses valleys that fill with water during the wet period, completely blocking 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 pack animal.

“Imagine being about to give birth, in labour, and travelling hours on a animal-drawn vehicle to get to a medical center. The primary issue is the wait but having to travel in this state also has an impact on the delivery,” says the surgeon.

Poor nutrition, which is on the rise, also elevates the likelihood of problems in pregnancy, including the uterine splits that medical staff see regularly.

Mohammed has remained in hospital in the two months since her surgical delivery. Experiencing malnutrition, she contracted an illness, while her son has been regularly checked. The male guardian has gone to other towns in seek jobs, so Mohammed is completely reliant on her mother.

The nutritional care section has increased to six tents and has cases exceeding capacity into other sections. Children rest beneath mosquito nets in sweltering heat in almost utter stillness as health workers work, preparing treatments and assessing weights on a scale made from a pail and cord.

In less severe situations children get packets of PlumpyNut, the uniquely designed peanut paste, but the most severe instances need a regular intake of fortified formula. Mohammed’s baby is administered his nutrition through a injector.

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

“Every day, I see further minors coming in in this tent,” she says. “The meals we consume is low-quality, 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 grow crops, you can find employment, but here we’re dependent on what we’re provided.”

And what they are provided is a limited quantity of grain, vegetable oil and salt, provided every two months. Such a minimal nutrition offers little sustenance, and the small amount of money she is given acquires minimal items in the weekly food markets, where prices have become inflated.

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

Failing to secure jobs in Chad, her partner has gone to Libya in the aspiration to earning sufficient funds for them to follow. She resides with his relatives, dividing up whatever food they can get.

Abubakar says she has already seen food rations being cut and there are concerns 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