Disabled mothers in northwestern Syria face additional challenges, inadequate services

IDLIB — Eleven years after Safaa Hanno (a pseudonym), 30, lost her legs in an airstrike on her home in Reef Dimashq, she gave birth to a daughter eight months ago in Afrin city, in opposition-controlled northwestern Syria.

“At my first check-up, the doctor asked me: Isn’t pregnancy difficult for you in this situation?” Hanno recalled, speaking with Syria Direct via Zoom. “My husband and I replied that it would be fine. The doctor was pleased with our decision, and with overseeing this unique case.” 

Hanno had given birth to her previous child, a boy, just one month before she was injured and lost her legs in 2013. Because of her condition she was not able to nurse and look after him. Her mother stepped in “until he was seven months old, when I was able to move and take care of him,” she said. Her oldest daughter was two years old at the time. 

In northwestern Syria, many disabled women like Hanno face unique challenges during pregnancy, childbirth and beyond. To hold on to their right to motherhood, they must not only navigate physical difficulties, but also barriers to accessing healthcare.

Reproductive risks

Some 56 percent of people ages 18 to 58 in opposition-held northern Syria have a disability, a disproportionate number of whom are women, according to a 2023 survey by the Assistance Coordination Unit (ACU), a Syrian organization working to identify needs on the ground. The survey included both northwestern Syria and the cities of Ras al-Ain (Serekaniye) and Tal Abyad in the northeast. 

Following the February 2023 earthquake, the number of disabled pregnant patients “increased even more,” Dr. Hiba Haj Yousef, an obstetrician-gynecologist at the al-Rafah Hospital in the Jenderes district of Afrin since 2020, said. Currently, the hospital’s obstetrics and gynecology department sees 300 patients a week, including three disabled women.

While disability itself does not affect a pregnancy or pose a danger to a fetus, “pregnancy can pose a danger to the mother in the case of motor disabilities, due to the lack of movement and possibility of a blood clot,” Haj Yousef said. “With sensory disabilities, genetic factors increase the likelihood of passing it on to the newborn,” she added. Patients with severe motor disabilities and depression, meanwhile, “may experience difficult labor or premature birth.”

While Hanno gave birth to her first two children naturally, her youngest daughter was delivered surgically earlier this year. “When my daughter’s life was in danger, and her heartbeat decreased, the doctors decided to perform a C-section,” she said. 

“I suffered a lot—I saw death with my eyes. After that, I was given general anesthesia, because my body did not respond to the spinal anesthesia,” Hanno said. 

Haj Youssef recalled one of her patients, a woman who became paraplegic after she was injured in the February 6, 2023 earthquake. She learned she was pregnant in the first month after she was pulled out from under the rubble. 

Opposition areas affected by the earthquake, which struck northern Syria and southern Turkey, saw many premature births linked to psychological stress and fear at the time, but Haj Yousef’s patient carried her pregnancy to term. Still, she “had a difficult labor” and required special medical care, the doctor added. 

During the birth, “she was given aspirin as a blood thinner, which caused an increase in fluid around the fetus,” Haj Yousef recalled. While in the end “the child was born in good health,” the mother continued to struggle, spending her postpartum period “in a bad psychological state,” the doctor added.

Another patient lost her hand in the February earthquake, before giving birth to her second child. Despite her injury, and a difficult pregnancy and birth, “her psychological condition was good,” Haj Yousef said. 

Read more: Premature births increase in northwestern Syria after earthquake

Umm Osama, 27, did not encounter any major complications in her three pregnancies, which ended in natural births at public hospitals. She lost her lower right leg in 2012 after she was injured by an airstrike on her home in Akhtarin, a town in the northern Aleppo countryside. 

Umm Osama has three children—ages seven, six and 22 months old. During the birth of her first child, “the medical staff was worried because of my situation, but I gave birth without complications and their fears dissipated in the next two, once they confirmed that everything was normal,” she told Syria Direct. 

Safaa Hanno hangs her daughter’s clothes to dry on the balcony of her apartment in Afrin city, northwestern Syria, 22/9/2024 (Syria Direct)

Unavoidable challenges

During her latest pregnancy, Hanno visited a doctor once a month at a private hospital. In the ninth month, she had to go to several appointments, each costing 500 Turkish lira ($15), to cover the exam, tests, imaging and transportation. It was “a large amount for me,” she said. 

