As shelling pierced the air outside, a recent medical school graduate continued to carefully examine a pregnant Syrian women who was about to go into a labor at a makeshift hospital.
The surgeon weighed his two options: figure out how to perform his first cesarean section, or risk the patient and her unborn baby dying on the operating room table.
Four years into the civil war in Syria that’s claimed more than 200,000 lives, such compromising childbirth situations have become the norm as the health system continues to languish. An estimated 64 percent of public hospitals have been damaged, destroyed or shut down, according to Save the Children and aid organizations struggle to reach the besieged areas where their services are needed most.
“Every moment of every day I feel I have had enough, but we have no other choice. People here need us,” Dr. S., who declined to reveal his identity due to security concerns, wrote in a blog post for Doctors Without Borders. “They are in desperate need of all kinds of medical care, from the most simple to the most complicated."
The turmoil he faces represents the lengths medical professionals must go in order to save mothers’ and newborns’ lives in the war zone.
The Syrian surgeon graduated from medical school shortly after the crisis broke out, worked in a number of field hospitals and then set up a clinic in a bombed out school located to the east of Damascus in 2012, according to Doctors Without Borders.
The humanitarian organization runs six health facilities in northern Syria and provides medical supplies and other support to physicians, like Dr. S., who are able to treat patients the group can’t access.
The area surrounding the clinic was under siege for eight months until last February. But perhaps the most chilling moment Dr. S. has experienced was in October 2013 when a pregnant woman in need of a C-section arrived and he didn’t have the necessary training to perform the operation.
Bomb damage to the upper floors of the abandoned school building used as a makeshift hospital in a besieged neighborhood of east Damascus in July 2013.
The group tried negotiating getting her safely transported to a maternity hospital to no avail.
A few days before her delivery date, Dr. S. tried to get a working Internet connection to research how to perform the procedure as the bombardments reached a “deafening” level, he wrote.
“The clock was ticking and my fear and stress started to peak,” he wrote. “I wished I could stop time, but the woman’s labor started.”
Dr. S. performed the surgery successfully and said “joy overwhelmed” him when he knew that both the mother and her daughter would survive.
While all areas of Syria’s health system have been shattered, the demise of maternal health care there demonstrates the loss of potential medical progress that was once within the country's reach.
Before the crisis, the country was on track to reach its United Nations Millennium Development Goals for both its child and maternal mortality rates, and a skilled birth attendant assisted in 96 percent of deliveries.
While exact figures aren’t available due to the conflict, experts say maternal and infant deaths are on the rise.
C-sections, which can present a whole slew of health complications, are also on the rise in the war zone. While women are aware of the health risks, the number of women opting for the procedure more than doubled in 2013 from 2011 since a C-section allows women to schedule the birth under more secure conditions, according to a recent Save the Children report.
While physicians remain concerned about operating under such difficult conditions, they say they see it as their duty to heal what they can of the conflict’s devastation.
“In this madness, our work as surgeons is to save as many lives as we can. Sometimes we succeed, and sometimes we fail,” Dr.S. wrote. “It is as if we repair the damage that the war left.”