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For a long time, jolting along the waterlogged 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 delivery, in agonizing discomfort after her uterus ruptured, but was now being jostled relentlessly in the ambulance that lurched across the uneven terrain of the road through the Chadian desert.

Most of the 878,000 Sudanese displaced persons who escaped to Chad since 2023, surviving precariously in this difficult terrain, are women. They reside in secluded encampments in the desert with scarce resources, few job opportunities and with healthcare often a life-threateningly long distance away.

The hospital Mohammed needed was in Metche, a different settlement more than 120 minutes away.

“I repeatedly suffered from infections during my term and I had to go the health post multiple occasions – when I was there, the labour began. But I wasn’t able 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 agony; it was so intense I became delirious.”

Her parent, Ashe Khamis Abdullah, 40, feared she would lose both her daughter and baby grandson. But Mohammed was rushed straight into surgery when she reached the hospital and an urgent C-section rescued her and her son, Muwais.

Chad was known for the world’s second-highest maternal fatality statistic before the recent arrival of refugees, but the conditions endured by the Sudanese place additional women in peril.

At the hospital, where they have birthed 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 fail to get to the hospital that concerns them.

In the 24 months since the civil war in Sudan began, the vast majority of the displaced persons who came and stayed in Chad are women and children. In total, about 1.2 million Sudanese are being hosted in the eastern region of the country, 400,000 of whom ran from the earlier war in Darfur.

Chad has taken the lion’s share of the millions of people who have escaped the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been displaced from their homes.

Many adult men have remained to be close to homes and land; others have been murdered, abducted or conscripted. Those of employable age soon depart from Chad’s isolated encampments to look for jobs in the capital, N’Djamena, or beyond, in adjacent Libya.

It implies women are left alone, without the resources to feed the young and old left in their responsibility. To reduce density near the border, the Chadian government has transferred refugees to smaller camps such as Metche with typical numbers of about a large community, but in distant locations with no services and minimal chances.

Metche has a hospital built by a medical aid organization, which started off as a few tents but has grown to feature an surgical room, but not much more. There is unemployment, families must walk hours to find firewood, and each person must subsist with about minimal water of water a day – far below the advised quantity.

This seclusion means hospitals are treating women with issues in their pregnancy when it is almost too late. There is only a one medical transport to cover the route between the Metche hospital and the clinic near the Alacha encampment, where Mohammed is one of nearly 50,000 refugees. The medical team has observed instances where women in severe suffering have had to remain overnight for the ambulance to come.

Imagine being nine months pregnant, in delivery, and making a lengthy trip on a animal-drawn transport to get to a hospital

As well as being rough, the route passes through valleys that flood 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 on foot or on a pack animal.

“Imagine being nine months pregnant, in childbirth, and making a long trip 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 effect on the childbirth,” says the surgeon.

Poor nutrition, which is increasing, also raises the chance of complications in pregnancy, including the womb tears that medical staff see regularly.

Mohammed has continued under care in the couple of months since her C-section. Experiencing malnutrition, she developed an infection, while her son has been carefully monitored. The parent has journeyed to other towns in search of work, so Mohammed is totally dependent on her mother.

The nutritional care section has increased to six tents and has cases exceeding capacity into other sections. Children lie under mosquito nets in oppressive temperatures in almost total quiet as health workers work, mixing medications and assessing weights on a scale made from a pail and cord.

In mild cases children get sachets of PlumpyNut, the uniquely designed peanut paste, but the worst cases need a consistent supply of fortified formula. Mohammed’s baby is administered his nutrition through a injector.

Suhayba Abdullah Abubakar’s infant son, Sufian Sulaiman, is being fed through 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 additional kids coming in in this structure,” she says. “The meals we consume is inadequate, there’s not enough to eat and it’s deficient in vitamins.

“If we were at home, we could’ve adjusted our lives. You can go and cultivate plants, you can find employment, but here we’re dependent on what we’re given.”

And what they are provided is a meager portion of grain, edible oil and salt, handed out every two months. Such a basic diet is deficient in nutrients, and the little cash she is given purchases very little in the local bazaars, where costs have risen.

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

Failing to secure jobs in Chad, her partner has traveled to Libya in the aspiration to gathering adequate cash for them to join him. She stays with his family members, distributing whatever meals they acquire.

Abubakar says she has already witnessed food supplies decreasing and there are worries that the abrupt cuts in overseas aid budgets by the US, UK and other European countries, could make things worse. Despite the war in Sudan having produced the 21st century’s worst humanitarian disaster and the {scale of needs|extent