Bombing, displacement and devastating earthquakes have created a hostile environment for pregnant women and mothers in northwestern Syria, medical professionals have warned.
The region is torn by a 12-year conflict which began with the violent crackdown of peaceful protests against President Bashar al-Assad. But the conflict escalated more and more as regional and global powers got involved -- including the United States and Iran --as well as the Russian military coming in to support Syrian government forces, in a conflict that killed half a million Syrians and led to mass internal displacement.
The earthquakes that hit Syria and Turkey on Feb. 6 earlier this year and their subsequent aftershocks brought further damage and took at least 8,476 lives in Syria alone and -- according to the United Nations Population Fund in a report released after the earthquakes -- around 130,000 pregnant women were in urgent need to access reproductive health services.
Wajeeha Rahum, 35, was thrilled when she heard the news that she was pregnant.
"Our dream was Najeeb, a brother to our son, Ahmed, and they would raise each other, and I actually got pregnant, thank God," Rahum told ABC News.
Displaced by the war with her parents, she had gotten married late and taken over the care of her husband's child. The family now lives in rebel-held Idlib where Rahum works as a nurse.
But two months after she got pregnant her house began to shake violently and crack when she realized she was living through the terrifying moments of a massive 7.8 magnitude earthquake that rocked her city in the middle of the night.
"Everything stopped and I said, 'This is the Day of Resurrection, it's over,' and I watched the story be true ... it felt like hours, and suddenly I started bleeding," she told ABC News. "I began to feel severe pain, and after four days, the miscarriage occurred, unfortunately."
Rahum says she and her family are trying to adapt to these circumstances as best they can, but their tragedy started over a decade ago. "The world knows the torment we have been suffering from for years, whether displacement, living in camps, or bombing ... we hope the world will help us", she says.
To this day, despite multiple attempts at ceasefires, the rebel-held areas are still shelled every other day, including attacks on health care facilities.
Midwives observe that the psychological toll of conflict has direct -- and sometimes deadly -- consequences on reproductive health in the region, noting a rise of stress-induced miscarriages, stillbirths and premature births, health professionals say.
During pregnancy, women are regularly advised by family and doctors alike to rest and avoid stress. But in their conditions, pregnant women like Rahum suffer from high levels of mental pressure.
"Fear and anxiety … sometimes lead to miscarriages, premature births, and bleeding episodes," Halima Haj Ali, a midwife and a member of Sima, a medical association that provides care in rebel-held northwestern Syria, told ABC News.
What Haj Ali has seen is a drastic deterioration of the conditions for pregnancy and maternity, especially in the camps for the displaced.
"Whenever the bombing increases, of course the number of miscarriages among women will increase due to tension and fear," she says. "In the past few days, the pace of bombing has intensified on Qarat Jabal al-Zawiya, south of Idlib."
The impact on patients is not only psychological, however.
"Postpartum mothers suffer from cases of malnutrition," Haj Ali told ABC News, "and this affects the breastfeeding of the child and thus affects the child's health, and this is what we see through our mobile teams."
War-induced food insecurity is another major threat to reproductive health as mother and child malnutrition is on the rise, compounded by shortages of medicine, medical professionals and health care facilities.
Over 76,000 pregnant and breastfeeding women need treatment for acute malnutrition -- and so do many of their children, according to a report from the U.N.
"An estimated 51,000 children under the age of five are likely to suffer from moderate and acute malnutrition," says the report.
Syria's food insecurity "has in recent years been exacerbated by global events, such as the economic collapse of Lebanon, the COVID-19 pandemic, the war in Ukraine and February's earthquakes," according to the U.N.'s World Food Programme. To respond to the growing needs of this isolated population, NGOs like the US-based Syrian Emergency Task Force deliver bags of rice, lentils and other foodstuff, as well as baby formula and schoolbooks to camps for the internally displaced.
The conflict has also brought 2.9 million internally displaced persons to northwestern Syria and those hospitals are not fit to cope with the needs of a much bigger population.
Shortages in prenatal medicines and in beds for pregnant patients have led to some of these women not getting access to basic care, Haj Ali points out. Several dozen hospitals have been targeted by attacks since 2011, leaving the health sector in tatters, while many health professionals fled the country.
It is estimated that at least 2.3 million women and girls in northwest Syria do not have easy access to sexual and reproductive health services, according to Physicians for Human Rights -- chief among them are mothers and girls living in perilous and unsafe IDP camps.
These conditions can have life-altering effects on young women and their reproductive health and autonomy.
'The camp environment suffers from a high rate of early marriage," warns Haj Ali.
This societal grouping can often lack sufficient awareness of reproductive health and are not ready at their age to be pregnant or face a high-risk pregnancy and complications during childbirth and postpartum as a result of their weak physical structure, Haj Ali observes. The organization she works for provides services to medical facilities and mobile clinics in the city of Idlib and in rural areas, including natural and caesarean delivery, prenatal and postpartum health care and family planning amid challenging and unstable conditions.
Despite the human tragedies she faces with her patients there, Haj Ali continues to hope for the closure of IDP camps and the return to safety of their residents.
"I have a feeling that all countries have failed us," she says. "But I also have faith that injustice will not continue."