Marjie Middleton, a midwife working with Medecins Sans Frontieres (MSF), spent several months this year on the Syria-Lebanon border. “I was there because MSF recognized that women’s health wasn’t being dealt with appropriately or not at all in the refugee situation,” she said. “They sent me over to assess and open clinics for women’s health. At the time, they had seven clinics open for primary health care, but none provided pre- or postnatal care. So we opened four, dealing specifically with women’s health and pregnancy.” She spoke with Syria Deeply about the mounting health problems faced by Syria’s women.
The trick is to try and tell you about the scope of the problem. It’s just so huge. I was completely taken aback by the complete lack of attention to women’s health. The priority is the war wounded and those who need surgery. But when a woman is pregnant, that’s also an “immediate” need.
Most of the refugees are crossing into the Bekaa Valley, which is one of the poorest areas of Lebanon. They’re coming across with nothing into an area that’s already poor. There’s no resources, and what there is is expensive, and even the refugees who can afford it have limited access. A lot of them are coming across pregnant and with other women’s health problems, and there’s nothing for them once they get there.
I was tasked with assessing the overall women’s health situation, so I spoke with hundreds of women up and down the Bekaa. They were from everywhere: Homs, Aleppo, Damascus. There were so many stories of hardship. The one thing that came through is that these women have had no access to health care for the last two years. Since the war started in Syria there’s been very limited medical care, especially women’s care, so they didn’t have access at home. And then they came over to Lebanon, where there’s none either.
Women were telling me how their last pregnancy was stillborn and now they’re pregnant again, and how scared they are being pregnant again and not having access to prenatal care. It’s a terrifying feeling. One woman came across after a stillbirth. They told her it had happened because she had high blood pressure. She was now pregnant again, and she came over to Lebanon and couldn’t find a free service for refugees, or one she could afford. She ended up taking a 45-minute bus ride to see a Lebanese gynecologist who was treating Syrian women for less money. He told her there was a problem with the baby and that she had to come back a second time, but she couldn’t afford to get back.
When I met her, she was desperate, nine months pregnant, and she said, “I can’t get help, but I know there’s a problem with the baby. I don’t know where to go, I can’t afford the fees.” We tried to this woman help, but lost contact with her. We think she went back to Syria to try and get assistance.
Another woman I met in one of our clinics was pregnant with her second baby. The first one was a healthy little boy. She was nine months pregnant in Syria when her husband was walking down the street, hit by a shell and killed. So in her ninth month of pregnancy, there she is with her little boy, alone. She crossed over to Lebanon. She knows nobody there, she has no money. She came to us and asked for help. She was due in 10 days. We were able to get her referred appropriately and she had a beautiful baby.
Imagine being nine months pregnant, having your husband die and then having nowhere to go but another country where you have no access to health care or any services, unless you’re very rich.
The U.N. was there, but they’re but no longer giving fast-track registration to pregnant women. They stopped in April for financial reasons. They also stopped paying 100 percent of birth costs for refugees. So now these women have to come up with 25 percent of the cost of delivery. Where we were, for a normal delivery, that fee would be between $50 and $200 for a cesarean. That’s a couple of days’ work for a daily laborer, and they might get one to two days a week if they’re lucky. So that’s their wages for a week. And that’s if you have a husband to do the daily work. If you don’t have a husband, or resources, you have no money to have the baby.
There are still some Lebanese in the Bekaa who are helping out, but the Lebanese host population is already saturated. We met some Lebanese midwives who were helping Syrians give birth for free, but they are having to stop because they can’t afford it anymore. Lack of access to information about services is also an issue. One woman we met was due to head back to Syria to give birth the following day, because she couldn’t afford to give birth to the baby in Lebanon. So we were able to give her the right information to get her into the cheaper-delivery program, paying only 25 percent. If we hadn’t met, she would not have known about how to access the service, and she would have had to cross back through a war zone to have the baby. We heard that a lot. Men saying to their wives, “We can’t afford to give birth in Lebanon, we have to go back.”
We were seeing quite a lot of newborns with problems. What happens is that moms and babies are discharged from the hospital immediately because they can’t afford more days. Babies are coming in dehydrated because mothers didn’t know how to breastfeed properly, or women switch to formula then can’t afford more. In the first two months of opening women’s health clinics, I thought we’d see 200 patients and we saw 850. It was quadruple what we expected. People in the Middle East tend to prefer obstetricians [to midwives], and we opened midwifery clinics, so we weren’t sure how we’d be received. But the women came. And they talked about their problems, what they were going through.
The other women’s health need that’s high is contraception and family planning. There’s a perception in Lebanon and the West that all Syrians want to do is have babies. I met so many women who said, “We are desperate for contraception in Syria, and we don’t want to have more babies. We don’t want to have them as refugees.” The requests for family planning were more than in any other refugee setting I’ve ever been in. These were intelligent women saying, “We know it’s not safe to have babies now in this setting.” And they can’t afford to buy contraception in Lebanon.
One woman had walked over the mountains with her children, and her first stop was us because she’d run out of her pill in Syria. She said, “I’ve run out. I’m crossing, I need it.” But she was already pregnant.