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For hours, travelling roughly on the soggy dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and tried hard stopping herself throwing up. She was in delivery, in extreme pain after her uterine wall split, but was now being shaken violently in the ambulance that jumped along the uneven terrain of the road through the Chadian desert.

Most of the hundreds of thousands of Sudanese displaced persons who escaped to Chad since 2023, barely getting by in this harsh landscape, are women. They stay in isolated camps in the desert with scarce resources, little employment and with medical help often a perilously remote away.

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

“I continuously experienced infections during my pregnancy and I had to go the health post multiple occasions – when I was there, the delivery commenced. But I found it impossible to give birth without intervention because my womb had given way,” says Mohammed. “I had to endure a long delay for the ambulance but all I remember was the suffering; it was so bad I became confused.”

Her mother, Ashe Khamis Abdullah, 40, was terrified she would suffer the death of her offspring and descendant. But Mohammed was hurried into surgery when she got to the hospital and an critical surgical delivery saved her and her son, Muwais.

Chad previously recorded the world’s second most severe maternal fatality statistic 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 doctors are able to rescue numerous, but it is what affects the women who are cannot access the hospital that worries the staff.

In the couple of years since the civil war in Sudan began, over four-fifths of the displaced persons who came and stayed in Chad are mothers and kids. In total, about over a million Sudanese are being accommodated 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 millions of 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 adult men have not left to be in proximity to homes and land; others have been killed, taken hostage or made to join the conflict. Those of working age soon depart from Chad’s barren settlements to seek employment in the capital, N’Djamena, or elsewhere, in neighbouring Libya.

It implies women are abandoned, 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 less crowded encampments such as Metche with typical numbers of about a large community, but in isolated regions with few facilities and minimal chances.

Metche has a hospital set up by a medical aid organization, which was initially a few tents but has expanded to include an surgical room, but little else. There is a lack of jobs, families must walk hours to find burning material, and each person must survive on about minimal water of water a day – far below the suggested amount.

This seclusion means hospitals are treating women with issues in their pregnancy when it is almost too late. There is only a sole emergency vehicle to cover the route between the Metche hospital and the health post near the camp at Alacha, where Mohammed is one of nearly 50,000 refugees. The medical team has seen cases where women in severe suffering have had to remain overnight for the ambulance to come.

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

As well as being uneven, the path goes through 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 critical situation, with some women having to make arduous trips to the hospital by walking or on a donkey.

“Imagine being about to give birth, in labour, and making a long trip on a donkey cart to get to a medical center. The main problem is the wait but having to arrive under such circumstances also has an impact on the birth,” says the surgeon.

Poor nutrition, which is increasing, also elevates the likelihood of issues in pregnancy, including the uterine ruptures that medical staff frequently observe.

Mohammed has remained in hospital in the 60 days since her C-section. Suffering from malnutrition, she got sick, while her son has been regularly checked. The father has journeyed to other towns in seek jobs, 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 extreme warmth in almost utter stillness as medical staff work, creating remedies and measuring kids on a device constructed from a container and string.

In mild cases children get packets of PlumpyNut, the specifically created peanut paste, but the critical situations need a regular intake of nutrient-rich liquid. Mohammed’s baby is given his nourishment through a injector.

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

“Every day, I see additional kids coming in in this structure,” she says. “The food we’re eating is low-quality, there’s insufficient food and it’s lacking in nutrients.

“If we were at home, we could’ve adapted ourselves. You can go and cultivate plants, you can get a job, but here we’re reliant on what we’re provided.”

And what they are allocated is a limited quantity of grain, edible oil and salt, handed out every couple of months. Such a minimal nutrition lacks nutrition, and the meager funds she is given acquires minimal items in the regular markets, where values have increased.

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

Unable to get employment in Chad, her husband has traveled to Libya in the hope of raising enough money for them to come later. She resides with his relatives, distributing whatever meals they acquire.

Abubakar says she has already observed food supplies decreasing and there are worries that the abrupt cuts in international assistance funds by the US, UK and other European countries, could worsen the situation. Despite the war in Sudan having produced the 21st century’s worst humanitarian disaster and the {scale of needs|extent