How conflict, devastating earthquakes created a maternal health crisis in northwest Syria

Pregnancy and childbirth services in northwest Syria have been devastated by conflict, isolation and earthquakes, meaning displaced women and girls can access only the most basic health services. (AFP)
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Updated 17 August 2023
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How conflict, devastating earthquakes created a maternal health crisis in northwest Syria

  • Even prior to the February 6 earthquakes, pregnancy and childbirth facilities had been devastated by conflict
  • Early marriage, malnutrition and shattered health facilities have all contributed to rising maternal mortality

LONDON: Pregnancy and childbirth can be dangerous for expectant mothers under normal circumstances. But in Syria’s war-torn, earthquake-stricken northwest, bringing new life into the world has become a harrowing ordeal.

Early marriage, a common occurrence in a region where households face financial hardship and girls are vulnerable to gender-based violence, often means young mothers are not sufficiently developed to cope with the physical demands of childbirth.

Combined with the absence of specialized health facilities, a shortage of medical professionals, and the impact of malnutrition caused by the ongoing conflict and barriers to foreign aid deliveries, maternal mortality in northwest Syria is high.

A recent report by UNICEF (the UN Children’s Fund) revealed a decline in the nutritional status of children below the age of five and among pregnant and breastfeeding women in the region’s displacement camps and war-scarred communities.

Diana Al-Ali, founder of the local nongovernmental organization Suriana, told Arab News: “Many postpartum mothers in displacement camps suffer from severe anemia and vitamin deficiencies.

“There has been a shortage of medication and nutritious food. We managed to supply baby formula, but the food allocated for lactating mothers fell short. We tried our best to provide them with bread and clean drinking water.”

At least 2.3 million women and girls in northwest Syria cannot access adequate sexual and reproductive health services, according to Physicians for Human Rights. Even prior to the Feb. 6 earthquakes, health infrastructure had already been devastated in the fighting.




New mum, Abeer, gave birth after falling while pregnant during the Syrian earthquake. (Sonya Al-Ali Maara/ActionAid)

In the country’s northwest, the earthquakes damaged 55 health facilities, suspending services in 15 of them, according to a Medecins Sans Frontieres report published in March.

Al-Ali said: “After the quake struck, there were pregnant women who went into labor under rubble or after surviving the tremor. However, no organization aided these women immediately after the disaster.

“Armanaz in northwestern Idlib, where Suriana operates, lacks a maternity hospital and clinics specialized in women’s reproductive health. Even the local hospital lacks gynecologists and only a midwife is available.”

Violet, a Syrian organization that runs two hospitals in Ein and in Azaz, has identified significant shortages in medications, equipment, and services, particularly those related to women’s reproductive health.

In part, these shortages were caused by the failure to renew a UN Security Council agreement that allowed for aid to enter northwest Syria directly via the Bab Al-Hawa border crossing from Turkiye.

The enclave, largely populated by families displaced by fighting elsewhere in Syria, is one of the last holdouts of the country’s armed opposition that rose up against Syrian President Bashar Assad’s regime following its crackdown on anti-government protests in 2011.

Years of regime shelling and air attacks have devastated the northwest region’s health infrastructure. According to Physicians for Human Rights, many among the traumatized population are too afraid to spend long in hospitals for fear they will be bombarded.

Russia, the Syrian government’s main international backer since 2015, vetoed the long-established Bab Al-Hawa agreement in July, requiring all humanitarian deliveries to pass through Damascus instead before their onward distribution to opposition-held areas.




Early marriage, malnutrition and shattered health facilities have all contributed to rising maternal mortality. (AFP)

Mohamad Isso, Violet’s health projects manager, told Arab News: “With the non-renewal of the cross-border resolution, we are highly concerned about the continuity of the essential health service that is completely dependent on the cross-border humanitarian operations.”

Thankfully, for the 4.6 million people in northwest Syria who depend on this vital aid corridor, a deal was reached with Damascus on Aug. 9 to reopen the crossing to humanitarian assistance for the next six months — when it will again be subject to renewal.

In the face of these interruptions to the flow of aid, Violet’s hospitals managed to provide medical consultations to at least 3,967 women and infants in June alone.

Of these, 428 were childbirths, both natural and cesarean section, 1,183 were consultations in the outpatient clinics, 262 were infant inpatients, and 2,094 were infant consultations.

Isso said: “While health centers do exist, they do not fully address women’s needs for reproductive health services.

“Despite the continuing collaborative efforts of various local and international organizations, including but not limited to the UN, significant gaps persist. These gaps include a shortage of medications, with patients often required to acquire medicines on their own for use during hospitalization.”

Isso also highlighted a shortage of services in essential facilities, such as laboratories and advanced imaging, which are particularly important for the early detection of growths, including breast and cervical cancer.

FASTFACTS

* Of the 4.6m people in northwest Syria, 63% are IDPs, of whom almost 80% are women and children.

* 2.3m women and girls do not have easy access to medical care, including sexual and reproductive health.

* Although 40% of the population live in camps, only 18% of all health facilities are in camp settings.

(Source: Physicians for Human Rights)

“In addition, there is a scarcity of human talent and expertise due to the severe brain drain, as medical cadres have been migrating to Europe and other parts of the world,” Isso added.

There is also the question of access, with many women and girls struggling to reach centers that offer reproductive health services.

“Access difficulties are the result of several factors, including geographical distance, insufficient financial means, or limited transportation options. This situation is particularly relevant for girls of childbearing age and newly married women.

“Women’s ability to access healthcare centers depends on having a companion such as a spouse or a guardian present for support or protection. This requirement further complicates women’s ability to schedule their visits to doctors,” Isso said.

Those health facilities that do exist are often located in overcrowded urban areas, stretching staff and services to their limit. Meanwhile, rural areas are badly underserved.

“The presence of a healthcare center depends on the location. In the city of Idlib, for instance, there are health centers and hospitals that provide integrated reproductive health services, but they are always crowded due to the population density,” Isso added.

In the displacement camps where Violet operates, Isso noted that “the health facilities are either a mobile clinic or a primary healthcare center.” These clinics “are equipped with basic materials for examinations, and often suffer a shortage of medicines” and “the sole medical professional available is a midwife.”

Other camps are not so well equipped.




A pregnant Syrian woman walks at a refugee camp in the city of Tyre, in southern Lebanon. (Reuters/File Photo)

 Al-Ali said: “There is no mobile clinic (where Suriana operates) to service women and provide them with medicines, necessary vitamin supplements, or sanitary products.

“For a long time after the quake, there were no nearby washrooms for displaced women. Postpartum mothers had to walk long distances just to use the bathroom (until charitable organizations built new restrooms for them).”

The lack of adequate services is especially dangerous for minors, many of whom were forced into early marriage as their parents could no longer afford to keep them, such is the financial desperation of displaced households.

Complications in childbirth are more common among these young mothers.

Hamzah Barhameyeh, advocacy and communication manager at the child-focused charity World Vision, told Arab News that conflict and economic collapse were the primary drivers behind the rise in the number of child marriages.

He said: “People in northwest Syria are struggling to make ends meet. A (seemingly) reasonable way out is to marry off their daughters at a young age to relieve themselves of some of the economic burdens they are facing.

“With the recent earthquake, we are expecting a dramatic rise in child marriage.”

Barhameyeh pointed out that World Vision’s support “takes a holistic approach,” aiding children, families, and their communities through projects aimed at tackling malnutrition, which includes direct food support to pregnant and lactating mothers.

Another focus was the provision of mental health support to mothers and their children as a preventive measure, he added.

Suriana, meanwhile, was now preparing training courses tailored specifically for new mothers to help them look after themselves and their infants.

“But our efforts need support from other bodies, which can provide mobile infirmaries to help mothers care for their health and their newborns,” Al-Ali added.

 


Lebanon has ‘more’ to do on Hezbollah disarming: US deputy envoy

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Lebanon has ‘more’ to do on Hezbollah disarming: US deputy envoy

Lebanese authorities “have done more in the last six months than they probably have in the last 15 years,” Ortagus said
“However, there’s a lot more to go“

DOHA: Lebanon still has “more” to do in disarming Hezbollah following the war between the Iran-backed group and Israel, Deputy US Envoy for the Middle East Morgan Ortagus said Tuesday.

