Syria is facing a reproductive health care crisis that is putting women and their babies at risk of serious issues, including death, a new report has found.
The report, released on Tuesday, documents the human cost of the 12-year conflict in the country and the consequences it has had for women. It was co-authored by Physicians for Human Rights (PHR), the International Rescue Committee (IRC), Syria Relief & Development (SRD) and Syrian American Medical Society.
The country’s health care infrastructure was already crippled by years of civil war. The strain on facilities only worsened after a series of earthquakes that hit Syria and Turkey last month. As a result, women’s mental and physical health took a hit, aid workers and physicians were operating beyond capacity, and life-saving resources remained scarce.
Access to reproductive care, in particular, has been hindered, and without immediate intervention, advocates and experts inside Syria told HuffPost that women’s lives are at stake.
“It’s important to recognize that behind these numbers, behind these pages of the report, we have horrifying stories about people and their bad experiences. Stories of losses of their children and their babies because of lack of services,” said Houssam Al-Nahhas, a Middle East North Africa researcher with PHR and lead author of the report.
Hospitals and health care facilities are nearly decimated, many targeted by airstrikes.
Since 2011, PHR has documented 601 attacks on medical facilities throughout Syria. Only 64% of hospitals and 52% of primary health care centers are functioning, while an estimated 70% of the health workforce has fled the country, according to a 2021 report by the IRC.
As a result, vulnerable populations continue to face life-threatening consequences. For example, half a million children are chronically malnourished, and roughly one-third of the population needs reproductive, maternal or neonatal health care.
This new report, which examined the impact of attacks on health care on sexual and reproductive health care services in northwest Syria from 2017 to 2022 and interviewed more than 260 women and health care workers, found that women were resorting to harmful coping practices, including delaying critical appointments. In addition, due to widespread poverty and intense fighting, many people from vulnerable populations were residing on the frontlines of the war, where housing was more affordable; meanwhile, civilian infrastructure, non-profit centers, and hospitals were relocating away from fighting zones.
Women living in those areas often had to make dangerous and expensive trips for medical appointments. They needed to pay for a private car to take the journey to see a doctor if they could afford it and were often worried about airstrikes that targeted medical facilities clustered in one region.
Some women hitchhiked rides if they couldn’t afford a private car. Many others didn’t make the trip, forgoing routine visits and not seeing a doctor until they delivered their babies.
The long, treacherous journey and targeted attacks on hospitals also meant a spike in cesarean births, a surgical procedure used to deliver a baby, which can be planned ahead of time but carries more risk than a vaginal delivery and requires a longer recovery.
According to the report, 12% of women had cesarean deliveries. In March 2020, that number jumped to 33% amid increased violence. Between January 2021 and September 2022, the average cesarean section rate was 23%.
Some women were unable to see a medical professional in time, contributing to a rise in maternal deaths, Okba Doghim, a physician and the programs director at SRD based in Syria and Turkey, told HuffPost.
Doghim recounted the story of a patient who was suffering from postpartum hemorrhage after delivery. The mother wasn’t able to reach the hospital in time. She died shortly thereafter.
If these women are lucky enough to make it to the hospitals, many are stuck waiting, contending with overloaded facilities, a lack of medical supplies, and proper doctors and staff. Additional barriers, such as the lack of information surrounding reproductive health, also contribute to maternal complications and even death, Doghim said.
After the earthquake, critical care centers languished even further. The surge in displaced populations, the destruction of roads, fuel shortages, and limited health care services and medical resources will likely impact as many as 148,000 pregnant women, 37,000 of whom are due to give birth in the next three months, according to the report.
“Even though Syria just got into the headlines recently because of the earthquake, it’s a long-term, protracted conflict that needs continuous attention. It’s not enough to support Syrians and the Syrian health system in the short term,” Al-Nahhas said. “It’s a long-term crisis that requires continuous attention and continuous support to make sure that communities will recover from the impact of the protracted conflict as well as this natural disaster.”