Credit: Save the Children/Hedinn Halldorsoon, EU Humanitarian Aid and Civil Protection on Flickr, under Creative Commons
(WOMENSENEWS)--Samira was 5 months pregnant when she had to leave her village in Syria with her four children. Her husband was killed during the fighting and she had to find a safe place for her family.
It took two months for Samira to get a shelter, says Save the Children in its March 10 report "A Devastating Toll: The impact of three years of war on the health of Syria's children." Samira and other names in the report were changed to protect their identities.
The difficulties Samira endured trying to ensure her family's survival triggered her labor at 7 months of pregnancy. "There was no hospital or medical staff nearby so the other women helped me," she says in the report. "My baby was born so prematurely and there was no special care to help him survive. He lived just two hours."
While the report has been stirring widespread media attention about the toll of the war on infants and children, it also flags the suffering of women who need antenatal, delivery and postnatal care in a country where three years of civil war has caused hospitals and routine health care to collapse. While 96 percent of mothers in Syria had medical assistance when giving birth before the conflict, now medical services for women are almost inexistent.
"We witnessed a woman giving birth on the doorstep of a hospital," says a doctor in the report. "When the building was hit, my colleague was providing care and he was trying to deliver the baby . . . They managed to get away but the hospital was flattened. They survived, but giving birth at the door of a hospital under such stress is indescribable."
The report offers horrific detail about the consequences of Syria's ruined health system. Children are having limbs amputated because clinics lack the necessary equipment to treat them. Patients are opting to be knocked out with metal bars for lack of anesthesia. Parents are arriving at hospital to find no medical staff and hooking up children themselves to intravenous drips.
In the parts of the report that focus on the deterioration of health care for women, Save the Children, the humanitarian aid group based in Westport, Conn., underlines a lack of ambulances, the scarcity of female hospital staff and frequent checkpoints and roadblocks encountered by women on the way to hospitals.
A recent assessment of 121 sub-districts in Syria showed that less than a quarter had regular access to reproductive services. In some besieged areas, such as parts of Homs, there are no reproductive services at all. "In some areas there are no midwives and the nearest one may be 20–30 minutes away," authors quote a doctor as saying. "The woman in labor has to be transported to the midwife and sometimes the only transportation available is a motorbike. This is extremely difficult and uncomfortable for the woman in labor and adds additional stress due to the unpredictability of traveling in an insecure environment to deliver her baby."
Most of the time now, midwives have run out of the medicines and equipment required for deliveries.
Authors note that the incidence of C-sections has more than doubled--to 45 percent in 2013 from 19 percent in 2011--as women choose to schedule their deliveries rather than risk going into labor in an insecure context. But C-sections entail major risks in war-time conditions where hospitals lack staff, medicines, equipment and face frequent power outages.
C-section risks for the mother can include infections, complications from anesthesia, hemorrhage, blood loss and dangerous clots. For the baby, the procedure is linked to increase in premature births, breathing problems and generally lower health scores, related to babies being deprived of the stimulation they normally experience as they travel through the birth canal.
As soon as they are born, babies are facing an imminent death in Syria.
Premature babies are dying in their incubators as a result of frequent electricity cuts. In one area, five newborns died this way in one day, according to the report. Newborn babies have to be kept warm for at least four to six hours but the unpredictability of power and cold winter months have made it difficult to guarantee such conditions.
For the newborns who do survive, Save the Children emphasizes the importance of breastfeeding in a context where diseases and infections are prevalent. Breast milk provides important protection for newborns in the form of antibodies needed to fight disease and valuable nutrients that infant formula does not contain, according to the report.
Save the Children says that 22 percent of newborn deaths could be prevented globally if babies were breastfed in the first hour of life.
Breastfeeding, however, was not widespread in Syria prior to the conflict with only 43 percent of children under 6 months exclusively breastfed. Breast-milk substitutes were widely used. However, the government of Syria has been controlling the production and distribution of infant formula through pharmacies. Now, the conflict has broken this supply network.
With the deteriorating situation, even fewer mothers are breastfeeding and the feeding practices seem to be worsening, authors find.
A recent assessment from Dara'a, the city in southwestern Syria that was the starting point of the 2011 uprising against the regime, showed that rather than breastfeeding, people were using water and sugar for infant feeding. Myths and misconceptions have proliferated about women's ability to breastfeed in a crisis. "When you run away the milk runs away," a woman says in the report.
Hajer Naili is a New York-based reporter for Women's eNews. She has worked for several radio stations and publications in France and North Africa and specializes in Middle East and North Africa women in Islam.
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