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For an extended period, travelling roughly on the flooded dirt track to the hospital, 18-year-old Makka Ibraheem Mohammed gripped firmly to her seat and focused on stopping herself being sick. She was in childbirth, in severe suffering after her uterine wall split, but was now being jostled relentlessly in the ambulance that jumped along the potholes and ridges 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 reside in secluded encampments in the desert with insufficient supplies, no work and with treatment often a perilously remote away.

The hospital Mohammed needed was in Metche, another refugee camp more than 120 minutes away.

“I kept getting infections during my pregnancy and I had to go the medical tent 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 confused.”

Her mother, Ashe Khamis Abdullah, 40, worried she would suffer the death of her offspring and descendant. But Mohammed was immediately taken for surgery when she arrived at 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 death rate before the ongoing stream of refugees, but the conditions endured by the Sudanese expose further women in danger.

At the hospital, where they have birthed 824 babies in mostly emergency conditions this year, the doctors are able to rescue numerous, but it is what affects the women who are fail to get to the hospital that worries the staff.

In the two years since the civil war in Sudan started, over four-fifths of the refugees who have arrived and stayed in Chad are females and minors. In total, about one point two million Sudanese are being sheltered in the east of the country, four hundred thousand of whom fled the earlier war in Darfur.

Chad has taken the lion’s share of the over four million people who have fled the war in Sudan; some have travelled to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been uprooted from their homes.

Many males have not left to be in proximity to homes and land; some were killed, abducted or forced into fighting. Those of adult age soon depart from Chad’s desolate refugee camps to find work in the capital, N’Djamena, or beyond, in neighbouring Libya.

It results in women are stranded, without the ability to provide for the dependents left in their charge. 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 was initially a few tents but has grown to feature an surgical room, but not much more. There is no work, families must journey for extended periods to find burning material, and each person must subsist with about minimal water of water a day – much less than the suggested amount.

This isolation means hospitals are admitting women with problems in their pregnancy when it is almost too late. There is only a sole emergency vehicle 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 encountered situations where women in extreme agony have had to remain overnight for the ambulance to come.

Imagine being expecting a child, in childbirth, and making a lengthy trip on a donkey-drawn vehicle to get to a medical facility

As well as being bumpy, the path goes through valleys that become inundated during the rainy season, completely preventing travel.

A surgeon at the hospital in Metche said all the situations she encounters is an critical situation, with some women having to make challenging travels to the hospital by foot or on a donkey.

“Imagine being in the late stages of pregnancy, in childbirth, and travelling hours on a animal-drawn vehicle to get to a clinic. The main problem is the lag but having to arrive under such circumstances 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 womb tears that medical staff see regularly.

Mohammed has stayed at the medical facility in the couple of months since her surgical delivery. Experiencing malnutrition, she got sick, while her son has been regularly checked. The male guardian has journeyed to other towns in search of work, so Mohammed is totally dependent on her mother.

The nutritional care section has grown to six tents and has patients spilling over into other sections. Children are placed under mosquito nets in oppressive temperatures in almost utter stillness as doctors and nurses work, mixing medications and assessing weights on a device constructed from a pail and cord.

In less severe situations children get small bags of PlumpyNut, the uniquely designed peanut paste, but the worst cases need a daily dose of fortified formula. Mohammed’s baby is administered his nutrition through a syringe.

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being given nutrition by a nose tube. The baby has been sick for the past year but Abubakar was consistently offered just painkillers without any diagnosis, until she made the trip from Alacha to Metche.

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

“If we were at home, we could’ve coped better. You can go and grow crops, you can get a job, but here we’re relying on what we’re given.”

And what they are given is a small amount of sorghum, cooking oil and salt, handed out every 60 days. Such a basic diet offers little sustenance, and the meager funds she is given acquires minimal items in the local bazaars, where values have increased.

Abubakar was transferred to Alacha after coming from Sudan in 2023, having run from the militia Rapid Support Forces’ raid on her home city of El Geneina in June that year.

Finding no work in Chad, her husband has gone to Libya in the aspiration to earning sufficient funds for them to join him. She lives with his kin, sharing out whatever food they can get.

Abubakar says she has already observed food distributions being reduced and there are worries that the sudden reductions in foreign support money by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having produced the 21st century’s worst humanitarian disaster and the {scale of needs|extent