AMMAN: When Miriam a-Zain, 38, gave birth to her daughter Rahaf in April, she was unable to properly breastfeed.

“I got a medical exam, which showed that I could produce milk, but the amount was far less than with my previous two children,” a-Zain tells Syria Direct.

A-Zain breastfed her two older children—now six and three years old—without any issues, but that was before the Assad regime’s advance this summer on rebel-held east Aleppo city.

“Because of the bombings—because of the fear that we face on a daily basis in Aleppo—my milk dried up,” says a-Zain. To make up for the shortage, a-Zain began raising her six-month-old daughter on baby formula, as are roughly 60 percent of infants across Syria. 

Local charities once distributed cans of formula for free, but since the city’s September encirclement, almost nothing has entered Aleppo. Even longstanding black market smuggling routes have closed under the pressure of the airtight siege, sources in east Aleppo tell Syria Direct.

“The city is down to its final 5,000 cans of formula,” Ali Sheikh Omar, president of the Aleppo Relief Commission told Syria Direct. “That’s hardly enough to cover a quarter of the city’s children and for one month at most.” The Aleppo Relief Commission is partner with the Aleppo Local Council and is responsible for the distribution of food and medical aid in rebel-held east Aleppo city.

 Aleppo charity distributes baby formula in April. Photo courtesy of the Abrar Charitable Organization.

As the number of formula cans dwindles, a-Zain says she can no longer get them.

In order to receive one of the last-remaining 5,000 cans of baby formula from the Aleppo Relief Commission, mothers must bring in a doctor’s note stating that they are unable to breastfeed.

“The distribution process is emotionally devastating,” Omar, the head of the Aleppo Relief Commission said. “There are so many babies in need, but there is so little that we are able to offer.”

As a result of the regime’s siege of rebel-held Aleppo, local aid organizations are now turning away mothers in need of baby formula, leaving the parents of at least 10,000 infants—such as a-Zain’s daughter—to turn to inferior, and potentially harmful, food substitutes.

“The last time around, one charitable organization said they could only give us one can every two weeks,” she said. “They apologized to us because they had gone through all the formula in their warehouse.”

Three weeks ago, a-Zain began feeding her six-month-old daughter a mixture of water and rice as a substitute, despite doctors warning her of the potentially severe malnutrition-related side effects.

“I feel terrible feeding her this, but it was our last resort,” a-Zain told Syria Direct.

Both the Aleppo Relief Commission and the Aleppo Local Council have appealed to international humanitarian relief organizations to address the city’s widespread food and medical shortages, but neither has heard anything in response.

“It’s been that way since the siege was imposed [in September],” Mohammad Fadila, president of the Aleppo Local Council, told Syria Direct. “We’ve sent out a number of urgent appeals…but because of the siege, nothing is getting into the city.”

In early September, government forces encircled the rebel stronghold and the 250,000 people trapped inside it. By the end of the month, regime and Russian forces drastically escalated their bombardment of the city, following the collapse of a ceasefire. Scores of casualties have since filled the city’s few remaining hospitals on a daily basis as a regime-led ground advance begins to chip away at opposition neighborhoods.

No supply amidst demand

There are two options for mothers such as a-Zain: paying as high as $15 for cans of formula at a local pharmacy, or resorting to inferior baby food alternatives, which pose digestive and other medical concerns.

“Even if you’re looking to buy baby formula, you can go to 10 pharmacies, and you’ll only be able to find one, maybe two, cans,” Hussam Mahmoud al-Ali, a doctor with the Aleppo Medical Directorate, told Syria Direct.

The few cans that are available are prohibitively expensive. “The only reason those few pharmacies will have a can or two is because families will sell their formula,” Abu Abood, an Aleppo pharmacist, told Syria Direct. “Residents are living in such abject poverty.”

New mothers are turning to food substitutes for their infants, such as water and rice, tea and bread, or cow’s milk.

 Aftermath of a September 27 airstrike in Aleppo city. Photo courtesy of the Aleppo Media Center.

“Mothers are fighting to stave off starvation because of the siege, which has led to a rise in an inability to breastfeed,” said Dr. Hussam al-Ali. “But these alternatives that mothers are turning to can lead to severe malnutrition and digestive health concerns for infants.”

Last week, an Aleppo child reportedly died due to severe malnutrition in the absence of baby formula, sources in east Aleppo tell Syria Direct, adding that residents fear a sharp increase in such cases as the siege drags into its fifth week.  

The World Health Organization (WHO), however, maintains that breastfeeding is still a viable option, even in active warzones.

“We must quash the common misconception that mothers cannot breastfeed adequately in stressful settings or if they have poor nutrition,” WHO’s Director of Nutrition for Health and Development Francesco Branca and UNICEF’s Chief of Nutrition Werner Schultink, wrote in a WHO statement in May.

But for thousands of mothers in besieged Aleppo, breastfeeding is no longer a viable option, whether due to the trauma of war or an earlier decision to feed their newborns baby formula when it was still available.

“It’s heartbreaking to say…but I wish that I hadn’t given birth to Rahaf in the midst of this war,” a-Zain told Syria Direct. “Death is everywhere here, in all of its streets.”

Every day, a-Zain says, “I feel tremendous sadness; whether it’s from the bombing or from the hunger, I’m terrified that my daughter could die any day.”