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Profiles of Maternal and Newborn Health in Humanitarian Settings: Conflict in Syria

By: Kayla McGowan, Project Coordinator, Women and Health Initiative, Harvard T.H. Chan School of Public Health; Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public Health

Read part 1 and part 2 of this series>>

Armed conflict and maternal health

Conflict contributes to surges in displaced and refugee populations and has important implications for health systems. Women living in conflict or post-conflict settings are particularly vulnerable to experiencing sexual violence, poor reproductive health, unwanted pregnancy and adverse maternal health outcomes. Armed conflict often forces people to leave their homes in search of refuge, compounding issues with access to high quality care. As Omar Robles of the Women’s Refugee Commission explains,

“When women and girls are displaced from their homes, the rigid, gendered expectations associated with motherhood and caregiving travel with them. Displacement doesn’t put a halt to maternal health needs or risks, it exacerbates them.” – Omar Robles, Senior Program Officer, Adolescents in Emergencies, Women’s Refugee Commission

Availability of high quality reproductive, maternal and newborn health services is extremely limited during armed conflict. Barriers to access often result in lower maternal health care utilization, and the resulting negative consequences on maternal health often persist after the armed conflict ends. For example, a study from the 2016 Lancet Maternal Health Series found that maternal mortality ratios (MMRs) in sub-Saharan African countries that recently experienced armed conflict were 45% higher than MMRs in countries without recent conflict.

Impact of armed conflict on health in Syria

According to the International Institute for Strategic Studies’ latest Armed Conflict Survey, the Syrian conflict has resulted in 290,000 deaths since 2011 and 3.4 million refugees as of 2015. The dire, ongoing armed conflict in Syria has had an enormous impact on the health system. A study from The Lancet reported that from early November 2015 through the end of 2016, nearly 1,000 people were directly harmed in over 400 incidents of violence against hospitals and the health sector. Roughly one quarter of these victims were health workers.

Like in other armed conflict settings, women in Syria are suffering from gender-based violence and a lack of access to high quality health care—particularly during pregnancy and delivery. The collapse of basic infrastructure such as incubators has resulted in countless preventable newborn deaths. Furthermore, a lack of standardized clinical guidelines, protocols and tools for addressing issues such as sexual assault, child marriage and rape has not only limited the humanitarian response, but may also contribute to poor maternal and newborn health outcomes in the region.

Women who have managed to flee and are now living as refugees in camps or in other countries may continue to face maternal health challenges and inadequate sexual and reproductive health services. For example, an assessment of over 400 pregnant Syrian refugees living in Lebanon found that among those who had received any antenatal care, less than a third received blood pressure measurement and urine and blood sample analyses. Interviews with Syrian refugees of reproductive age living in Lebanon revealed that the number of women using family planning methods was about 34.5%—a rate below that reported among the general population before conflict arose.

A call to action: Addressing the health needs of women and children in humanitarian settings

While programs to improve reproductive, maternal and newborn care should be grounded in high quality evidence, the humanitarian response requires immediate, deliberate action. As Zulfiqar Bhutta explains,

“Notwithstanding any uncertainties around exact burden of maternal ill health and mortality in conflict settings and humanitarian emergencies, the impact of this current global reality on the health and wellbeing of millions of adolescent girls and women is enormous.” – Zulfiqar Bhutta, Robert Harding Inaugural Chair in Global Child Health, The Hospital for Sick Children, Toronto

Timely data collection and analysis is essential to identifying the most pressing issues for women and children, as Massimo Diana points out:

“Data collection on maternal, newborn and child health in emergencies can be challenging due to the sensitive nature of the information and possible recall of past trauma. The maternal health community must tailor the data collection to each emergency setting and put women’s health at the forefront. The fast-changing nature of emergencies affect maternal health in all humanitarian crises. Adaptability of health workers and planning flexibility are often key to ensure women’s health during humanitarian crises.” – Massimo Diana, Representative, UNFPA Syria

For the most part, poor reproductive and maternal health outcomes in conflict and post-conflict settings are preventable with evidence-based interventions. Omar Robles suggests,

“Most all pregnancy-related deaths are preventable. Displacement or a humanitarian setting doesn’t necessarily make this statement any less true.” – Omar Robles, Senior Program Officer, Adolescents in Emergencies, Women’s Refugee Commission

Every woman everywhere has a right to receive high quality, timely, respectful care. With more investment in research, programs, policy and multi-sector collaboration, the global community can ensure the provision of safe maternal and newborn health services in all settings.


Read more about maternal and newborn health in humanitarian settings on the Maternal Health Task Force (MHTF) blog:

Learn about a recent technical meeting co-hosted by the MHTF:

Health in Humanitarian Settings: Learning Through Case Studies to Inform Programs and Policies

Access resources highlighting the unique needs of adolescent girls in humanitarian settings:

Adolescent Girls in Disaster & Conflict: Interventions for Improving Access to Sexual and Reproductive Health Services
United Nations Population Fund

Adolescent Girls in Emergencies: A Neglected Priority
Humanitarian Practice Network

Check out OpenWHO, the World Health Organizations’ new interactive, web-based, knowledge-transfer platform offering online courses to improve health emergency response.


What did you think of this mini-series highlighting profiles of maternal and newborn health in humanitarian settings? We would love to hear from you!

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