Syrian women waiting for pre-natal care at a Lebanese clinic know their pregnancies may end prematurely due to stress and fear, and that they may be unable to provide for their babies.
Many of the women are unable to cover the high cost of hospital care in the northern Lebanese city of Tripoli, home to thousands of Syrians uprooted by the conflict that has ravaged their country for nearly two years.
Instead, the refugees flock to a clinic run by a charity.
Gynecologist Nashwa Shakfi says that although they are safe from the bombardment and fighting across the border, many of the women give birth prematurely.
“Even here, stress and fear can cause miscarriages,” says Shakfi, adding that she sees dozens of pregnant women each day and works extra hours to try cover the demand.
In a small, bare ward, Shakfi attends to women who have travelled long distances to escape the violence. Some of them, she says, have come to Lebanon from the far north of their country.
“Many of them think they won't be able to pay for their baby’s needs, so they prefer to abort,” says Shakfi.
Shakfi's French-trained colleague, Ghazi Aswad, says he believes that many women who give birth at the clinic have suffered sexual violence at the hands of militias.
“There are women who give birth here whose babies we believe were conceived as a result of rape committed by militiamen in Syria,” says Doctor Aswad.
“But even the women don’t talk about it, because Syria’s conservative society views (rape) as taboo,” he adds.
Women still in Syria suffer other complications too, says Shakfi.
“The number of C-sections has exploded in Syria, because many women in the late stages of pregnancy fear going into labour at night, when it would be impossible to get to a hospital,” says Shakfi.
“They talk advantage of lulls in fighting to have a C-section, often before their babies are due.”
In the war-stricken central Syrian city of Homs, 25-year-old Umm Nura was terrified throughout her ninth month of pregnancy that she would need to go to hospital at night.
She ended up seeking a Cesarean section at Homs’ only functioning hospital, she told AFP over the Internet.
“When I came to from the anesthetic, the first thing I heard was the sound of machinegun fire just outside,” says Umm Nura, an architecture graduate.
Her journey to the hospital had been a terrifying adventure, she says.
“We crossed many checkpoints to get there, and I pretended my baby was on its way to get through. Even the maternity ward was full of soldiers,” says Umm Nura.
Activists say the army routinely detains injured people whom they believe may be fighters or dissidents.
According to the international humanitarian organization Doctors Without Borders (MSF), more than 40 percent of births in Syria are by C-section.
Cesarean sections “can give rise to complications for a second pregnancy,” and they are dangerous if the patient is not given a blood transfusion and proper post-natal care, MSF’s Franz Luef told AFP.
Before the conflict erupted in March 2011, Syrians had a free and “good health system,” says Luef, head of mission for MSF in rebel-controlled areas of northern Syria.
Now, however, “the public health system has collapsed,” he adds.
“If emergency obstetric care is not provided in cases where it is needed, both the mother and the child will most certainly die.”