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.

 


Sudan paramilitary drone strike hits border city near Eritrea: govt source

Updated 03 May 2025
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Sudan paramilitary drone strike hits border city near Eritrea: govt source

KHARTOUM: Sudanese paramilitaries have carried out a rare drone strike on the eastern city of Kassala, near the Eritrean border, a source from the rival army-aligned government said Saturday.
“A drone targeted the fuel storage area at Kassala airport,” the government source told AFP, blaming it on the paramilitary Rapid Support Forces and reporting no casualties or damage.


Gaza rescuers say three babies among 11 killed in Israel strike

Updated 03 May 2025
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Gaza rescuers say three babies among 11 killed in Israel strike

  • An overnight Israeli strike on the Khan Yunis refugee camp killed at least 11 people
  • Israel resumed its military offensive in Gaza on March 18 after a two-month truce

GAZA CITY: Gaza’s civil defense agency said Saturday that an overnight Israeli strike on the Khan Yunis refugee camp killed at least 11 people including three babies up to a year old.
Civil defense spokesman Mahmud Bassal reported 11 killed “after the bombardment of the Al-Bayram family home in the Khan Yunis camp” in southern Gaza at around 3:00 am (0000 GMT).
Bassal told AFP that eight of the dead had been identified and were all from the same extended family, including a boy and girl, both one-year-olds, and a month-old baby.
Contacted by AFP, the Israeli military did not immediately comment on the strike.
Israel resumed its military offensive in Gaza on March 18 after a two-month truce in its war against Hamas that was triggered by the Palestinian militant group’s October 7, 2023 attack.
On Friday the civil defense agency said Israeli strikes killed at least 42 people across the war-ravaged territory, which has been under a total Israeli blockade since March 2.
Israel halted aid deliveries to Gaza, saying Hamas had diverted supplies. Israel says the blockade is meant to pressure the militants into releasing hostages held in the Palestinian territory.
UN agencies have urged Israel to lift restrictions, saying that Gazans were experiencing a humanitarian catastrophe and warning of famine.


‘The janjaweed are coming’: Sudanese recount atrocities in RSF attack on a Darfur camp

Updated 03 May 2025
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‘The janjaweed are coming’: Sudanese recount atrocities in RSF attack on a Darfur camp

  • The RSF has repeatedly claimed Zamzam and nearby Abu Shouk Camp were used as bases by the military and its allied militias
  • The paramilitaries destroyed Zamzam’s only functioning medical center, killing nine workers from Relief International

CAIRO: Umm Al-Kheir Bakheit was 13 when she first came to Zamzam Camp in the early 2000s, fleeing the janjaweed, the infamous Arab militias terrorizing Sudan’s Darfur region. She grew up, married and had three children in the camp.
Now 31, Bakheit fled Zamzam as the janjaweed’s descendants — a paramilitary force called the Rapid Support Forces — stormed into the camp and went on a three-day rampage, killing at least 400 people, after months of starving its population with a siege.
Bakheit and a dozen other residents and aid workers told The Associated Press that RSF fighters gunned down men and women in the streets, beat and tortured others and raped and sexually assaulted women and girls.
The April 11 attack was the worst ever suffered by Zamzam, Sudan’s largest displacement camp, in its 20 years of existence. Once home to some 500,000 residents, the camp has been virtually emptied. The paramilitaries burned down large swaths of houses, markets and other buildings.
“It’s a nightmare come true,” Bakheit said. “They attacked mercilessly.”
The attack came after months of famine
The attack on Zamzam underscored that atrocities have not ended in Sudan’s 2-year-old war, even as the RSF has suffered heavy setbacks, losing ground recently to the military in other parts of the country.
Throughout the war, the RSF has been accused by residents and rights groups of mass killings and rapes in attacks on towns and cities, particularly in Darfur. Many of RSF’s fighters originated from the janjaweed, who became notorious for atrocities in the early 2000s against people identifying as East or Central African in Darfur.
“Targeting civilians and using rape as a war weapon and destroying full villages and mass killing, all that has been the reality of the Sudan war for two years,” said Marion Ramstein, MSF emergency field coordinator in North Darfur.
Zamzam Camp was established in 2004 to house people driven from their homes by janjaweed attacks. Located just south of el-Fasher, the capital of North Darfur province, it swelled over the years to cover an area 8 kilometers (5 miles) long by about 3 kilometers (2 miles) wide.
In the spring of 2024, the RSF clamped a siege around Zamzam as it moved against el-Fasher, one of the last strongholds of the Sudanese military in Darfur.
Many have died of starvation under the siege, Bakheit and others said. “For too long, there was no option but to eat grass and tree leaves,” she said.
Famine was declared in the camp in August after RSF attacks forced the UN and aid groups to pull out of Zamzam. A comprehensive death toll from the famine is not known.
Ahlam Al-Nour, a 44-year-old mother of five, said her youngest child, a 3-year-old, died of severe malnutrition in December.
The RSF has repeatedly claimed Zamzam and nearby Abu Shouk Camp were used as bases by the military and its allied militias. It said in a statement that it took control of the camp on April 11 to “secure civilians and humanitarian workers.” It denied its fighters targeted civilians. The RSF did not reply to AP’s questions on the attack.
‘The janjaweed are coming’
Bakheit, who lived on the southern edge of Zamzam, said she heard loud explosions and heavy gunfire around 2 a.m. April 11. The RSF started with heavy shelling, and people panicked as the night sky lit up and houses burst into flames, Bakheit said.
By sunrise, the RSF-led fighters broke into her area, storming houses, kicking residents out and seizing valuables, Bakheit and others said. They spoke of sexual harassment and rape of young women and girls by RSF fighters.
“The children were screaming, ‘The janjaweed are coming’,” Bakheit said.
About two dozen women who fled to the nearby town of Tawila reported that they were raped during the attack, said Ramstein, who was in Tawila at the time. She said the number is likely much higher because many women are too ashamed to report rapes.
“We’re talking about looting. We’re talking about beating. We’re talking about killing, but also about a lot of rape,” she said.
The paramilitaries rounded up hundreds of people, including women and children. Bakheit said fighters whipped, beat, insulted and sexually harassed her in front of her children as they drove her family from their home.
She said she saw houses burning and at least five bodies in the street, including two women and a boy, the ground around them soaked in blood.
The fighters gathered Bakheit and about 200 other people in an open area and interrogated them, asking about anyone fighting for the military and its allied militias.
“They tortured us,” said Al-Nour, who was among them.
Al-Nour and Bakheit said they saw RSF fighters shoot two young men in the head during the interrogation. They shot a third man in the leg and he lay bleeding and screaming, they said.
One video shared online by RSF paramilitaries showed fighters wearing RSF uniforms by nine bodies lying motionless on the ground. A fighter says he is inside Zamzam and that they would kill people “like this,” pointing to the bodies on the ground.
Much of the camp was burned
The RSF rampage, which also targeted Abu Shouk Camp north of el-Fasher, went on for days.
The paramilitaries destroyed Zamzam’s only functioning medical center, killing nine workers from Relief International. They killed at least 23 people at a religious school, mostly young students studying the Qur’an, according to the General Coordination for Displaced Persons and Refugees in Darfur.
Much of the south and east of the camp was burned to the ground, the General Coordination said.
Satellite imagery from April 16 showed thick black smoke rising from several active fires in the camp. At least 1.7 square kilometers (0.65 square miles) appeared to have been burned down between April 10-16, said a report by the Yale School of Public Health’s Humanitarian Research Lab, which analyzed and published the imagery. That is about 10 percent of the camp’s area.
The imagery showed vehicles around the camp and at its main access points, which HRL said were probably RSF checkpoints controlling entry and exit.
By April 14, only about 2,100 people remained in the camp, according to the UN’s International Organization for Migration.
An arduous journey
After being detained for three hours, Bakheit, Al-Nour and dozens of other women and children were released by the paramilitaries.
They walked for hours under the burning summer sun. Bakheit and Al-Nour said that as they passed through the camp, they went by burning houses, the destroyed main market and bodies of men, women, children in the streets, some of them charred.
They joined an exodus of others fleeing Zamzam and heading to the town of Tawila, 64 kilometers (40 miles) west of El Fasher. Al-Nour said she saw at least three people who died on the road, apparently from exhaustion and the effects of starvation and dehydration.
“The janjaweed, once again, kill and torture us,” Bakheit said. “Like my mother did about 20 years ago, I had no option but to take my children and leave.”


