Obstacles to maternity care in northwest Syria endanger pregnant women

Many hospitals, few services

Historically, women in northwest Syria had access to numerous hospitals and clinics for maternal health care, but bombardment and overall violence have destroyed many of these facilities. Now there are fewer places where pregnant women and new mothers can enjoy safer delivery care and maternal health care, from prenatal through to postnatal care. 
Women must now rely on a small number of functional facilities at considerable distance from their homes, and undertake an uncertain journey due to either damaged roads or security risks. 

“When my daughter-in-law's due date arrived, we rushed to the hospital nearest to our home, only to find it closed because of no funding for it to operate, according to the guard outside the hospital,” said 61-year-old Aisha Mansour. “We then went to the neighboring city, but we were prevented from getting into the city due to fighting.”As of June 2024, 160 health facilities in northwest Syria were at risk of either complete or partial closure, according to the United Nations Organization for the Coordination of Humanitarian Affairs (OCHA).  Further, 50 percent of all functional health facilities will fully or partially suspend their activities by December 2024 due to funding cuts. 

Even though a small number of functioning health facilities remain, the services provided to women are limited due to a lack of specialized doctors, including OB-GYNs, medical equipment, medicines, and other consumables. 

“Specialized doctors are either displaced or have emigrated to neighboring countries and beyond, seeking better opportunities,” said Chiara Martinotta, MSF project medical referent in northwest Syria. “This resulted in a lack of obstetrician-gynecologists [OB-GYNs] to provide advanced maternity care, which has led to the remaining health care facilities being overburdened with patient needs.”  

Social constraints on health care access

"A woman arrived dead due to severe bleeding, and when she was examined by a midwife, there were severe injuries evident,” said Fatima Al-Nassan, MSF midwife supervisor in northwest Syria. “Her mother told us that there was a nearby health facility, but the husband insisted on taking her to a traditional birth attendant instead.”Pregnant women are frequently obliged to have a male escort when attending health care services, and are often required to obtain consent from a male relative before considering seeking health care in the first place. This can cause delays and affect pregnant women’s mobility in reaching a hospital or clinic in time, especially if it’s difficult to find a suitable escort. 

Women’s household responsibilities like caring for children and managing domestic tasks can significantly limit their ability to prioritize their own health. They may also  fear being judged due to social stigma, which can prevent them from seeking timely medical attention during pregnancy.

“A lot of women regret becoming pregnant,” said Kawthar Ali, a young mother displaced from Aleppo. “They face criticism from society due to the poor living conditions they are in, and the harsh life in camps. [Some people] believe that bringing more children would only increase their family's hardships.”Early pregnancy also remains a pressing issue tied to social norms. In 2024 alone, one in four mothers admitted to MSF supported maternity hospitals were 19 years old or younger. 

The impact of economic hardship

“I had to buy medicine from a private pharmacy because the hospital didn't have it,” said Khalid Yusuf, a displaced father of seven living in the Jindiris area. “Our living conditions are bad. I can’t afford to buy medicines.” 

Inflation has skyrocketed in Syria, making everything more expensive. Families can’t afford private consultations or surgical procedures. Poverty is widespread, and many pregnant women are anemic or severely malnourished. As of June 2024, more than 13 million Syrians, more than half the population, are facing high levels of acute food insecurity. Additionally, more than 650,000 children under the age of 5 show signs of stunting due to severe malnutrition, and a third of the country’s children live in food poverty, consuming just two or fewer food groups a day. 

In many internal displacement camps where MSF works, 1 in 5 families have no adult males in the household. 
With the loss of male breadwinners and soaring living costs, pregnant women have no choice but to participate in agricultural labor, often elevating risks to their health and the well-being of their unborn babies. 

The situation is worse for displaced people living in tents on private lands; they are forced to endure extreme conditions during harsh winters and scorching summers. To make matters worse, some are being threatened with eviction by landowners demanding their land back. 

Navigating a health care obstacle course

Pregnant women and new mothers living near the front lines face the ongoing dangers of getting caught in crossfire, becoming victims of violence, or being detained. 

Movements are heavily restricted by checkpoints, curfews, and military operations. Women and new mothers must assess these risks and barriers carefully before even leaving their homes to seek maternal care. This can cause delays or discourage them from seeking care outright. 

“The pressing need to address the barriers preventing and delaying pregnant women’s access to care in northwest Syria cannot be ignored,” said Siham Hajaj, MSF head of mission in northwest Syria. “With the funding cuts, the situation will only deteriorate. MSF urges international donors to recognize the high needs for maternity care and to increase support at both basic and specialist levels, allocating sufficient resources for the women and babies lives at risk.”

Our work in Syria

Since 2023, MSF teams in northwest Syria have assisted more than 25,500 deliveries, performed more than 5,500 cesarean sections, and completed more than 111,000 maternal consultations. However, the growing need for maternal care far outpaces current capacity, especially as funding for health care continues to decrease.  

MSF constructed a new maternity hospital in the Jindiris area to help address the severe shortage of dedicated maternal health care facilities. The hospital will provide comprehensive services such as prenatal and postnatal care, safe delivery services, and emergency obstetric care. Additionally, MSF’s team has expanded maternity services at Al Shahba’a hospital in Mare’e city, offering cesarean sections, surgery, and neonatal care, and receiving referrals from other health facilities in northwest Syria.