Dr. Dima Um Nour is a gynaecologist, working in Al-Amal Pediatrics and Maternity Hospital in A’zaz, Aleppo Governorate in northwest Syria. She has been working in Al-Amal hospital tirelessly, serving pregnant women, for over three years. On World Health Day, she describes what she witnesses every day and how the devastating earthquakes have impacted her patients.
The workday starts at 8.30am.
Every morning my patients wait in the lobby of our hospital. We receive pregnant women who come in for routine checkups, others who come in for their gynecological exams, or women who are scheduled to give birth, as well as walk-ins and emergency cases.
Every day I see 65 to 75 women. Most of them come from A’zaz city and its surrounding villages and camps. 78% of people living in A’zaz are internally displaced people. So, most of the women, children and newborn babies we receive here, have lost their homes and stability multiple times due to the conflict and most recently also due to the earthquakes. They may live in makeshift camps, in abandoned factories and farms or in crowded houses. Sometimes living in a house is no better than living in a tent in a camp, as in most cases, people who have accommodation usually share it with 4 or 5 families all cramped together in a house without access to clean water, sanitation facilities, or hygiene items.
In fact, no matter where you live, for most people in northwest Syria, access to clean water and hygiene items like soap and sanitary pads are a luxury. Given this grim picture, and especially after the earthquakes struck, it is no surprise that everyone is worried about the spread of cholera and other infectious diseases. This could have a life-threatening impact on pregnant women.
Many of my patients are really struggling to make ends meet.
Often, when we prescribe medication or ask them to run a medical test, the first question we get is “do we really need this?” People do not have enough money to cover their medical expenses and prescriptions. The majority of our patients cannot read or write, which has many repercussions for their daily lives and activities. For example, when I ask my expecting patients to track their weight, they tell me they cannot read their weight. Most of them have never been vaccinated either.
The overall situation in northwest Syria was already difficult for everyone before the earthquakes, but now, everyone’s lives have just become a nightmare. People lost what they had managed to rebuild – their homes, their belongings and are now facing renewed displacement. We lost family members and friends. Those who have managed to find a home, are now forced to live in the open and in tents again, they are exposed to extreme weather conditions, like the recent storm we experienced in the region; and access to basic everyday items and goods such as food and water is limited. Everyone was affected, without exception. What I am witnessing as a doctor after the earthquakes is something I have never seen before.
I came back to work right after the earthquakes. We immediately started receiving pregnant patients who had pre-scheduled appointments and others who came because they were now facing complications due to the shock they had undergone because of the earthquakes.
Before the earthquake, we used to have two cases of miscarriage per week at Al-Amal Hospital. Now, we see four miscarriages per day."
In several cases, these are late miscarriages, which are miscarriages occurring after the 7th month of pregnancy. I remember a case of a woman who was close to giving birth, being more than 8 months pregnant. She came for a regular check-up right after the earthquakes and during the ultrasound we found out that her baby’s heartbeat had stopped. It was one of the hardest cases. In another case, a woman who was pregnant with triplets lost all 3 of them. We received her a while after the earthquake, but we estimate the miscarriage took place the day of the earthquake or the following.
We also observe a devastating increase in stillbirths, witnessing 3 times more cases of stillbirths than we had seen in the past. And last but not least, we also see a very high number of premature births, with an increase of 10-12% compared to the pre-earthquake number of cases. This means that currently 3 out of 10 of births at Al-Amal Hospital are premature.
Almost all women we currently have admitted into our hospital need mental health treatment and psychosocial support.
Every day I refer almost all my patients to the mental health department. Some patients present more common psycho-physical symptoms, such as disruptions in their menstrual cycle, insomnia, sleep disturbances and flare-ups of skin diseases because of stress and anxiety, but others suffer from very severe mental health conditions. There are also cases of pregnant women who are telling us they have suicidal thoughts.
The earthquakes coupled with existing unhealthy living conditions, poor sanitation or little to no access to safe drinking water and food, have all contributed to the further deterioration of the population’s health, including mental health in the northwest region. The threat of a cholera outbreak is looming, with growing numbers of suspected cases being reported daily. Thankfully, so far, the strict disinfection and sanitization measures we have in place are working but every day we pray it will stay like that.
Despite everything and against all odds, I am always trying to see the bright side of things.
Every baby we take care of, and every successful delivery offers a glimmer of hope. We need to continue working and give people hope. Give them a hand to rise and rebuild their life. If the world can hear me, I urge them to continue supporting the people of Syria with medicine, medical equipment, and the tools to rebuild homes and livelihoods, as well as invest in education and support our children. They are our future.