She Pays the Highest Price: The Toll of Conflict on Sexual and Reproductive Health in Northwest Syria
Date
Summary
"The findings of this study amplify the voices of affected women and health care workers regarding SRH needs on the ground."
The earthquake that struck southern Türkiye and northern Syria in February 2023 compounded already precarious access to health care in the conflict-afflicted region, contributing to the collapse of the fragile health care system in northwest Syria. Informed by interviews with over 260 health care workers and patients in northwest Syria conducted in 2022, this study shines a light on the barriers women and girls faced, even before the earthquake, in accessing sexual and reproductive health (SRH) services. The report, which was co-published by Physicians for Human Rights (PHR), the International Rescue Committee (IRC), Syria Relief & Development (SRD), and the Syrian American Medical Society (SAMS), offers recommendations to other non-governmental organisations (NGOs) and to the international aid community, donor governments, Syrian governing entities, and intergovernmental bodies to support the availability of and access to SRH care in northwest Syria (NWS).
The report outlines the stark gap between the availability and demand of SRH services. Of the 367 functioning medical facilities in northwest Syria, only 7% offer comprehensive maternity care. Outpatient reproductive health care services exist in fewer than 40% of facilities. Despite efforts to provide free delivery and newborn care, overcrowding at hospitals causes significant gaps in maternal and newborn services. Violence in the region has also contributed to the overall lack of skilled care providers, especially midwives and gynaecologists, the report finds. Particularly in frontline areas, healthcare providers have moved their operations away from the fighting, limiting the number of accessible facilities, despite sustained need.
Focus group respondents indicated that family planning was among the most straightforward services to access. However, healthcare workers and administrators expressed concern that their patient population lacked sufficient awareness about family planning services, noting cultural and social norms that value fertility and having many children might form a barrier to women availing themselves of such services. Because transportation is costly and dangerous during attacks, a health manager in rural Idlib described the "need to provide mobile teams and awareness sessions on family planning, which positively affects the community".
Similarly, in a focus group discussion in an informally organised internally displaced person (IDP) camp in Aleppo, al-Zeitoun, women reported the need for "increasing awareness regarding family planning and GBV [gender-based violence]...especially in camp settings and among IDPs". In urban Idlib, a nurse explained the need to "intensify sessions to raise awareness of GBV and introduce GBV services", and a health manager suggested provision of in-home awareness sessions to individuals or groups of women. Early marriage is a form of GBV of concern throughout NWS. A nurse in rural Aleppo noted the need for early marriage awareness campaigns for all segments of society.
Respondents reported deep stigma based on social and cultural norms around accessing health care for sexually transmitted infections (STIs) and HIV/AIDS; these taboos and norms have produced a culture of fear and hesitation among many women and adolescent girls. Some health professional respondents appeared reluctant to acknowledge that STIs and HIV/AIDS exist in NWS, reflecting potential widespread bias among providers. In urban Idlib, both male and female health care workers described the need for broad community education about STIs.
Focus group discussions demonstrated how the lack of access to SRH care and ongoing violence also result in mental health issues in NWS. Both health care providers and community member respondents were not always aware of existing efforts and available services, indicating that more resources are needed to educate the community about the availability of mental health and psychosocial support efforts.
In this context, the report provides a legal and policy analysis, noting that all parties to the conflict in NWS are obligated to protect the right to health, including the right to SRH, for civilian populations in areas they control. And "Donors have an ethical obligation to support humanitarians in promoting the right to health by providing assistance without discriminatory effect. This includes the duty to provide care to the most vulnerable, including women and the disabled."
In concluding, the report calls on concerned parties - donors and health actors, active governing entities in NWS, United Nations (UN) Security Council and UN Member States, and the wider whole of Syria humanitarian coordination system to take action in their response to the earthquakes - for example:
The earthquake that struck southern Türkiye and northern Syria in February 2023 compounded already precarious access to health care in the conflict-afflicted region, contributing to the collapse of the fragile health care system in northwest Syria. Informed by interviews with over 260 health care workers and patients in northwest Syria conducted in 2022, this study shines a light on the barriers women and girls faced, even before the earthquake, in accessing sexual and reproductive health (SRH) services. The report, which was co-published by Physicians for Human Rights (PHR), the International Rescue Committee (IRC), Syria Relief & Development (SRD), and the Syrian American Medical Society (SAMS), offers recommendations to other non-governmental organisations (NGOs) and to the international aid community, donor governments, Syrian governing entities, and intergovernmental bodies to support the availability of and access to SRH care in northwest Syria (NWS).
