Birth under bombing II

An interview with a doctor in Idlib

This interview is from the Autumn 2019 issue of Syria Notes.

My name is Dr Farida and I’m a gynaecologist and an obstetrician living in Idlib. I graduated from medical school in 2008, and I was then living in Aleppo city. When eastern Aleppo was liberated from Assad forces, I moved to that part of the city, and during the last three years in Aleppo I was the only female obstetrician there. I left Aleppo at the end of 2016 when the population was forcibly displaced by Assad forces.

Syria Notes: Please tell us about the work you are doing in Idlib.

Dr Farida: The biggest healthcare challenge in Idlib is the shortage of doctors and lack of medical specialists and consultants. Every two gynaecologists or obstetricians are caring for more than one hundred thousand women. This puts doctors under extreme pressure. The lack of stability, non-stop bombardment, and constant flow of newly displaced people makes things very difficult.

A lot of people face psychological problems that affect their health, and frankly we don’t know how best to deal with these problems. As gynaecologists or obstetricians we can deal with physical pain and problems, but we don’t have the training or the experience to deal with psychological problems.

What are the challenges for women expecting a baby, and for women in childbirth?

The biggest problem facing mothers in labour is the lack of transportation. Especially, if a mother goes into labour at night and there is no private car available to reach a doctor or a hospital. So, a lot of women give birth at their home or their tent. There are not many trained and experienced midwives to help them give birth out of the hospital safely.

Often mothers develop severe complications, such as extreme bleeding. Most of the time the mother reaches the hospital when it’s too late to save her. On top of all of that, most pregnant women are very anaemic and suffer from iron deficiency. Their haemoglobin levels are below what is safe for a pregnant woman. This makes any simple bleeding mother has during delivery or pregnancy very dangerous. The mother will be in high risk of hypovolemic shock which can eventually cause her death.

The lack of transportation and the extreme poverty are killing women in Idlib. Antenatal care is not available for the vast majority. We see most women when they are in labour, and only few manage to see a doctor once or twice during pregnancy. A lot of mothers don’t know what to watch out for. Some mothers only find out they are pregnant with twins when they are in labour. Some give birth to babies suffering from embryonic abnormalities.

Photo: Tarmala Maternity and Children’s Hospital after it was bombed on 15 May 2019. Photo by Suhail al Ali, via Syrian Network for Human Rights.

Please tell us about something that happened in your work that stayed with you.

I want to tell you the story of one patient I took care of. She was the sweetest person you could meet. She married very young—I think she was thirteen years old. She got pregnant often. Almost every year or so she gave birth to a new child. By the age of twenty-two, she was a mother of eight children.

After the birth of her last child, her husband was killed in an airstrike in Aleppo city. She lost her life a few months after her husband’s death. She was killed in another air strike. She left eight children behind. Her eldest was seven or eight years old, and her youngest was few months old.

Every time I remember her I tear up, she was full of energy and positivity. She loved to laugh and to tell jokes. I saw her after her husband lost his life and she looked like something inside her died with him. She died shortly after, and her mother took care of the children. They were displaced with the rest of us to Idlib, but I have not heard anything about them since.

How does targeting hospitals affect your work and the health of your patients? 
Have you ever delivered a baby while the area was under bombardment?

When I was in Aleppo city I delivered several babies while the hospital I worked in was under attack. It happened quite often, and I can’t describe how I felt during these moments. The planes are above us, bombing the area of hospital, while I was trying to bring a new life safely into the world.

Once I was in the operating room performing a Caesarean operation when we were hit by an air strike. The open belly of the patient was filled with dust and debris and the sterilisation of the operating room was compromised. We had to clean her belly and do as much sterilisation as we could.

What can be done to ensure expecting mothers in Idlib have a safe birth?

Stopping air strikes is the most important thing to help women have a safe delivery. Civilians need to live in a safe and stable area. Recently a mother in Hass city lost her life in an airstrike. She was trapped under rubble and her womb ruptured. When rescuers pulled her out, her baby was out of her womb and lying next to her. He lost his life too.

On the medical front, one of the essential things for safe delivery is to treat the widespread iron deficiency anaemia in women. This will increase the chances of survival among mothers. We need more doctors and more facilities. Bombing is destroying the hospitals we do have. All the equipment and precious resources poured into these hospitals are being destroyed too.

I dream of a teaching hospital for the area, with consultants to teach the resident doctors we have. Right now, there is no one to teach them what they need. Creating a teaching hospital in an area where airstrikes never stop feels impossible. But this is what is really needed and what I will keep dreaming of.

There are four to five million people in Idlib and northern Aleppo. The more land the regime takes, the more people are being squeezed into areas near the borders. All these people are in need of urgent medical care. People are living on the streets. Some don’t even have the luxury of a tent.

More than a half million have been displaced very recently. Many are pregnant women. They don’t have food to eat or any means to maintain good nutrition. There are no toilets! Imagine being pregnant and needing to pee often but there are no toilets to use.

What can be done to protect expecting mothers in Idlib?

Let them stay safely in their homes. enough with forced displacement. There is nowhere left for civilians to go. The border with Turkey is closed and Idlib is full of displaced civilians. The village where I live is full of families sleeping on the streets with no other alternative. It’s heartbreaking, people are taking only what they can carry and fleeing for safety. Women, children and elderly.
If only the bombing will stop, we could manage to survive. I fear it will only get worse with the regime advancing. May God protects us.