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For a long time, travelling roughly on the flooded dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and tried hard stopping herself vomiting. She was in labour, in agonizing discomfort after her womb tore, 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 hundreds of thousands of Sudanese displaced persons who escaped to Chad since 2023, living hand to mouth in this difficult terrain, are women. They reside in isolated camps in the desert with scarce resources, little employment and with healthcare often a perilously remote away.

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

“I continuously experienced infections during my gestation and I had to go the clinic on numerous visits – when I was there, the labour began. But I wasn’t able to give birth without intervention because my womb had given way,” says Mohammed. “I had to wait two hours for the ambulance but all I can think of the pain; it was so bad I became disoriented.”

Her parent, Ashe Khamis Abdullah, 40, feared she would suffer the death of her offspring and descendant. But Mohammed was immediately taken for surgery when she got to the hospital and an urgent C-section rescued her and her son, Muwais.

Chad previously recorded the world’s second most severe maternal mortality rate before the recent arrival of refugees, but the conditions endured by the Sudanese put even more women in peril.

At the hospital, where they have delivered 824 babies in mostly emergency conditions this year, the medics are able to rescue numerous, 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 erupted, over four-fifths of the people who reached and remained in Chad are women and children. In total, about one point two million Sudanese are being sheltered in the eastern part of the country, four hundred thousand of whom escaped the earlier war in Darfur.

Chad has taken the lion’s share of the over four million people who have escaped 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, abducted or conscripted. Those of adult age rapidly leave from Chad’s barren settlements to find work in the capital, N’Djamena, or elsewhere, in adjacent Libya.

It results in women are stranded, without the ability to sustain the children and the elderly left in their responsibility. To prevent congestion near the border, the Chadian government has moved individuals to more compact settlements such as Metche with typical numbers of about fifty thousand, but in distant locations with limited infrastructure and few opportunities.

Metche has a hospital set up by a medical aid organization, which started off as a few tents but has expanded to include an surgical room, but few additional amenities. There is no work, families must travel long distances to find firewood, and each person must subsist with about minimal water of water a day – well under the advised quantity.

This isolation means hospitals are treating women with problems in their pregnancy dangerously late. There is only a single ambulance to serve the area between the Metche hospital and the medical tent near the camp at Alacha, where Mohammed is one of close to fifty thousand refugees. The medical team has observed instances where women in extreme agony have had to endure a full night for the ambulance to arrive.

Imagine being expecting a child, in delivery, and travelling hours on a animal-drawn transport to get to a medical facility

As well as being rough, the path goes 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 arduous trips to the hospital by foot or on a pack animal.

“Imagine being in the late stages of pregnancy, in delivery, and journeying for an extended time on a animal-drawn vehicle to get to a clinic. The biggest factor is the delay but having to arrive under such circumstances also has an impact on the birth,” says the surgeon.

Undernourishment, which is increasing, also raises the chance of problems in pregnancy, including the womb tears that medical staff frequently observe.

Mohammed has remained in hospital in the two months since her C-section. Afflicted by malnutrition, she got sick, while her son has been regularly checked. The parent has gone to other towns in seek jobs, so Mohammed is completely reliant on her mother.

The malnutrition ward has grown to six tents and has individuals overflowing into other sections. Children are placed under mosquito nets in extreme warmth in almost complete silence as doctors and nurses work, mixing medications and assessing weights on a instrument created using a container and string.

In less severe situations children get small bags of PlumpyNut, the specifically created peanut paste, but the most severe instances need a daily dose of nutrient-rich liquid. 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 nasogastric tube. The child has been sick for the past year but Abubakar was consistently offered just painkillers without any medical assessment, until she made the trip from Alacha to Metche.

“Every day, I see more children arriving in this structure,” she says. “The food we’re eating is low-quality, there’s too little nourishment and it’s not nutritious.

“If we were at home, we could’ve adjusted our lives. You can go and grow crops, you can get a job, but here we’re dependent on what we’re distributed.”

And what they are provided is a small amount of grain, cooking oil and salt, distributed every 60 days. Such a basic diet offers little sustenance, and the meager funds she is given purchases very little in the local bazaars, where values have increased.

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

Failing to secure jobs in Chad, her spouse has traveled to Libya in the hope of raising enough money for them to join him. She resides with his family members, sharing out 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 make things worse. Despite the war in Sudan having produced the 21st century’s most severe crisis and the {scale of needs|extent