When she could no longer afford the costs, Hanno had to go to a public clinic. She also gave birth in a public hospital, as “a C-section at a private hospital costs $200,” which her family could not afford.

Hanno has a manual wheelchair she uses to move around near her home, while she relies on crutches and a prosthesis for her left foot to travel farther distances. She has no prosthesis for her right leg, which was amputated above the knee. Her mother accompanied her to all her doctor’s appointments during pregnancy and after the birth.

At first, Hanno found it difficult to care for her infant daughter, especially “bathing her and changing her clothes.” Over time, “I adapted, little by little,” she said. One remaining difficulty is her inability to carry her daughter and walk with her. “When I leave the house, my husband, mother or father carries our daughter,” she said. “My heart breaks because I can’t carry her.” 

Disabled women are not prioritized in local medical centers, Hanno said. Long wait times at public facilities drove her to initially seek out a private clinic, despite the expense. Umm Osama agreed that there is a lack of consideration for the needs of disabled people in northwestern Syria, calling for “a more supportive environment for mothers with disabilities.” 

Umm Osama found it difficult to reach medical centers during her three pregnancies, as public transportation and facilities do not consider the needs of those with motor disabilities. She had to rely on “a taxi, or my husband taking me on his motorcycle,” she said. 

Haj Yousef noted that hospitals do not have special equipment for disabled women, “except for wheelchairs and stretchers.” Her hospital “used to have mobile clinics, but they were shut down because of a lack of funding.”

Read more: Women in northwestern Syria pay the price of donor fatigue

Limited services

Disabled women have the same sexual and reproductive health needs as other women. However, “due to multiple and intersecting forms of discrimination on the basis of gender and disability” they face “unique and pervasive barriers to full realization of their sexual and reproductive health and rights,” according to Women Enabled, an international advocacy organization. 

This includes “substandard care” and maternal and newborn health materials not being “regularly available in accessible formats.” Equipment and facilities may be physically ill-equipped or poorly designed for disabled women, who also encounter financial, social and psychological barriers when accessing reproductive healthcare, according to the organization. 

“Before it stopped, the mobile clinic helped reach women with disabilities who find it difficult to reach medical centers,” Haj Youssef said. 

The doctor is not aware of any entity in northwestern Syria providing specialized, integrated services for disabled women. She stressed the need for “a referral network, ways to transfer patients to and from their residences and provide assistive devices such as wheelchairs, glasses and hearing aids, as well as reproductive health education and family planning methods.” 

While some organizations provide services to women with disabilities, “these are often limited,” Amjad al-Maleh, founder of the Association of War-Wounded Women in Northern Syria, said. “There is an urgent need to expand services to be comprehensive and sustainable,” he added.

His organization focuses on “supporting injured women, psychologically and socially, with services to integrate them in society,” along with providing “basic medical equipment, such as crutches and wheelchairs” and “vocational rehabilitation.” 

Working with health specialists from other organizations, the association has held reproductive health awareness sessions for women with disabilities, but “these activities were limited by the lack of resources and support available,” al-Maleh added.

The organization has lost financial support, but continues to operate, “relying on the volunteer efforts of injured women,” he added. It currently holds psychological support sessions and local awareness-raising efforts, as well as fundraising to meet the basic needs of the injured. 

“Many women working [within the association] are [themselves] war wounded, have faced and overcome great physical and psychological challenges and are working to support their peers,” al-Maleh said. 

The lack of services available to disabled women make family support crucial, Umm Osama, who relied on her mother during her three births, said. Still, this does not negate the need for “self-reliance,” as she put it. 

“Organizations should provide more facilities and services for disabled mothers, because they face greater difficulties in caring for their children,” Umm Osama said. “Not taking our special circumstances into account causes additional challenges.”

Hanno’s mother, sisters and neighbors also supported her following the birth of her daughter earlier this year. “They all helped me and accompanied me,” she said, also praising the role of her 13-year-old daughter, who “took on a big burden for me.” 

“I hope that public medical centers would have all services and medicines, and that they would have proper doors to enter,” she said. 

Hanno gave her infant daughter the name Wuroud, meaning “roses.” She chose it because “her arrival was a turning point, changing the course of my life and making it more beautiful,” she said. 

This report was produced in collaboration with the Association of War-Wounded Women in Northern Syria as part of Syria Direct’s Sawtna Training Program for women journalists across areas of control in Syria. It was originally published in Arabic and translated into English by Mateo Nelson.