One Thursday in February, Rasha Al Shwafi began to feel sick. Heavily pregnant with twins, she initially passed it off as a mild indigestion. But as the day wore on, she found that she could no longer endure the pain. Still some weeks away from her due date, the pain steadily intensified; and along with it, her anxiety grew. That same afternoon she was rushed to the Republican Hospital in the Yemeni capital Sanaa.
But while traveling from her home in Al Hamami on the outskirts of Sanaa, she was forced to give birth to one of the twins in the car. On arrival, the baby girl was immediately rushed to the intensive care unit (ICU). Minutes later, she was pronounced dead. And despite frantic efforts to rescue the second twin in a caesarean operation, her sibling too did not survive. Al Shwafi, who is in her early twenties, was distraught. All hopes of starting a family were dashed.
Such stories are all too familiar in the once popular cradle of civilization, ‘Arabia Felix,’ a year after the Saudi-led Arab coalition launched ‘Operation Decisive Storm’ against Yemen’s Houthi militants. Three weeks into the offensive, it was unclear whether or not the conflict would abate.
In a recent report, Human Rights Watch listed nearly 91 unlawful airstrikes during the conflict on weddings, schools, heritage sites and medical facilities. The massive scale of damage on Yemen’s infrastructure, including hospitals, has rendered nearly half a million pregnant women unable to deliver their newborns in safety, according to the United Nations. The impact of the war on maternal healthcare has been devastating.
Access to remote mountainous areas is an enormous challenge for many international organizations. Medicines Sans Frontiers (MSF) is one of the few groups to successfully set up mobile clinics and partner with local hospitals across the country. “One of the key problems facing these women is the lack of immediate access to medical facilities,” said Colette Gadene, head of the MSF mission in Yemen.
Young pregnant women have become the invisible victims of this protracted conflict. Some have also turned into war widows overnight. With no bread-winners in the family, many are left to choose between using their limited resources to feed their family or seek medical care. “What we are seeing across our facilities is that patients are arriving at a much later stage of their pregnancy. This results in undetected infections and complications,” Gadene added.
Women are also avoiding antenatal care given the high cost of transportation; the cost of fuel has doubled by more than 55 percent since the start of the war in March 2015, according to a recent report by aid organization, Oxfam.
MSF alone has conducted nearly 8000 deliveries at its 11 centers and make-shift mobile clinics across the country. This figure does not include births in local hospitals, and so the number of dead infants since the start of the Saudi-led operation is largely unknown.
Deserted Maternity Wards
At the Sabaeen Hospital in the center of Sanaa, doctors and nurses scurried along the corridors shaken up from an attack in the first week of September 2015. When I arrived a week later, the ward was deserted with remnants of shrapnel and glass from shattered windows strewn across the floor, and electrical wires hanging from the ceiling. Two newborns were killed—one in the nursery and the other in the pediatric emergency room—by the sheer impact of the strike.
Four days after reopening the hospital, its general manager, Saleh Mohammed Al Salem, said: “We had to open the hospital. It’s not easy; where will these people go? We are a specialist hospital for mothers and children. We are struggling, the children’s ICU has no air conditioning.”
Gynecologist Dr. Miriam Ahmed said, as she examined an ultrasound, that since the start of the bombing campaign she has seen a significant rise in the number of miscarriages, still-births and ruptured membranes caused by the stress of war.
“There is a fluid protecting the baby—if that is ruptured the baby will not survive,” she added.
“We are seeing many such cases these days, since the start of the war. I remember another case, she escaped the bombing, got into the car and was bleeding heavily. When she arrived here the baby was no more,” said Ahmed.
In another ward, a clearly anemic Gumriya Abdullah Al Jumhairi, 35, was lying on her bed. What would have been her third child had died in her womb two months after it was conceived. “The war of course makes it difficult, but we are not afraid,” she said wearily.
Prior to visiting Sabaeen Hospital, Jumhairi had consulted a private clinic to perform a procedure to remove the remaining tissue from inside her uterus. However, the costs were staggeringly high at 60,000 YER ($280). “How can we afford this? Even death is expensive,” she added. With nearly 21.2 million Yemenis in desperate need of humanitarian assistance, this is hardly a surprise.
In addition to the high cost of medical treatment, Yemenis must worry about their hospitals being safe from the shelling. In the past six months alone, MSF clinics were hit more than four times, despite signage on the roofs of most of its premises. MSF medical coordinator, Dr. Mitsuyoshi Morita, said that many mothers are now opting to give birth at home, or in caves.
“The health facilities are closed and it’s difficult to deliver drugs. Ambulances are shot down and patients don’t want to stay in the hospital long after [giving] birth,” Morita added.
When Lemis Muallim learned about her pregnancy six months ago, she was ecstatic. But her joy was suddenly overcome by fear. The thought of abortion crossed her mind, but she couldn’t bring herself to discuss it with her husband.
Looking out the window of her mafraj (room with a view), in one of Old Sanaa’s gypsum and redbrick buildings, she was absent-minded. “When we heard the news, I was so happy. I wanted to be a mother all my life.”
