Amid Syria’s civil war, a rise in miscarriages among displaced women in the northeast

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Updated at 2:02pm EST with information on the first COVID-19 case confirmed in Syria.

Kobane, Syria—Miscarriages have surged among displaced women in northeastern Syria over the last several months, according toa report released in January by Women Defend Rojava. As the Syrian war rages into its tenth year, thousands continue to flee their homes. Months after Turkish forces launched an offensive in the Rojava region, which some have likened to genocide, the rise in miscarriages sheds light on the unseen impacts of the occupation.

Towns near the Syrian-Turkish border, including Kobane, Ayn Issa, and Tell Abyad, are bearing the brunt of the rise in violence, and its toll on civilians—particularly women—is coming into sharper focus.

Dr. Nasan Ehmed, a physician at the Kobane Maternity Hospital, has seen at least four times the number of miscarriages since October 2019, when the Turkish offensive began, according to data collected by the hospital. Before then, Dr. Ehmed saw anywhere from 11 to 20 miscarriages per month; now, he said, there are approximately 80 incidents per month due to premature births, uterine bleeding, or uterine tearing. In the month of October, the jump in miscarriages was almost exclusively localized in Tell Abyad, which was an early focal point for Turkish forces. Speaking to Women Under Siege through a spokesperson at Women Defend Rojava, Dr. Ehmed attributed the increase to particularly intense levels of displacement, trauma, and deprivation.

On October 6, 2019, the Trump administration announced a withdrawal from the region, claiming that the escalating conflict had become “untenable” for the U.S. military. Three days later, Turkey initiated “Operation Peace Spring,” its third incursion into Syria since 2016, “to prevent the creation of a terror corridor across our southern border,” Turkish President Recep Tayyip Erdoğan tweeted, and to establish a purported “safe zone” for refugee resettlement of at least 30 kilometers (roughly 18 miles) into Syria. Airstrikes into the Kurdish territory followed, as did “a wave of displacement,” according to a statement by the Kurdish-led Syrian Democratic Forces (SDF).

The SDF are a U.S.-backed militia alliance largely dominated by the People's Protection Units (YPG), a Syrian Kurdish militia that was a critical partner to the U.S. in the ground battle against the Islamic State in Syria. Ankara considers the YPG, along with its political arm, the Democratic Union Party (PYD), as indistinguishable from the Kurdistan Workers' Party (PKK) in Turkey, which is recognized as a terrorist organization by the U.S. and the European Union. Ankara maintains that Operation Peace Spring is to secure its border against these Syrian Kurdish fighters, whom it deems a threat to its national security.

The withdrawal dealt a disastrous blow to the SDF, who saw the offensive as an existential threat to Rojava, or the Democratic Federation of Northern Syria, the de facto autonomous territory formed by the PYD in the wake of governmental collapse in 2013. The Rojava project promised a new kind of nation state: one that was democratic, secular, and committed to liberal values of gender equality, environmental sustainability, and ethnic plurality. While it was far from perfect (critics pointed to the PYD’s collusion with the Assad regime for protection), the dream of a grassroots mode of democratic governance symbolized hope in a region devastated by authoritarian rule and violence at the hands of the Islamic State.

Since U.S. forces effectively abandoned them, the Kurds have been particularly exposed to geopolitical risk—and deteriorating access to care.

Gender-based violence and lack of access to medical care have left women—especially pregnant women—uniquely at risk in this period of ongoing violence and forced migration. Dr. Ehmed treated one woman who went into labor in a camp near Kobane late at night, unable to arrive at the maternity hospital until the following morning. As a result of uterine tearing, she lost her pregnancy. “The biggest impact on the pregnancy, for the fetus and the mother, is the level of stress of the mother,” Dr. Ehmed said. “The increase in adrenaline and stress hormones makes the lining of the womb tear and stops the fetus developing.”

Mali Ebrahimi, a sexual and reproductive health referent for Doctors Without Borders, told *Women Under Siege *via email that she’s documented similar maternal impacts further west in Aleppo and the Idlib governorate, where a humanitarian crisis is playing out “on a monumental scale,” according to the UN. “We are not able to provide exact data, but what we do know is in the last month, there has been an increase in miscarriages and stillbirths, early membrane rupture, and induced hypertension. This means that women are under stress and are lacking necessary vitamins and iron,” she said, adding, “We are also seeing increased violence against women.”

Transport to health clinics presents its own obstacles: access to cars and drivers was already limited in Kobane, but now, travel is even more dangerous. Jamila Hamy, who works for the Kurdish Red Crescent in Qamishli to Kobane’s east, said that Turkish forces had been targeting ambulances, making it harder for civilians to access urgent medical care and for aid organizations to carry out their work.

“All the human rights standards on paper do not apply in real life,” Hamy told Women Under Siege. “According to human and legal rights standards, they’re not allowed to hit ambulances, kill medical personnel, hit hospitals and medical points,” yet these kinds of violations have been widely documented by journalists and local social media accounts.

While the latest report from the United Nations Commission of Inquiry on Syria pointed to war crimes committed during Operation Peace Spring, its findings haven’t produced any accountability—much less relief—for those who remain trapped in this conflict.

Hamy said she feared aid efforts would suffer as the violence intensified and the number of civilians unable to cross the border continues to swell. Organizations like the Kurdish Red Crescent have aimed to fill the region’s “healthcare vacuum” by supplementing their own training and educational programs focused on specific areas of need.

The Kurdish Red Crescent provides education on gestational periods, anemia awareness and prenatal nutrition, breastfeeding, and post-childbirth care. While such programs provide vital education to women who might otherwise not be able to access it, within the context of war-torn infrastructure, food insecurity, and political instability, they can only help so much.

The escalation of the COVID-19 global pandemic adds yet another dimension to the growing healthcare concerns in a war zone. Syria's state media has confirmed its first case of coronavirus, and with the destitute living conditions of the displaced—and the lack of access to basic resources, such as water, food, and medicine—conditions for a devastating outbreak are already in place.

For the 80 women who lose their pregnancies each month, access to maternal health care and education is no theoretical issue. From gender-based violence intensified by conflict and displacement, constricted mobility newly compounded by the threat of a global pandemic, and the utter impossibility of proper health care needed to deliver new life into the world, it’s hard to imagine a future for oneself, let alone for a future child.