In war-torn Syria, women’s health is increasingly precarious

On a cold and rainy day, a woman arrives with her husband on a motorbike at a hospital supported by Doctors Without Borders in the governorate of Idlib, in northwestern Syria. He is here to give birth. Ratiba, a displaced mother of four children, three of whom were born in the Syrian conflict, is raising her children in a tent and struggling to make ends meet. Like thousands of women in Syria, she was diagnosed with malnutrition during her pregnancy. As a result, he claimed to suffer from “constant dizziness, high blood pressure and fatigue”.

Ratiba is not alone in her situation. Today, northwestern Syria is home to 4 million people, including 2.7 million internally displaced people, 80% of whom are women and children. For more than a decade, MSF has seen firsthand how women, like the rest of the population, have been directly affected by the conflict and its consequences. Many live in precarious conditions and suffer from food insecurity. Existing challenges such as gender-based violence and child marriage further exacerbate women’s vulnerabilities. “Even the normal stages of a woman’s life, such as menstruation, pregnancy or breastfeeding, become a complex burden,” said Teresa Graceffa, MSF’s medical coordinator in Syria.


Access to health care is another major challenge due to insecurity, distance from health facilities and the cost of services and transport. “A woman from afar recently gave birth near the entrance to an MSF-supported hospital,” said Caroline Masunda, MSF’s medical contact in Syria. He waited until he had enough money to pay for transportation, as there was no ambulance available. This is worrying because late arrivals for delivery could lead to medical complications for both mother and baby. »

Eleven years of war have also damaged the mental health of women, and many of them suffer from anxiety, depression or post-traumatic stress disorder. Most of the women and adolescent girls who receive psychological support in MSF structures say that their distress is directly or indirectly linked to the conflict. “I recently referred a 25-year-old displaced mother of five to a mental health specialist because she was showing symptoms of depression. She was so overwhelmed with sadness that she could no longer breastfeed her newborn,” explains Soumaya, MSF health lawyer.

Since 2012, MSF has been providing sexual and reproductive health (SRH) services to women in northwestern Syria. This includes prenatal, postnatal and neonatal care; delivery management, including caesarean sections; gynecological visits, family planning and mental health support. In 2021, we assisted over 18,000 births in Aleppo and Idlib governorates and provided over 200,000 consultations through co-managed and supported hospitals, health centers and mobile clinics.

As humanitarian needs continue to grow, the fragile health system in northwest Syria faces structural challenges and funding gaps remain a major challenge.

In the refugee camps visited by MSF teams, women regularly express their concern about the reduced availability of maternity and childcare services. “Every time we go to the nearby hospital, we see fewer doctors and nurses, and most services are often not available,” says Fatima, a mother of seven who recently suffered a miscarriage. . “I learned that the hospital where my daughter was born is now closed,” she adds.


Over the past year, MSF has seen several health facilities and projects reduce their activities or close after losing funds. Additionally, hundreds of medical facilities were damaged or destroyed during the conflict. Many health workers have been killed or have fled the country. Essential drugs and medical supplies are often not available. All of this has had a negative impact on access to essential services for pregnant women, girls and their babies. As a result, MSF has scaled up its activities to respond to a 50% increase in deliveries in three of its co-managed hospitals, where cesarean deliveries also tripled in 2021. This increase continued in the first two months of 2022 .

It is clear that the humanitarian response is not matching the needs and there is an urgent need to increase funding for lifesaving activities, including sexual and reproductive health services, in the country. “Women in northwestern Syria need quality, long-term sexual and reproductive health services to lead healthy lives. This is definitely not the time to let them down,” says Dr Faisal Omar, MSF head of mission in Syria.


In northwestern Syria, MSF currently supports seven hospitals, including a burns ward, as well as 12 primary health care centers and 3 ambulances. In addition, MSF supports 11 mobile clinics serving IDP camps. The organization also runs water, sanitation and hygiene activities in nearly 100 IDP camps in the northwest.

In northeast Syria, MSF provides vaccination support in 12 sites. It runs a primary health clinic, a non-communicable disease control program, a mobile wound care clinic and a reverse osmosis plant to provide drinking water to Al-Hol. MSF also runs two non-communicable disease clinics and provides primary healthcare services, including treatment for tuberculosis in a detention centre. In addition, MSF supports a hospital, as well as an outpatient clinic which includes an emergency room, and has launched a nutritional programme.


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