Update: Maternitainer to Dar'a

Update: Maternitainer to Dar'a

 
“Security in Dar’a Governorate in southern Syria has deteriorated since late January 2014, resulting in a growing number of IDPs”.[1]
 
On April 16th a mobile medical facility for women has left the harbor of Antwerp to go to Dar’a-Syria. This mobile unit will provide a clean and safe place where women can give birth in the presence of a skilled birth attendant. Also, women who have been victim of sexual violence can be treated there, without the fear of being stigmatized, as the facility is simply known as a ‘general health clinic for women’.
 
 
What is a Maternitainer?
The Maternitainer is a quick to install flexible and mobile delivery unit build in a 20 Ft shipping container, which can rapidly be deployed because it is based on a truck. It offers a safe and clean place for women to give birth and provides all the preconditions necessary for intra partum and post partum assistance. For victims of sexual violence the Maternitainer aims to provide treatment to injuries and post exposure prophylactic treatment as prevention to sexual transmittable infections. Due to the multifunctional use of the Maternitainer the moral and cultural stigma imposed on victims of sexual violence is decreased, as from the outside the facility is ‘just a general health clinic for women’.
 
Why is there need for a Maternitainer?
 
- Dar’a’s humanitarian situation deteriorates
Due to its strategic location as transit route between Syria , Jordan and the Gulf states, the governorate of Dar’a, existing out of 16 sub-districts, has always been one of the most militarized regions inside Syria. Since the beginning of the protests in March 2011 Dar’a has served as battleground between opposition forces and forces loyal to the Syrian government (GoS), with shifting border from time to time. Due to insecurity, and sometimes lack of permission, access for international aid has been extremely limited.
 In former days Dar’a hosted around 1 million Syrians, mostly Sunni Muslim but also approximately 29,000 Palestinians and some Druze. Today Dar’a has seen very high levels of displacement both of Syrians fleeing across borders into Jordan (around 40%) as well as the return of refugees from Jordan back into Syria. The biggest catastrophe so far in terms of numbers is the immensely high amount of IDP’s who fled to Dar’a and settled in the community with host families, in public buildings / unfurnished buildings or in collective shelters. According to UNICEF over 355,000 people were in the midst of 2013 displaced in the governorate of Dar’a (see map 1).
 
- Health needs of the Syrian population
 In the Syrian Needs Analysis Project (SNAP) of 2014 both food and health security have been prioritized as the most important aid sectors for the IDP population as well as for the resident population who has not been displaced but has seen their resources shrink severely (see map 2). Regarding the health needs a UN-interagency mission reported that 50% of the hospitals in Dar’a governorate are not functioning, that in some districts between 50-80% of the health facilities are damaged or destroyed and that over one-third of the health staff has fled the governorate. Despite this all-encompassing tragedy, some groups have been appointed to be extra vulnerable. 
 
“Women, particularly pregnant and lactating women are increasingly becoming vulnerable as the crisis limits access to basic services, including to reproductive healthcare services, and they are exposed to reinforced negative practices and perceptions” (SHARP, 2014).
 
- Being pregnant in times of war
That women need to deliver in the presence of a skilled birth attendant is widely known and pursued in many different settings. Nevertheless, ongoing conflicts jeopardize health structures and decrease access to facilities still functioning. In some of Syria’s governorates, including Dar’a, less than 30% of the basic emergency obstetric care centers are still functioning, leaving large numbers of women without the possibility to safely deliver their baby in the presence of a skilled birth attendant (SHARP, 2014). This lack of basic emergency obstetric clinics causes an increase in elective caesarean sections; caesarean sections which are medically seen not necessary but preferred because of uncertainty of reaching a medical facility on time for delivery. Besides the trauma inflicted by the surgical intervention, which can weigh severely upon the health of the women, chances of sepsis and hemorrhage also increase as compared to a normal delivery, which puts the women in unnecessary dangerous position.
 
Many women of reproductive age face challenges in accessing vital reproductive healthcare services including information regarding where and when to seek care, the availability of safe transportation and the high financial cost of services” (SHARP, 2014). 
 
- Increase of sexual violence
 As reported by many agencies, sexual violence prospers wherever there is disorganization, an absence of structure, a lack of hope and takes place across every stage of a conflict. Although currently most coverage of the Syrian war tends to focus on fighting a more insidious and devastating dimension has emerged; that of rape used as tool of control, intimidation, humiliation and devastation.
Today many organizations have raised awareness of the staggering increase of sexual violence inside Syria, mostly against women and girls (although men and boys are also known to be victimized by this kind of violence) (see graph 1).
Last year IRC strikingly quoted: “Rape has become a significant and disturbing feature of the Syrian civil war” (IRC, 2013). Not much later also the director of the Women Under Siege Project stated that Syria faces a: Massive rape crisis” (The Atlantic, 2013).
 
Due to the nature of the conflict related sexual violence, women are often sexually assaulted using sticks, guns, branches of trees and bottles, causing physical injuries and increasing the risk of sexual transmittable diseases and unwanted pregnancies. Most of the women withhold themselves from- or are obstructed access to health care after they have been sexually victimized. In addition to the shame and isolation a woman faces when her environment knows about her abuse many are displaced and surrounded by people who they don’t know and don’t trust and many of them have no clue where to go to.
 
A call for action
 
Based upon ongoing cooperation with Mother Agnes of the Monastery of Sint James the Mutilated and her cry for intensification of aid provided to the Syrians, especially the women, Hospitainer, Cordaid and Bijzonder Noden decided to send a Maternitainer to Dar’a to provide a clean and save place where women can give birth in the presence of a skilled birth attendant. At the same time, the Maternitainer is stocked with all the medicines needed to treat women who have been sexually abused.
 
Mother Agnes, who also coordinates a Hospitrailer-project in Homs, has set op a team of 36 midwives who are able to work around the clock to assist women in their deliveries. The Maternitainer has been send to Syria on Wednesday April the 16th and will arrive approximately 2-3 weeks later in the city of Dar’a (see map 3). It will be placed next to a health post, which was in former days a basic health facility but, after the bombing of the Dar’a- and Jasem hospital, used as surrogate health facility. This health post and its available rooms will be used as pre- and post-delivery ward. Because of its strategic location the facility is accessible for everyone, an important precondition when medical facilities are deployed in conflict areas.


[1] Source: http://ggs.gmu.edu/

back