March 8, 2017

Women’s health and reproductive care in Syria have been disproportionately imperiled since the beginning of the conflict in 2011. In late 2016, as the siege of eastern Aleppo stifled the city’s civilian population and medical infrastructure, a group of brave medics on the ground continued providing care despite constant aerial threats. One of these medics, Dr. Farida, the last female obstetrician in besieged Aleppo, delivered babies in the most extreme circumstances.

Dr. Farida worked primarily at one of the SAMS-supported facilities in east Aleppo, M2, an OB/GYN and pediatric clinic. Every day, she witnessed the undue effects of the siege on every aspect of women’s health, from the lack of preventative care to the woefully inadequate nutrition for new mothers and their babies. Throughout the crisis, preventative care, obstetric care and reproductive care have suffered immensely from the lack of medical staff, equipment, supplies, and the risks elicited by a trip to the hospital.

In besieged eastern Aleppo, expecting mothers could not safely access medical facilities for routine check ups to ensure pregnancies were progressing as normal. When survival is at stake, mammograms, cervical screenings, and routine check-ups become an unattainable luxury for women in besieged areas. For many women, a trip to the hospital was impossible due to lack of fuel and the constant bombardment,. These circumstances led to deaths at home due to eclampsia or bleeding, according to Dr. Farida

IMG_8508 (1)In Syria, civilians are all too aware that hospitals are amongst the most dangerous places. Dr. Farida mentions that many women scheduled cesarean sections at night, when the likelihoods of attacks were lower. Dr. Farida recalls completing a c-section during a chemical attack, “As the hospital filled with chlorine gas, I had to place an oxygen mask on myself, my patient and my nurse, rushing to another hospital where we successfully completed the operation. It was one of those days when we had no other option but to leave the hospital to save their lives.”

Dr. Farida also witnessed the effects of violence that has largely targeted civilians, recalling women who lost their babies in attacks. One woman lost her baby due to shrapnel that entered her leg and travelled to her womb, completely splitting the baby in half.

Malnutrition also increased dramatically under the siege, severely impacting newborn babies and women’s health. According to Dr. Farida, babies born during this time were much smaller, weighing 3 kilograms or less. Critical supplies, such as milk and baby formula, were not allowed to enter the besieged area. New mothers, under a toxic amount of physical and emotional stress, faced difficulties breastfeeding, which was their only option to feed their children. Women’s menstrual cycles were interrupted or stopped completely. There was a complete lack of access to contraceptives, for example hormonal birth control or IUDs, with which to have agency over their reproductive health.

During the siege, only four midwives worked at M2 hospital. Dr. Farida played an instrumental role in training midwives and nurses in response to this shortage. She trained four nurses to be midwives. Despite her hospital being bombed out of service , Dr. Farida was determined to continue her work, moving to another hospital, M3.

“Midwives didn’t go to the hospital during last few weeks of siege, preferring to die in their homes,” said Dr. Farida.

Our SAMS-supported female physicians have shown steadfast resolve and determination in the face of unfathomable obstacles, determined to continue treating patients because they regard it as their duty. On International Women’s Day, we are especially grateful to the strong, determined Syrian women we have the privilege to work with, heroic women like Dr. Farida, whose determination to persist and rebuild has saved countless lives.