The Atlantic: Working At A Women's Clinic In A Syrian Refugee Camp
January 25, 2014
Written by: Hannah Myrick Anderson
As Syrian peace talks continue, women in refugee camps face a lack of basic resources and the loss of a structured community.
The dozens of bustling people and the swirling dust make it hard to see very far down the main street that runs through Zaatari, the largest Syrian refugee camp in Jordan. The road is lined with ramshackle stalls made of corrugated steel, pieces of aluminum and planks of wood. These little shop stalls display plastic-mannequin heads modeling hijabs, piles of fly-covered vegetables and stacks and stacks of World Food Program boxes. “Not for sale” read the sides of the boxes, but here on the street their contents are spilled out, sorted, and sold. There is a mechanic shop where men are welding and tinkering. There is a barber. There are several restaurants. Young boys push wheelbarrows full of things they have purchased or things they have received from the UN. Shopkeepers yell prices at the passers by.
They call it the Champs-Élysées, this street full of shops and people, this marketplace where thousands of displaced Syrian refugees strive for a bit of normalcy by selling goods, bartering, and chatting with neighbors.
The reproductive health clinic stands just off of this street. Early in the morning, before the thick summer heat sets in, the women step through the gate that divides the clinic from the chaos of the Champs-Élysées. Sometimes men wander in.
“No men allowed!” shouts the midwife through the open door of the portable tin building, or “caravan,” that houses the clinic. “No men! This clinic is only for women!” she shouts, waving her arms wildly back and forth.
Three caravans belong to the clinic. One serves as a makeshift waiting room for the dozens of women waiting to be seen. The second caravan houses a desk, an exam bed and a tiny bathroom. It is here that the midwife registers each of the women, gives out birth control, pregnancy tests, and consults on breast feeding. If women need to see a doctor for any reason, if, for instance, they are pregnant and need an ultrasound, the midwife sends them on to the third caravan where a doctor sits at a desk next to an exam table with an ultrasound machine powered by a generator. All of the staff at the clinic are Jordanian.
I spend most of my days working in the little clinic with the midwife.
“They call me ‘Mama Munira’,” she tells me, on my first day. “Sometimes they tell me they feel like my children, but sometimes they are very angry with me because I cannot give them what they want. It is very hard work.”
I hear tenderness in her voice as she speaks of the refugees. Sometimes the tenderness turns to anger when the women cluster around her door, fighting to be seen first. Or when they peek through the windows as she examines a patient.
“It cannot be this way,” she says. “How can I have a proper conversation with a patient if there are so many others listening and watching? The patient must have privacy.”
Exasperated, she tries to create an ordered system. One of the Syrians, a former patient, is in charge of keeping track of the women in the order they came through the gate, and directing them to wait in the caravan behind the clinic until it is their turn.
I assist Munira each day by helping her take down patient information and counseling the women on how to properly take their birth control pills. Sometimes the women laugh because my Arabic spelling is not very good and they have to correct me when I write their names. They want to know who thisajnabieh, or foreigner is. I explain that I am a medical student volunteer from America. I tell them that I grew up in Jordan, just a few kilometers from where the camp now stands.
Our first patients today are two sisters, each carrying a baby on her hip. They are dressed in black robes and black head coverings with silver sequin detailing on the edges. They smile shyly at Munira as they explain to her that they have come for some type of birth control. I ask them for their refugee cards. Each produces a little white card with a serial number on it. These cards allow them access to food rations, housing, and free healthcare and medications in the camp. They also serve as an identification card, made necessary by the fact that many refugees have lost official documentation in the chaos leaving Syria and entering Jordan. Munira pulls out a glass case that shows the different birth control products she has on hand. She points to each one of them and explains how they work. She points out the IUD, the DepoProvera injection, the two different types of pills and the package of condoms.
The sisters decide that they would like to use the condoms. They begin to giggle as Munira asks them if they know how to use them. As the giggling continues, she unwraps a condom and demonstrates its use. They promise to go home and explain it all to their husbands. I give each of the women a blue card with their names, serial numbers, the date, and the item they received from us. If the women return to us, they can give us this card and we will know what form of birth control we have given them in the past and that they have already been counseled on its proper use. When the two sisters leave us they are still giggling a little.
The next patient is a pretty girl of 16. Her hijab perfectly matches the teal of her outer robe. Her makeup is immaculate. She has been married for a little more than a year. She has one baby at home and has come today for a pregnancy test. She is one of many teenage girls in the camp who are wives and mothers.
“Ya habeebti (oh, my darling),” says Munira to our patient, “Do you want another baby when you have one so young at home?”
The girl shakes her head. “No, but my husband wants one.”
When asked, the Syrian women tell me that marriage between the ages of 15 and 18 is common and expected in Syria. They also say girls are married even younger in the camp. Here, the social structure that existed in Syria is almost entirely broken down. In the midst of a fragmented society, women are not surrounded by a large protective extended family. They live in very close quarters to men who are not related to them. There is little security in the camp, and much fear of rape. Therefore, many parents feel that they need to protect their daughters by marrying them off as soon as possible. Because the family’s former social structure has been broken, the family may no longer have the option to marry a girl to a relative or someone they know well.
Early marriage in the camp not only exposes girls to men who may or may not be known by the family, it also exposes them to pregnancy at an early age. Once a girl is married, it is expected by her family, her husband’s family, and society in general, that she will begin having babies.
Munira reaches out and takes the girl’s hand.
“You are so young now, and so is your baby. If you are pregnant now, then congratulations, you will have a new baby. But if your pregnancy test is negative, and you are not ready for another baby you should try some birth control. Your body is so young, you are still growing. Try to wait a couple years before you have another baby.”