As part of a deal agreed to end 14 months of fighting last November, Hezbollah was to withdraw its fighters north of Lebanon’s Litani River, while Israel was to pull all its forces from south Lebanon.

The Lebanese army has been deploying in the area as Israeli forces have withdrawn and has been dismantling Hezbollah infrastructure there.

UN peacekeepers are also present in the area and play a role in supervising the ceasefire.

Lebanese authorities “have done more in the last six months than they probably have in the last 15 years,” Ortagus said at the Qatar Economic Forum referring to efforts to disarm Hezbollah.

“However, there’s a lot more to go,” she added.

“We in the United States have called for the full disarmament of Hezbollah. And so that doesn’t mean just south of the Litani. That means in the whole country,” Ortagus said at the Qatar conference calling on Lebanese politicians “to make a decision.”

It has also continued to launch raids on its neighbor despite the ceasefire.

Last month, President Joseph Aoun said the army was deployed in more than 85 percent of Lebanon’s south, and that the sole obstacle to full control across the frontier area was “Israel’s occupation of five border positions.”

In defiance of the ceasefire agreement, the Israeli military continues to occupy five positions close to the border that it has declared to be strategic.

Drought-hit Syrian farmers hope sanctions reprieve will restore agriculture

Updated 22 min 58 sec ago
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Drought-hit Syrian farmers hope sanctions reprieve will restore agriculture

ALEPPO: Severe drought in Syria this year could lead to the failure of an estimated 75 percent of local wheat crops, according to the United Nations’ Food and Agriculture Organization, threatening the food security of millions of people.
Toni Ettel, the FAO’s representative in Syria, told Reuters the agency anticipated a “food shortage of 2.7 million tons of wheat for this year, which is sufficient to feed 16.3 million people over one year.”
Under former President Bashar Assad, Damascus depended on wheat imports from Russia to support a bread subsidy program during past droughts.
Wheat farmers like Asaad Ezzeldin, 45, have seen their crops fail due to the drought. It has further strained Syria’s beleaguered agricultural sector that suffered from fighting and heavy bombardment during 13 years of civil war.
“Agriculture in Aleppo’s northern countryside has been hit because of the lack of irrigation. There is no rainfall,” he said.
Moscow, a staunch ally of Assad, suspended wheat supplies to Syria soon after Islamist rebels toppled him, citing uncertainties about the country’s new authorities.
In a surprise announcement last week, US President Donald Trump said he would order the lifting of all sanctions on Syria. Washington is likely to begin providing some sanctions relief in the coming weeks.
The flow of funds could revive the agriculture sector, providing much-needed technologies for irrigation and infrastructure renewal, Ettel said.
Unable to buy wheat and fuel, Syria’s new government had lobbied for a lifting of the sanctions that for years isolated the Syrian economy and made it dependent on Russia and Iran.
Syria’s agriculture ministry did not reply to a request for comment.
European Union foreign policy chief Kaja Kallas said on Tuesday she hoped ministers would reach an agreement on lifting EU economic sanctions on Syria. The EU has already eased sanctions related to energy, transport and reconstruction, and associated financial transactions, but some argued this was not enough to support its political transition and economic recovery.


UK sanctions Israeli settlers in West Bank

Updated 24 min 41 sec ago
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UK sanctions Israeli settlers in West Bank

Britain said on Tuesday it had sanctioned a number of individuals and groups in the West Bank who it said had been linked with acts of violence against Palestinians.


Syria FM says sanctions relief shows ‘international will’ to support country

Updated 29 min 17 sec ago
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Syria FM says sanctions relief shows ‘international will’ to support country

  • Lifting sanctions expresses the regional and international will to support Syria, said Al-Shaibani

DAMASCUS: The Syrian Arab Republic’s foreign minister said on Tuesday that the lifting of sanctions on his country shows an “international will” to support his country, after EU countries agreed to end most of its sanctions.