Israel carries out strikes on two Syrian cities, Syrian state news agency says

An Israeli fighter jet fires a rocket as it flies over an area near the Syrian capital Damascus on April 30, 2025. (AFP)
Updated 03 May 2025
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Israel carries out strikes on two Syrian cities, Syrian state news agency says

  • Israel bombed Syria frequently when the country was governed by Assad, targeting a foothold established by his ally Iran during the civil war

CAIRO: Israeli strikes targeted the vicinity of Syria’s Damascus, Hama and Daraa countryside late on Friday, Syrian state news agency SANA reported.
The strikes on Damascus countryside killed one civilian and injured four others in Hama, SANA added.
Israel’s repeated strikes on Syria act as a warning to the new Islamist rulers in Damascus, which Israel views as a potential threat on its border.
The Israeli army confirmed the strikes on Syria on Friday, saying it targeted “a military site, anti-aircraft cannons, and surface-to-air missile infrastructure.”
The Israeli army has previously said it targeted Syria’s military infrastructure, including headquarters and sites containing weapons and equipment, since mainly Sunni Muslim Islamist fighters toppled President Bashar Assad in December.
Earlier on Friday, Israel bombed an area near the presidential palace in Damascus, in its clearest warning yet to Syria’s new Islamist-led authorities of its readiness to ramp up military action, which has included strikes it said were in support of the country’s Druze minority.
Israel bombed Syria frequently when the country was governed by Assad, targeting a foothold established by his ally Iran during the civil war.

 


Sudan’s Rapid Support Forces claims to have seized strategic western town

Updated 02 May 2025
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Sudan’s Rapid Support Forces claims to have seized strategic western town

  • RSF paramilitaries say they took key town of Al Nahud in West Kordofan state
  • Area is home to the headquarters of the 18th Infantry Brigade

CAIRO: Sudan’s notorious paramilitary group claimed a “sweeping victory” Friday saying it took control of the key town of Al Nahud in West Kordofan state in a fight that intensified a day earlier.
A victory there by the Rapid Support Forces, or RSF, would mark a strategic loss for Sudan’s military in its war with the paramilitary force as the territory is home to the headquarters of the 18th Infantry Brigade.
The Sudanese army didn’t immediately comment on its social media channels on whether it lost Al Nahud to its rival.
Sudan’s Culture and Information Minister Khalid Ali Aleisir said on his Facebook account on Friday the RSF committed crimes against defenseless citizens in the town, looting their properties and destroying public facilities.
The RSF said on its Telegram channel Friday that it destroyed vehicles belonging to the army and seized their weapons and ammunition during the battle for Al Nahud. The paramilitary group also claimed that it managed to secure the city’s facilities and markets after defeating the army.
The war erupted on April 15, 2023, with pitched battles between the military and the RSF in the streets of the capital Khartoum that quickly spread to other parts of the country.
RSF attacks in Al Nahud have killed more than 300 unarmed civilians, the Preliminary Committee of Sudan Doctors’ Trade Union said on Facebook on Friday. The Associated Press couldn’t independently verify that figure.
The Resistance Committees of Al Nahud condemned the RSF attacks, which it said began Thursday morning.
“They invaded the city, stormed residential neighborhoods, terrorized unarmed civilians, and committed cold-blooded murders against innocent civilians whose only crime was to cling to their dignity and refuse to leave their homes to the machine of killing and terror,” the Resistance Committees said Thursday on Facebook.
An army loss of Al Nahud would impact its operational capabilities in Northern Kordofan state, according to the Sudan War Monitor, an open source collaborative project that has been documenting the two-year-war. Al Nahud is a strategic town because it’s located along a main road that the army could use to advance into the Darfur region, which the RSF mostly controls.
Al Nahud also shelters displaced people fleeing from Al-Obeid, Umm Kadada, Khartoum and El-Fasher — the provincial capital of North Darfur province, according to the Darfur Victims Support Organization.
Meanwhile, in North Darfur, the fighting has killed at least 542 people in the last three weeks, though the actual death toll is likely higher, according to UN Human Rights Chief Volker Türk. This figure includes the recent RSF attacks on El Fasher and Abu Shouk displacement camp, which killed at least 40 civilians.
“The horror unfolding in Sudan knows no bounds,” said Türk i n a statement on Thursday.
Türk also mentioned “extremely disturbing” reports of extrajudicial killings committed by RSF, with at least 30 men in civilian clothing executed by the paramilitary fighters in Al Salha in southern Omdurman.
“I have personally alerted both leaders of the RSF and SAF to the catastrophic human rights consequences of this war. These harrowing consequences are a daily, lived reality for millions of Sudanese. It is well past time for this conflict to stop,” said Türk.
The war in Sudan has killed at least 20,000 people, but the real toll is probably far higher. Nearly 13 million people have fled their homes, 4 million of them streaming into neighboring countries.
Half the population of 50 million faces hunger. The World Food Program has confirmed famine in 10 locations and warns it could spread further, putting millions at risk of starvation.