The girl nods her head.
“You can send your husband here,” says Munira. “If he does not understand I will explain to him.”
I hand the girl a pregnancy test. And explain to her how to use it. She promises to come back after she sees the results.
I spend some of my days working on the other side of the camp at a second reproductive health clinic. Two doctors and one midwife sit around a desk in one of the caravans. A wardrobe full of medicine stands to their right, and an exam table with an ultrasound machine to their left. A second caravan houses a small delivery room staffed 24 hours a day by a doctor and midwife.
The delivery room opened a couple days before I arrived in the camp, and I am lucky enough to get to witness a delivery there during my first week.
“I have seven children, this baby will be the eighth,” says Fatima as I help her onto the delivery bed. She grips my hand tightly as her contractions rise and fall. She closes her eyes and moans. The midwife injects a vial of Pitocin into Fatima’s arm to speed the labor process. The contractions come more and more quickly and Fatima moans more loudly with each one.
“Why me,” she begins to mutter. “Oh God, why me? Why in this place?”
“Don’t moan.” says the doctor, who has just entered the room. “Pray to God!” He squirts some green gel on her abdomen, quickly running a battery operated fetal heart monitor over her. The heart sounds strong.
Fatima begins to recite the Shahada. “There is no God but Allah, and Mohammed is his prophet.” The words come out in a bit of a screech as her pain increases. Her grip tightens on my hand.
“Again!” shouts the doctor.
She recites it again and again as the minutes drag on.
“Ah, the head is close,” exclaims the doctor. He prays a prayer for the baby as it prepares to enter the world. With a huge push and groan from Fatima the baby crowns.
“Quick,” says the doctor to me. “Put your hands around the head.”
Fatima shrieks out another prayer and the baby is born. Relief floods her face.
The midwife and I work together to clean up the baby and Fatima. Fatima has a plastic grocery bag with a few articles of baby clothes in it and we dress her new little boy and then wrap him up in a blanket. She names him Abdul Rahman.
After she rests for a few hours, the doctor tells Fatima she can go home. No sisters or mother or aunts accompany her on the dusty path back to her tent full of seven children. Any female relatives who might have helped her are far away, still in Syria.
The midwife turns to me.
“It’s a hard place for babies,” she says.
I nod silently. “Yes,” I think, “yes it is.”
After just a couple of days at this clinic, I start to notice a pattern. While many women come for regular prenatal check-ups and ultrasounds, those who aren’t pregnant often complain of the same issue—abdominal and lower back pain, and frequent, burning urination.
“They all have UTIs,” explain the doctors. This diagnosis is never confirmed by urinalysis, but the doctors are fairly certain of it nonetheless. They write prescription after prescription for antibiotics.
I bring a little notebook with me to the clinic each day to keep track of how many UTI cases are seen by the doctors. I find that aside from prenatal visits, UTI’s are the most common reason women come to the clinic.
I ask the doctors why they think so many women have the same complaint. They say that the women aren’t drinking enough water. The extreme heat makes the women sweat and lose a lot of their water to evaporation. When I start asking the women more about their water drinking and toilet habits, I find that their main complaint is the state of the bathrooms. The community bathrooms are rectangular concrete block structures made up of six stalls. These six stalls are shared by 50 to 60 people. The patients tell me that the bathrooms are so filthy that they try to avoid using them more than twice a day. Women also tell me that they fear going to the bathrooms alone and won’t go unless they have another female to accompany them. Rumors abound about men who hide out in the bathrooms waiting to rape unsuspecting women.
There is often tension between the mostly Jordanian aid workers and the Syrian refugees. On a couple of occasions, the car that brings me and the other clinic staff in to the camp each morning, is prevented from entering the camp by a mob of angry men waving sticks.
“We demand better living conditions,” they yell.
Sometimes the women at the clinic grow angry at the doctors. They stand outside the clinic with children in tow. “We’ve been waiting for hours!” they say. “Our children are tired. Let us see the doctor.” Sometimes the women who are very pregnant begin to feel faint, and their mothers or sisters or friends drag them over to the door.
Sometimes I go outside and sit with the women who are waiting.
“What do you think of this clinic?” I ask them in Arabic.
“Sometimes it is ok. Sometimes it is very bad. But the doctors here, they do not like us. They don’t do proper exams. They just give us medicine and tell us to leave.”
One mother is holding a crying baby.
“It’s hot while we wait, and we wait a very long time.” she says. “But I don’t think these Jordanians care. I think that my children will die here in this desert.”
This was a phrase I heard frequently.
“We will die if we have to stay here in Jordan,” the women say. “No one cares about us Syrians.”
Here, in the midst of chaos, in a camp full of displaced people fleeing a war torn country, it’s easy for the women to feel forgotten, as though they’ve entirely lost their place in the world. Gone are their homes and their possessions. Gone are some of their family members and friends. Gone is their membership in a specific community. They struggle to create some kind of normalcy. They set up shops. They move their tents close to people they knew in Syria. They try to find jobs working for the aid agencies. But their society is still fragmented.
While continued aid is needed to sustain the refugees in the Zaatari camp, it seemed to me that many of the troubles that the women in the camp faced were less about a lack of resources and more about a lack of a structured community. Girls got married and pregnant at younger and younger ages not because there was nothing else for them to do in the camp (there are schools), but because their normal protective environment had been shattered. Women were sick with UTI’s not because they didn’t have access to water or bathrooms, but because they didn’t feel safe around the people sharing their restrooms. Women like Fatima bore a heavy burden raising large families not just because they now had fewer possessions, but also because they no longer had a network of extended family helping out with the children.