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For hours, jolting along the soggy dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and concentrated on stopping herself vomiting. She was in childbirth, in extreme pain after her womb tore, but was now being shaken violently in the ambulance that bumped over the dips and bumps 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 live in secluded encampments in the desert with limited water and food, little employment and with medical help often a life-threateningly long distance away.

The medical center Mohammed needed was in Metche, a different settlement more than two hours away.

“I repeatedly suffered from infections during my gestation and I had to go the health post on numerous visits – when I was there, the labour began. But I could not give birth naturally because my uterus had collapsed,” says Mohammed. “I had to wait two hours for the ambulance but all I recall is the agony; it was so bad I became disoriented.”

Her parent, Ashe Khamis Abdullah, 40, feared she would be bereft of her offspring and descendant. But Mohammed was rushed straight into surgery when she arrived at the hospital and an urgent C-section saved her and her son, Muwais.

Chad already had the world’s second worst maternal death rate before the recent arrival of refugees, but the situations faced by the Sudanese place additional women in risk.

At the hospital, where they have assisted in the arrival of 824 babies in mostly emergency conditions this year, the doctors are able to save many, but it is what occurs with the women who are not able to reach the hospital that worries the staff.

In the 24 months since the internal conflict in Sudan began, 86% of the people who reached and stayed in Chad are mothers and kids. In total, about 1.2 million Sudanese are being accommodated in the eastern part of the country, four hundred thousand of whom escaped the earlier war in Darfur.

Chad has hosted the bulk of the 4.1 million people who have run from the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been displaced from their homes.

Many adult men have stayed behind to be close to homes and land; others have been slain, taken hostage or made to join the conflict. Those of working age rapidly leave from Chad’s barren settlements to find work in the main city, N’Djamena, or beyond, in adjacent Libya.

It results in women are stranded, without the means to sustain the young and old left in their care. To avoid overcrowding near the border, the Chadian government has transferred refugees to more compact settlements such as Metche with average populations of about 50,000, but in distant locations with few facilities and few opportunities.

Metche has a hospital set up by a medical aid organization, which began as a few tents but has grown to feature an operating theatre, but few additional amenities. There is a lack of jobs, families must travel long distances to find fuel, and each person must get by with about a small amount of water a day – far below the recommended 20 litres.

This seclusion means hospitals are admitting women with complications in their pregnancy at a critical stage. There is only a one medical transport to travel the path between the Metche hospital and the medical tent near the settlement of Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has observed instances where women in severe suffering have had to remain overnight for the ambulance to reach them.

Imagine being expecting a child, in labour, and making a lengthy trip on a animal-drawn transport to get to a clinic

As well as being rough, the route passes through valleys that fill with water during the wet period, completely cutting off travel.

A surgeon at the hospital in Metche said every case she sees is an critical situation, with some women having to make long and difficult journeys to the hospital by foot or on a pack animal.

“Imagine being about to give birth, in childbirth, and travelling hours on a cart pulled by a donkey to get to a clinic. The main problem is the wait but having to travel in this state also has an impact on the childbirth,” says the surgeon.

Malnutrition, which is on the rise, also raises the chance of issues in pregnancy, including the uterine ruptures that medical staff often encounter.

Mohammed has stayed at the medical facility in the couple of months since her C-section. Experiencing malnutrition, she developed an infection, while her son has been carefully monitored. The male guardian has gone to other towns in look for employment, so Mohammed is totally dependent on her mother.

The undernourishment unit has grown to six tents and has individuals overflowing into other sections. Children lie under mosquito nets in extreme warmth in almost utter stillness as doctors and nurses work, preparing treatments and weighing children on a device constructed from 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 administered his nutrition through a syringe.

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being given nutrition by a nasogastric tube. The child has been ill for the past year but Abubakar was only provided with painkillers without any medical assessment, until she made the trip from Alacha to Metche.

“Every day, I see further minors joining us in this tent,” she says. “The meals we consume is low-quality, there’s too little nourishment and it’s deficient in vitamins.

“If we were at home, we could’ve adjusted our lives. You can go and farm produce, you can get a job, but here we’re reliant on what we’re provided.”

And what they are provided is a meager portion of grain, edible oil and salt, distributed every 60 days. Such a basic diet offers little sustenance, and the little cash she is given acquires minimal items in the regular markets, where values have increased.

Abubakar was moved to Alacha after arriving from Sudan in 2023, having run from the militia Rapid Support Forces’ attack on her birthplace of El Geneina in June that year.

Unable to get employment in Chad, her husband has gone to Libya in the desire to earning sufficient funds for them to follow. She resides with his relatives, distributing whatever meals they acquire.

Abubakar says she has already seen food distributions being reduced and there are concerns that the sudden reductions in overseas aid budgets by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having created the 21st century’s worst humanitarian disaster and the {scale of needs|extent