But in a country bereft of basic infrastructure, thinking about a future for her child has left her feeling hopeless. Muallim said the conflict has dragged Yemen into the dark ages by reducing its infrastructure and heritage sites to rubble. After several failed peace talks and broken ceasefires on both sides, Muallim has no one to turn to, but God.
“You know many women are scared. But we have faith; we believe Allah gives us what is right. We believe in our destiny. A child is a gift from God,” she said. “Ending the pregnancy is like killing the form, it’s killing the soul,” she added.
The Quran is clear that new life is sacred. The termination of a pregnancy, for personal or financial reasons, is deemed unlawful (haram), except in rare circumstances, when the mother’s life is in danger, the fetus is suffering a congenital anomaly or in the case of rape.
But the unrelenting strikes at any time of the day can be nerve-wrecking for anyone, let alone a pregnant woman. “I was more scared for my baby. Sometimes it felt the explosions were nearby, and I couldn’t sleep.” Even the mere sound of the fighter jets hovering in the sky creates a sense of imminent doom for young mothers. Windows rattle, glasses break, children cry, and Muallim simply wonders if she would live to see sunrise.
Muallim still felt fortunate that she was able to buy water and use a generator, in comparison to the majority of Yemen’s women who struggle with ten minutes of electricity a day, and a water supply every fortnight.
Initially, Muallim used to visit the Motherhood and Childhood Hospital, but the stress of anticipation, malnourishment and a lack of vitamins have left her weary.
Unlike Muallim, Azhar Al Aswadi felt compelled to end her pregnancy in July 2015. A young woman in her early twenties, an ultrasound at the Khalifa Hospital in the Yemeni city of Taiz showed the fetus was suffering a disability. “The baby did not form well,” she said.
“Many people told me that it is a sin to end the pregnancy, but I consulted a sheikh and I told him that the baby is disabled. He assured me it isn’t a sin,” she said. Sheikhs in
Yemen are deemed integral to the functioning of society. Many are consulted not solely for religious advice, but for resolving property and other disputes—more so in the absence of a government.
Due to lack of hospitals, and medical professionals in Taiz, Aswadi travelled for 10 hours by car to the University of Science and Technology Hospital in Sanaa for the procedure.
Aswadi was grateful that she was financially capable to seek such medical help because her husband worked for the government’s education office in Al Shimayateen. Generally speaking, women don’t openly discuss abortion if they fall accidentally pregnant as Yemen is a deeply conservative society. “This is a sin, but if the baby will harm the mother then she can ask a sheikh and he will advise her,” she added.
After giving birth, new mothers face significant obstacles as Yemen’s healthcare facilities have beyond collapsed. Even before the war, the country was struggling with the lack of basic medicines, medical equipment and qualified professionals.
MSF’s Morita said follow up care is non-existent. “In general the war environment is unfavorable for the development of children, for the families affected, and for the infant’s growth. These children are invariably wounded, killed, and then unheard of.”
“The younger children are scared, the older seem to be inured to the violence and in the long run have mental implications,” added Morita.
Due to regular sieges at seaports and checkpoints by all warring factions, food is not easily accessible, and women do not receive adequate nutrition to breast-feed their newborns. “The internally displaced people are surely worst affected. In Hajjah, people wait for up to two months for food to arrive,” said Gadene. The Internally Displaced Monitoring Center estimates there are more than 2.5 million internally displaced Yemenis as of December 2015, a number many in Yemen consider as an underestimate.
On one October day, outside the Sabaeen Hospital, an anxious man stood waiting for his wife to give birth. For Mohammed Sameh, who works as a correspondent at Anadolu News Agency, the anticipation might be over soon, but he feels himself staring into an abyss. “We have been suffering from our situation for a long time now. My wife was pregnant before the war, and it doesn’t look like there is a solution [to the conflict]. Only Allah can help us get through this,” he said nervously.
Still he was grateful, and the excitement abounded with every passing minute. “Alhamdulillah, we are blessed. Many women struggle to make it this far, so God has been with us until now.”
He was financially secure, but understood that there were no guarantees the situation would hold, come tomorrow. “The feeling is mixed. I am happy, but it’s a very bad situation.
War is the worst situation in the world. I don’t know about my future. I don’t know about my baby’s future,” he said.
The conversation about Sameh’s new born inevitably shifted to Yemen’s war. “We have hope, more hope to go through this situation than we have in the government. Despite the bad circumstances, people are going on with their life, they are smiling through this pain,” he said.
Despite ceasefire promises and the next round of peace talks scheduled for April 10, Muallim said there are no signs the airstrikes, shelling or the ground fighting will cease. Her neighbors reassure her to prevent fear getting in the way of her pregnancy as its imperative for the well-being of her newborn.
If there’s anything that keeps her going these days, it’s the arrival of her newborn in three months. “Maybe when my baby is born, this war will end. Who knows?”
Unsure about the child’s gender, her mother’s initial instinct is that it’s a boy. Muallim has decided if it’s a boy she will call him Yahya, (or John), the name of a Prophet in Islam.
The hope is that he will be born into a different Yemen; one of peace, and stability.