The report outlines the stark gap between the availability and demand of SRH services. Of the 367 functioning medical facilities in northwest Syria, only 7% offer comprehensive maternity care. Outpatient reproductive health care services exist in fewer than 40% of facilities. Despite efforts to provide free delivery and newborn care, overcrowding at hospitals causes significant gaps in maternal and newborn services. Violence in the region has also contributed to the overall lack of skilled care providers, especially midwives and gynaecologists, the report finds. Particularly in frontline areas, healthcare providers have moved their operations away from the fighting, limiting the number of accessible facilities, despite sustained need.
Focus group respondents indicated that family planning was among the most straightforward services to access. However, healthcare workers and administrators expressed concern that their patient population lacked sufficient awareness about family planning services, noting cultural and social norms that value fertility and having many children might form a barrier to women availing themselves of such services. Because transportation is costly and dangerous during attacks, a health manager in rural Idlib described the "need to provide mobile teams and awareness sessions on family planning, which positively affects the community".
Similarly, in a focus group discussion in an informally organised internally displaced person (IDP) camp in Aleppo, al-Zeitoun, women reported the need for "increasing awareness regarding family planning and GBV [gender-based violence]...especially in camp settings and among IDPs". In urban Idlib, a nurse explained the need to "intensify sessions to raise awareness of GBV and introduce GBV services", and a health manager suggested provision of in-home awareness sessions to individuals or groups of women. Early marriage is a form of GBV of concern throughout NWS. A nurse in rural Aleppo noted the need for early marriage awareness campaigns for all segments of society.
Respondents reported deep stigma based on social and cultural norms around accessing health care for sexually transmitted infections (STIs) and HIV/AIDS; these taboos and norms have produced a culture of fear and hesitation among many women and adolescent girls. Some health professional respondents appeared reluctant to acknowledge that STIs and HIV/AIDS exist in NWS, reflecting potential widespread bias among providers. In urban Idlib, both male and female health care workers described the need for broad community education about STIs.
Focus group discussions demonstrated how the lack of access to SRH care and ongoing violence also result in mental health issues in NWS. Both health care providers and community member respondents were not always aware of existing efforts and available services, indicating that more resources are needed to educate the community about the availability of mental health and psychosocial support efforts.
In this context, the report provides a legal and policy analysis, noting that all parties to the conflict in NWS are obligated to protect the right to health, including the right to SRH, for civilian populations in areas they control. And "Donors have an ethical obligation to support humanitarians in promoting the right to health by providing assistance without discriminatory effect. This includes the duty to provide care to the most vulnerable, including women and the disabled."
In concluding, the report calls on concerned parties - donors and health actors, active governing entities in NWS, United Nations (UN) Security Council and UN Member States, and the wider whole of Syria humanitarian coordination system to take action in their response to the earthquakes - for example:
- Ensure that members of the affected population have access to fact-based information about SRH service availability.
- Build health work force capacity, prioritising the work of female healthcare providers in order to overcome potential cultural barriers to accessing SHR services.
- Engage health facilities, health workers, and social workers in addressing misinformation and awareness-building initiatives to enable community members to better understand what SRH services are available and how to access them.
- Adopt a holistic approach to SRH service provision, which includes awareness-raising campaigns around SRH rights and de-stigmatisation at the community level, and that focuses on both health-seeking behaviour and perceived health priorities.
- In hard-to-reach areas, strengthen community networks through structured psycho-social support programmes.
- Empower community-led initiatives to increase the number of ground-up approaches to health care system development to reflect patient populations' needs and desires.
- Monitor SRH needs and the provision of SRH services and share regular analysis to inform priorities for programming, advocacy, and funding.
Source
Posting from Amany Qaddour to IBP Global Network on March 17 2023; and PHR press release, March 14 2023 - accessed on March 23 2023. Image credit: Abdullah Hammam / IRC
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