SYRIA/TÜRKIYE – The numbers are beyond comprehension: Over 9 million people in Türkiye in Türkiye and 9 million in Syria affected by two massive earthquakes. Among them, some 350,000 pregnant women in both countries – women who need vital, immediate access to health services in structures that are no longer standing, amid rubble that used to be roads. 

In Syria, the earthquakes only deepened entrenched suffering from 12 years of conflict that have left 90 per cent of Syrians destitute and forced half the population from their homes, most of them women and children – many taking refuge in Türkiye. 

In Türkiye, a country home to the largest number of refugees in the world and which has shown enormous generosity to its Syrian neighbours for years, tens of thousands are now living in makeshift shelters.

In a humanitarian crisis, women and girls are still, always, the hardest hit. The last to eat, the most exposed to sexual violence and exploitation, the heads of houses they no longer hold.

No response, including this one, should be gender blind: Our response can’t be either. Women and girls have to be put first. Here’s why.

1. Crises can mean life or death for pregnant women

Thousands of hospitals, including UNFPA-supported facilities and safe spaces, have collapsed or been damaged. This has left pregnant women and new mothers struggling to access essential care, including emergency obstetric support and caesarean sections.

Um Subhi and her newborn received maternal support from UNFPA at a temporary camp in Jinderis, in Syria. “When the earthquake hit I was breastfeeding my baby, I didn't know what happened. I've never experienced anything like this in my entire life,” she said.

We know that in crisis and disaster settings, maternal deaths can rise dramatically from complications that would be easily managed in settings where health systems were functioning.

There are an estimated 133,000 pregnant women in affected areas of Syria, around 44,000 of whom will deliver in the next three months. In the ruins of the region’s worst natural disaster in recent history, they must rely on a health system bludgeoned by over a decade of bombardments, economic chaos and near total lack of supplies or staff.

In Türkiye, an estimated 14,400 of the 130,000 pregnant women directly affected by the earthquakes will deliver within a month. Nearly the entire health infrastructure in the most affected areas has been damaged or destroyed – 70 per cent of family health centres are damaged and 60 per cent of maternal health and obstetric services are not operating, endangering tens of thousands of lives.

2. Disrupted sexual and reproductive health access could trigger a secondary disaster 

Over 100 health facilities in Türkiye and more than 170 in Syria have been destroyed or damaged, including at least seven hospitals. This puts at immediate and longer-term risk the health of some 2.2 million women and girls of reproductive age in Syria and 4.1 million in Türkiye, all of whom need the sexual and reproductive health care of their choice. 

Without contraceptive supplies or access to them, unintended pregnancies will spike, as could sexually transmitted infections, including HIV. Other diseases could more easily spread too, such as COVID-19 and influenza and pre-existing outbreaks of cholera, hepatitis A and measles in Syria. 

It is critical to get reproductive health and protection services up and running again. We must ensure access to reproductive health care for all women and girls who need it, regardless of where they may be, including in temporary shelters and within host communities in both Syria and Türkiye.

3. Gender-based violence protection needs soar just as services shutter 

In a crisis, women and girls are also at much greater risk of violence and abuse, while social security and protection services break down and health facilities collapse. Yasmin*, 26, is a single mother of five children. Originally from Deir-ez-zor in eastern Syria, she has lived in Türkiye for five years and took shelter at a UNFPA safe space for women and girls set up in a sports hall after the earthquakes.

Her husband was physically and emotionally abusive towards her. “He threatened me, he wanted to take my children away.” UNFPA previously provided shelter in a safe space, and now with her home severely damaged she said, “Now they have moved me to this centre because it is safer.”

UNFPA safe spaces in Syria and Türkiye are ensuring prevention and response services for gender-based violence, for tens of thousands of women and girls living in over-crowded, makeshift camps or on the streets. They are facing acute protection risks, including a greater risk of gender-based violence, exploitation and abuse, and violations such as child and forced marriage - all of which have become increasingly ‘normalized’ during Syria’s protracted crisis. 

Millions of survivors are meanwhile enduring terrible trauma and need access to mental health and psychosocial support. 

4. Displacement takes a severe physical, mental and social toll

Over 100,000 households have reportedly been displaced by the earthquakes, although the true number is likely much higher. Many people are staying with host communities or returning to unsafe, uninhabitable homes; many more are living on the streets or in refuges, unable to rebuild their houses or livelihoods.

Syria already has the largest number of internally displaced people in the world at 6.8 million, with the same number having fled for neighbouring countries. People forced from their homes by war, disease outbreaks and financial ruin were later met with droughts and floods that destroyed what remained of their livelihoods. With this latest disaster, millions more are facing the trauma of involuntary migration once again. 

Almost half of them are women and girls, grappling with homelessness, discrimination, poverty and escalating risks of exploitation and abuse.

Rojin is a 36-year-old mother of four, now sheltering in a UNFPA safe space for women and girls in Diyarbakır, in Türkiye. Originally from Syria, she and her family are living alongside 15 others in a single room of an animal feed factory. She told UNFPA, “We stayed outside in a park for four days. We couldn’t take anything, I just took this dress and wore it. Nothing, nothing for children, no shoes… the situation is very difficult.”

UNFPA is providing dignity kits containing essentials such as soap, underwear, menstrual hygiene products, laundry detergent and warm clothing, as well as  ensuring that showers and toilet facilities are lit and safe to use, to limit the exposure of women and girls to gender-based violence. 

5. Now more than ever, solidarity and financial support must be provided

UNFPA has been on the ground since day one, coordinating with partners to reestablish sexual and reproductive health and protection services in Syria and Türkiye. But we urgently need funding for more clinics, mobile health teams and safe spaces. Additional staff, equipment and supplies, including life-saving maternal health medicine, contraceptives and menstrual hygiene products, are also in alarmingly short supply. 

Since the onset of the crisis, with the generous support of our partners who have funded us over the years and with additional contributions from Australia, the Central Emergency Response Fund (CERF), Norway, Sweden, and the United Kingdom, UNFPA has been able to scale up its number of facilities and mobile health teams to reach vulnerable people displaced by the earthquakes and provide essential services. 

Yet millions of women and girls are still not receiving the support they desperately need. In Türkiye, UNFPA is appealing for $19.7 million to scale up the delivery of reproductive health and protection services. To date the appeal is 39 per cent funded. In Syria, UNFPA is appealing for $24.8 million, of which we have received only a third. We cannot forget that the earthquakes have exacerbated the pre-existing crisis in Syria, for which UNFPA is also appealing for $141.2 million. As the European Union and Sweden host an international donors' conference to secure financial contributions following the earthquakes, we urge a show of solidarity to ensure this arrives without delay – the women and girls of Syria and Türkiye deserve all the support we can give them.

*Name changed for privacy and protection