Enab Baladi – Hassan Ibrahim

“Crucial hours between life and death” was what Fatima experienced two hours after she delivered her baby at al-Nour Hospital in Taftanaz, eastern Idlib. She suffered a health relapse resembling a seizure that worried her husband and family, marring the joy of her baby girl’s birth.

Mohammed (26), Fatima’s husband, considered discharging a woman two hours after childbirth a lack of concern for health and disregard for others’ lives. He said, “If someone had a broken hand, they would stay in the hospital for more than two hours.”

Mohammed told Enab Baladi that his wife gave birth to their daughter in mid-July and insisted on keeping her at the hospital for longer when the staff planned to discharge her after two hours, claiming her condition was stable. They allowed the baby to stay in the nursery.

An hour after Fatima reached their home near Maarat Misrin, north of Idlib, her signs of exhaustion and fatigue increased. She lost focus and consciousness, and her husband rushed her back to the hospital, where she stayed for two days receiving care and pain relief before being referred to an internal medicine doctor.

Fatima’s story is one among many similar experiences faced by women in hospitals and health centers in Idlib, northwestern Syria, where they faced the risk of death due to inadequate care in the most painful moments when they needed care the most.

Inappropriate medication

When Fatima and her husband consulted an internal medicine doctor, they were told that the medication prescribed to her was inappropriate and worsened her condition. The doctor prescribed a different medication, which she’s been taking since then, and she’s seeing gradual improvement.

The husband admitted that the hospital services were good during previous visits, but this one incident was enough to risk her life. He added that he wouldn’t return to the hospital and regretted that this situation had repeated with other patients.

The husband’s biggest sorrow was that a nurse had given his wife two pills under her tongue before discharging her, indicating that her condition wasn’t suitable for discharge.

According to obstetrician Dr. Tuqa Furawati in Idlib, the duration required to discharge a woman after childbirth varies depending on the nature of the childbirth and the woman’s health condition. In cases of natural childbirth without complications or post-delivery bleeding, the woman could be discharged 2-6 hours after delivery.

However, if there are risk factors such as bleeding, anemia, or underlying conditions like hypertension or diabetes, the attending obstetrician determines the hospital stay duration.

The medical website “babycenter” indicates that after natural childbirth, a woman is likely to stay in the hospital for 24-48 hours. In contrast, the average stay for a cesarean section ranges between two to four days. Women experiencing complications during or after childbirth may need to stay longer.

Born in the bathroom

After a long wait at al-Ikhaa Hospital in Atmeh, north of Idlib, a woman gave birth in the hospital’s bathroom due to the staff’s refusal to assist her coupled with maltreatment, causing outrage in northern Syria.

The childbirth occurred in the bathroom after a lengthy conversation between the pregnant woman’s relatives and the hospital’s female staff, who refused her admission, arguing that it wasn’t her due date despite her evident labor pains and her relatives’ pleas for examination and delivery assistance.

Dr. Molhem Ghazi, Director of Secondary Care at the Health Ministry in the Salvation Government in Idlib, stated that the ministry formed a committee to investigate the reasons behind the woman’s refusal at the hospital.

The Ministry of Health’s committee reported that they had received a notification about the incident, reviewed its details, and are following up on it, suggesting that the errors were individual cases.

Meanwhile, the hospital’s funding organization, the Syrian Expatriate Medical Association (SEMA), issued a statement saying an investigation by the administrative accountability section of the association was conducted. The findings confirmed:

• A breach of organizational policies and the Code of Conduct by a midwife in mishandling one of the patients by refusing her admission.
• The on-duty doctor at the hospital violated policies and procedures by failing to adequately manage the situation.
• Inadequate follow-up by the reproductive health officer.
• No evidence of misconduct by the pediatrician.

Based on these findings, the executive administration adopted the investigation committee’s recommendations by:

• Terminating the midwife’s contract.
• Issuing a written warning to the doctor.
• Issuing a written warning to the reproductive health officer.
• Conducting an awareness campaign for all hospital staff about organizational policies and the Code of Conduct.
• Ensuring greater adherence to policies, codes, protocols, and job duties.

Insufficient care

The lack of adequate healthcare and the compounded suffering of women aren’t solely due to individual errors or maltreatment; they are also a consequence of the deteriorating healthcare sector in northern Syria in addition to the worsening economic and living conditions.

Northwestern Syria is home to 5.1 million people, 4.2 million of whom require assistance, 3.4 million suffer from food insecurity, 3.4 million are internally displaced, and two million live in camps, according to the United Nations. Local statistics suggest that the population ranges between 5.5 and 6 million people.

In April 2022, Médecins Sans Frontières (Doctors Without Borders) in Syria reported a woman delivering her baby at the door of an MSF-supported hospital in Idlib after traveling a long distance to reach it. The woman had been waiting to gather enough money to cover transportation costs due to the lack of ambulances, highlighting the concerning situation since delayed childbirth can pose medical risks to both mother and child.

Midwives face numerous challenges in their work and personal lives in an area already suffering from bombing and medical equipment shortages. More than 4,000 midwives in northwestern Syria have faced intersecting crises in recent years, including the February 6th earthquake, war, and COVID-19.

Women of reproductive age, particularly in over 1,400 internally displaced persons (IDP) camps in northwestern Syria, are especially at risk due to insufficient healthcare. Despite 80% of IDPs being women and children, only 18% of healthcare facilities are located in camps, where 40% of the population resides.

Many healthcare facilities are forced to reduce operations, close departments, or cut back on working hours due to funding shortfalls. By the end of July, more than 110 healthcare facilities, including 34 hospitals, had already ceased operations.

If funding issues persist, the Health Cluster warns that 50% of all healthcare facilities in northwestern Syria will either completely or partially shut down by December 2024, according to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA).