Newborns in Syria’s southern-most province are dying preventable deaths because there are only 15 neonatal incubators in all the rebel-held territory in Daraa, says Dr. Yaarub a-Zoubi, the Director of the Center for Incubators and Children in the opposition’s Daraa Health Directorate.
An estimated 40 percent of children born in the province require treatment in an incubator, a-Zoubi tells Syria Direct’s Sarah Abaid, with stays ranging from a few hours to more than one month. The high number of newborns needing incubators is “due to premature births and the circumstances of the war,” a-Zoubi says.
Neonatal incubators are used to maintain stable environmental conditions for premature, sick or underweight newborns. The devices can keep infants warm, help them breathe and allow medical staff to continuously monitor them.
Without enough incubators to care for all the newborns who need them, medical staff “must make a choice,” says a-Zoubi. Doctors either try to care for children without incubators—warming them with blankets—or send them to nearby regime-held territory. Either way, many infants die, from inadequate care or en route to regime territory, due to a lack of oxygen.
Even if an incubator is available, vital secondary devices such as oxygen hoods, ventilators and blood oxygen monitors are scarce in Daraa, according to the doctor.
“Every child we are unable to help affects us,” says a-Zoubi.
“We are not able to give some children their right to live.”
Q: How many newborns in Daraa need incubators? How many incubators are available? How many should there be, under ideal circumstances?
Out of all children born in the area, 40 percent need incubators, due to premature births and the circumstances of the war. That means that for every 100 children born, 40 need an incubator. Meanwhile, there are only 15 incubators in all of [opposition-held] Daraa—nine in the eastern countryside and six in the west of the province.
In order to not turn away any of these cases, we would need four times this number of incubators.
Newborn twins at a Daraa field hospital in October 2016. Photo courtesy of Daraa al-Balad Field Hospital.
Q: There have been recent reports about problems with the existing incubators, such as a shortage of the oxygen supply. What is the importance of these components for the incubators?
Oxygen is difficult and expensive to buy and bring [into opposition-held Daraa], since we do that through the regime [private companies in regime-held areas]. As for the shortage of respirators, many children die because they need to be put onto a respirator in order to help them breathe, and they don’t get the chance. There is also a shortage of devices to monitor blood oxygen levels, which has consequences for the child.
Then there is the microdrip mechanism [Ed.: an apparatus for delivering small, measured amounts of IV solutions, most often used for newborns and infants]. A microdrip should only be used one time. But because of the difficulty getting them, we use them multiple times, on different children.
This is extremely dangerous because it could cause poisoning from drug [interactions], in addition to the contamination of the device itself with microbes. Blood-borne pathogens can spread from one child to another because the microdrip is used more than one time.
Because of a lack of antiseptic, the incubators cannot be sterilized after each patient. This means there is also a risk of transmitting meningitis from child to child. All these shortages make it more likely for newborns to die.
Q: How long do newborn patients need to remain in the incubator in order to recover?
It ranges from two hours to as long as a month for a premature baby. For meningitis, 14 days, and 10 for septicemia. It varies on a case-by-case basis. Some children have stayed for 45 days.
Cases that take a long time [to heal] deprive the other waiting infants of their chance to live. We can’t secure incubators for all of them.
Q: If an incubator is not available, what is the alternative?
We must make a choice. One option is to monitor the child on a bed without an incubator and warm them with clothing or cotton if they are underweight. This puts their lives at risk.
The other choice is to send the child to regime-held areas. Of course, this is difficult because of the security situation and [residents’] fear of the checkpoints at the entrances to Suwayda and Damascus. Many children die on the way there.
Q: Have there ever been multiple children in need of an incubator on the same day and there were not enough? What have you done in this situation?
This has happened many times, of course. We can’t take everybody. When the child is sent to regime areas, they [sometimes] die on the road because of a lack of oxygen and because family members don’t know how to care for them. They need specialized nursing and care, but they are transported in private, unequipped cars because ambulances and specialized medical personnel are not available.
Q: What is the child mortality rate on a monthly basis?
We are not able to give some children their right to live. When we lose them, it is a personal loss. The number of deaths at the hospital I work at is 20 percent. This is just in a single hospital. Most of those who die are premature, underweight babies. For other hospitals it is 30 percent.
There are children who die because the maternity hospital is far away, so a child is born with a midwife at home. [If there are problems,] the delay in getting them to an incubator causes brain damage due to a lack of oxygen and other physical damages. Then, even if that child survives, he lives with permanent medical issues.
Q: Have you contacted organizations or donors regarding the incubators?
We are always in contact with humanitarian organizations, but the cost to buy and operate the incubators, along with the lack of experienced medical staff, is the excuse we are given.
Q: Were incubators available before the revolution?
Before the revolution, incubators were available. The Daraa National Hospital, al-Hrak Hospital, Tafas Hospital, all of them had incubators. There were more respirators, continuous oxygen, widely available specialists, nurses, doctors. It was much better, before.
Q: Is there any case that impacted you the most, that stuck in your memory?
Every day there is an experience that impacts us. Every child we are unable to help affects us.