In a press conference in Damascus alongside his Jordanian counterpart, Asaad Al-Shaibani said that “lifting sanctions expresses the regional and international will to support Syria,” adding that “the Syrian people today have a very important and historic opportunity to rebuild their country.”


Syria’s driest winter in nearly 7 decades triggers a severe water crisis in Damascus

Updated 42 min 26 sec ago
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Syria’s driest winter in nearly 7 decades triggers a severe water crisis in Damascus

  • Now, there is only a trickle of water following the driest winter in decades
  • “I have been working at the Ein Al-Fijeh spring for 33 years and this is the first year it is that dry,” Bashi said

BARADA VALLEY, Syria: Inside a mountain above the Syrian Arab Republic's capital, Hassan Bashi walked through tunnels that used to be filled with water from a spring famous for its pure waters.

The spring rises inside the ruins of a Roman temple in the Barada Valley and flows toward Damascus, which it has been supplying with drinking water for thousands of years. Normally, during the winter flood season, water fills all the tunnels and washes over much of the temple.

Now, there is only a trickle of water following the driest winter in decades.

Bashi, who is a guard but also knows how to operate the pumping and water filtration machines in the absence of the engineer in charge, displayed an old video on his cell phone of high waters inside the ruins.

“I have been working at the Ein Al-Fijeh spring for 33 years and this is the first year it is that dry,” Bashi said.

The spring is the main source of water for 5 million people, supplying Damascus and its suburbs with 70 percent of their water.

As the city suffers its worst water shortages in years, many people now rely on buying water from private tanker trucks that fill from wells.

Government officials are warning that the situation could get worse in the summer and are urging residents to use water sparingly while showering, cleaning or washing dishes.

“The Ein Al-Fijeh spring is working now at its lowest level,” said Ahmad Darwish, head of the Damascus City Water Supply Authority, adding that the current year witnessed the lowest rainfall since 1956.

The channels that have been there since the day of the Romans two millennia ago were improved in 1920 and then again in 1980, he said.

Darwish said the springwater water comes mainly from rainfall and melted snow off the mountains along the border with Lebanon, but because of this year’s below-average rainfall, “it has given us amounts that are much less than normal.”

There are 1.1 million homes that get water from the spring, and in order to get through the year, people will have to cut down their consumption, he said.

The spring also feeds the Barada River that cuts through the capital. It is mostly dry this year.

In Damascus’s eastern area of Abbasids, Bassam Jbara is feeling the shortage. His neighborhood only gets water for about 90 minutes a day, compared with previous years when water was always running when they turned on the taps.

Persistent electricity cuts are making the problem worse, he said, as they sometimes have water but no power to pump it to the tankers on the roof of the building. Jbara once had to buy five barrels of undrinkable water from a tanker truck that cost him and his neighbors $15, a large amount of money in a country where many people make less than $100 a month.

“From what we are seeing, we are heading toward difficult conditions regarding water,” he said, fearing that supplies will drop to once or twice a week over the summer. He is already economizing.

“The people of Damascus are used to having water every day and to drinking tap water coming from the Ein Al-Fijeh spring, but unfortunately the spring is now weak,” Jbara said.

During Syria’s 14-year conflict, Ein Al-Fijeh was subjected to shelling on several occasions, changing between forces of then- President Bashar Assad and insurgents over the years.

In early 2017, government forces captured the area from insurgents and held it until December when the five-decade Assad dynasty collapsed in a stunning offensive by fighters led by the Hayat Tahrir Al-Sham group, or HTS, of current President Ahmad Al-Sharaa.

Tarek Abdul-Wahed returned to his home near the spring in December nearly eight years after he was forced to leave with his family and is now working on rebuilding the restaurant he owned. It was blown up by Assad’s forces after he left the area.

Abdul-Wahed looked at the dry area that used to be filled with tourists and Syrians who would come in the summer to enjoy the cool weather.

“The Ein Al-Fijeh spring is the only artery to Damascus,” Abdul-Wahed said as reconstruction work was ongoing in the restaurant that helped 15 families living nearby make a living in addition to the employees who came from other parts of Syria.

“Now it looks like a desert. There is no one,” he said. “We hope that the good old days return with people coming here.”