Syrian mothers make a painful journey to access health care

Maryam Daher, 33, is being treated at a hospital supported by Jordan-based Doctors Without Borders, which provides services in northwest Syria. Mary had lost her fetus. She rode 20 kilometers with her 18-year-old son on a motorcycle to reach the hospital.

“There was no ambulance available near my home,” she says “I was exhausted when I arrived, wondering how I was going to make the trip home after the surgery. “

As a result of the war that devastated Syria for 13 years, the two earthquakes that hit the country in February 2023, and the lack of health infrastructure, pregnant women and new mothers find it difficult to care essential health, especially in northwestern Syria. .

Emergency health services

In the past, women in northwestern Syria had many hospitals and clinics providing maternity care services, but many of them were destroyed due to bombings and acts of violence. Now, not many places accept pregnant women and new mothers.

As a result of this situation, women rely on a limited number of resources to continue working, since they are separated by long distances, and have to make an unsafe journey on damaged roads and as a result on security risks.

Aisha Mansour, who is 61 years old, explains this way, saying, “When it was time for my daughter-in-law to give birth, we ran to the nearest hospital to our house, only to find it closed due to lack of funding, according to the guard in front of the hospital.

According to reports from the United Nations Health Organization in northwestern Syria, 160 health facilities were at risk of total or partial closure since last June, including nine facilities designated for special health care. A report says The United Nations Office for the Coordination of Humanitarian Affairs announced at the end of July that 50 percent of all operational health facilities will suspend their operations in whole or in part by next December due to increased funding. less.

Although some health facilities are still functioning, services for women are still limited due to the lack of specialized doctors, such as obstetricians and gynecologists, and the lack of medical equipment, medicines and other supplies. When women need to go into hospital, they are often not found.

The medical reference for Doctors Without Borders in northwestern Syria, Chiara Martinotta, explains that the special doctors “have either been displaced or migrated to nearby or distant countries in search of better opportunities .” This has led to “a shortage of obstetricians and gynecologists providing advanced maternity care, increasing the burden on remaining health resources that are already burdened by patient needs.”

Social restrictions

Another problem Syrian women face in accessing health care is the reluctance to go to hospitals for fear of “social stigma and prejudice” which makes it a shame for a woman to announce that she is pregnant.

Kawthar Ali, a 23-year-old displaced mother from Aleppo, says, “Many women regret when they find out they are pregnant, because they face harsh criticism from society because of the poor living conditions and the difficult life in the camps that more children will increase the challenges.”

Doctors Without Borders explains that abortions cannot be given to women without their husbands signing prior consent in facilities supported by the organization, attributing this to “the cultural norms in the area.” Early pregnancy is also one of the “urgent challenges” related to social norms, according to the organization, which indicates that in 2024 one in four women aged 19 years or younger will have visited on the maternity hospitals it supports.

The director of obstetrics at Doctors Without Borders in northwestern Syria, Fatima Al-Naasan, says, “We found a woman who died of severe bleeding, and when the midwife examined her, she found a serious injury clearly visible on her mother that the man wanted to go to a traditional midwife despite the existence of a health facility near their home.

In addition, pregnant women must be accompanied by a male relative to receive health services, and must then obtain their consent before deciding whether to receive care, leading to delays in their access to medical services and which affects their ability to travel to reach the hospital. or a clinic at the right time, especially if it is difficult to find a partner.

The impact of the crisis

As inflation worsens and prices rise in Syria, families cannot afford private consultations or surgeries.

Poverty is widespread in the region, and many pregnant women suffer from anemia or severe malnutrition. In August 2023, the humanitarian organization’s nutrition group in northwestern Syria estimated that 7 to 15 percent of pregnant and breastfeeding women in the governorates of Idlib and Aleppo were likely to suffer from malnutrition.

Khaled Youssef, one of the displaced people living in Jindires district and a father of seven children, says, “I had to buy medicine from a private pharmacy because it was not available in the hospital Our living conditions are bad, and I am unable to buy medicines.”

The situation becomes more difficult due to the lack of families with two breadwinners, since not every family out of five in many of the displacement camps covered by MSF missions bring in an adult male to take care of family matters.

Because of all these conditions, pregnant women have no choice but to contribute to generating income by working in agriculture, which increases the risks to the health and safety of their fetuses.

The situation is getting worse for displaced people who live in dilapidated tents on private land. They have to endure difficult conditions through harsh winters and broken summers. What makes the situation more difficult is that some of them are in danger of being evicted by landowners who want to evict them and take them back.

This disturbing trend was confirmed in the 2024 estimates that included some camps in Aleppo and Idlib in northwestern Syria where Doctors Without Borders is working. With further funding cuts expected, access to basic food services could decline, putting women and babies at greater risk.

Field movements

However, organizations such as Doctors Without Borders try to overcome this situation through various initiatives. Since 2023, MSF teams in northwestern Syria have assisted with more than 25,500 births, performed more than 5,500 cesarean sections, and provided more than 111,000 medical consultations to mothers.

The group is trying to build a new maternity hospital in the Jenderes area to help deal with the severe shortage of maternity facilities. This hospital will provide maternity. In addition, work is underway to expand the scope of maternity services at Al-Shahba Hospital in the city of Mare’, where it will provide caesarean section services, surgery and care for babies , and also receiving referrals from other health facilities in northwestern Syria.

“The urgent need to remove the barriers that delay or prevent pregnant women from receiving care in northwest Syria cannot be ignored,” said Siham Hajjaj, head MSF’s mission in northwest Syria. ” MSF appeals to “International donors to address the great maternal needs and increase support at the basic and special levels.”