Miscarriages and malnourishment: The perils of pregnancy in Yemen

Abeir Mohammed* sits at the foot of her mother’s mud-brick house in Sawan, east of Yemen‘s capital Sanaa.

She struggles as she searches for the words to describe the loss of her unborn child due to toxoplasmosis in July, this year. 

Usually preventable, toxoplasmosis is an infection caused by a parasite often found in cat faeces or undercooked meat, but that can also be transmitted through contaminated water.

In the early months of her pregnancy, Abeir visited Omar Al-Mokhtar medical centre in Sawan, where she was assured about the wellbeing of her pregnancy.

Six months later, she couldn’t feel her baby move. This was accompanied by persistent fatigue, pain and headaches, which prompted her to return for a medical examination. 

When the centre said she had miscarried, after an earlier misdiagnosis, her trust in the doctors waned. 

She travelled to different hospitals in the capital desperate for another outcome, but the response was the same.

“I saw the dead child. One foot was incomplete,” she told Al Jazeera.

She underwent surgery to remove the foetus from the womb at Al Sabaeen hospital. 

The lingering scars, she says, are a reminder of the trauma she endured, without postnatal therapy. 

Unable to afford the cost of the surgery, 100,000 Yemeni rials ($200), she borrowed money from relatives abroad.

Gynaecologists have warned Abeir against getting pregnant for at least six months.

“I would be have been dead if I went to hospital a week later because my baby’s body was decaying and generating poison,” she said.

It was her second miscarriage since the start of the Saudi-led coalition bombing campaign in March 2015.

Doctor shortage

Deemed by the UN as the worst man-made humanitarian catastrophe, little is known about Yemen’s mothers and their newborns.

Apart from the physical trauma, many suffer from an unspoken mental anguish.

Due to the country’s failing healthcare system, owing to the protracted war, expectant mothers do not have proper medical support. 

Specialised doctors have fled Taiz, Sanaa and medical centres because they have not received salaries for more than two years. 

With or without financial resources, women seek treatment in understaffed hospitals and are at the mercy of unqualified medics.

Widespread corruption, disease and relentless air raids, in addition to increasing pressure on existing staff, have compelled hospitals to turn to new graduates for help.

But they are technically unlicensed doctors.

“Some students have not graduated from an authorised medical university,” said Dr Youssef Al-Hadhri, spokesperson for the public health and population ministry within the Salvation Government in Sanaa.

Unlicensed hospital staff work for paltry sums of money. 

“The ministry does not have numbers of [how many] unlicensed doctors working in Yemen’s hospitals, both public and privately,” said Hadhri.

‘Doctors didn’t know what they were doing’

In the summer of June 2017, Lamis Ali*, a 25-year-old from Taiz, was expecting twins.

But one was outside the uterus, also known as an ectopic pregnancy, and had a limited chance of survival.

Lamis was overcome by lassitude for five months after the birth of her son. 

She endured severe abdominal pain, vaginal bleeding and poor blood circulation. 

“Doctors failed to identify the deceased child outside the womb, they didn’t know what they were doing,” she said.

It was only after a visit to Dr Tawfik Mikhlafi’s clinic that she underwent surgery at Al Sabaeen hospital in Sanaa to remove the remains of the dead foetus from her womb.

The worst case I have ever seen was of a mother bleeding profusely, but there was no blood at the blood bank. Her family was forced to shuttle between hospitals to get blood for her.

Nasreen al-Haj, gynaecologist

At Al Thawra hospital in Sanaa, the smell of death wafts in corridors filled with mangled bodies.

Nasreen al-Haj, a gynaecologist specialising in emergency Caesarean sections, says there is a lack of equipment, clean hospital gowns, sterile surgical suture and mattresses.

“The worst case I have ever seen was of a mother bleeding profusely, but there was no blood at the blood bank. Her family was forced to shuttle between hospitals to get blood for her,” she recalled. 

If women can’t be cared for at the government hospital, they are forced to seek private care.

“Some families can’t pay for C-section emergencies. Some can’t even pay for regular checkups, beds and blood. They wait until they can afford financial help, and often, it’s too late.”

‘Sharp rise’ in maternal, infant mortality

At the reproductive health department in the Sanaa health ministry, director general Zainab al-Badawi says maternal and infant mortality rates have risen since the war began in 2015, after an earlier decline in 2013.

“Now, we see children born with birth defects, children who are low weight, and miscarriages are not uncommon. Unfortunately, we don’t have numbers on the maternal and infant mortality rates. Though, I can confirm that during the past four years, there has been a sharp rise.”

Naval and air blockades have restricted the flow of life-saving medicines, vitamins and food supplies. 

More than one million pregnant or lactating women are acutely malnourished. 

The United Nations warns that 13 million people in Yemen are facing starvation, nearly half the population.

“We can’t compare the huge impact of Saudi-led aggression with the failure of the salvation government, the Sanaa-based Houthi government,” said Hadhri, adding the Saudi-led coalition has crippled more than 430 health facilities.

The unabated bombing has made it impossible for mothers to travel to health centres and hospitals in time.

Hadhri said the relocation of the Central Bank of Yemen to Aden resulted in the discontinuation of the salaries of 48,000 health employees.

Al-Badawi’s department in Sanaa health ministry is responsible for keeping records. She admits the aggression on Yemen has disrupted statistical work.

“Records can’t be sent from most Yemeni cities, especially those in the south after bridges have been bombed and the roads closed.”

Statistics used to be prepared manually, but a lack of supervision, fund shortages and the ambiguous political and security situations in wartime have made it impossible to continue.

*Name has been changed to protect the anonymity of speaker.