Pregnant women and recent mothers in refugee camps are exceptionally vulnerable, yet they often lack the care they need. New research in Greece documents forced cesareans, malnutrition, and post-natal neglect.
In August 2016, Feiza from Syria gave birth to her fifth child. She called the boy Ahmed. I met Feiza three days after she came back from the hospital in Softex camp, near Thessaloniki. She complained of pain in her stomach, saying that it was swollen and blue in some parts, No doctor has been to see her or her baby since she left the hospital. The camp, where over 2000 people live, only provides basic medical help – gynaecology is outside their expertise.
Feiza complained that cesarean sections were being performed in the hospital even when they were neither requested nor needed. “Refugee”, she said by way of explanation, shrugged, and looked at the ground. It’s the only English word she knows.
“It is the first time for me to give birth to a child with the cesarean sections”, Maryam, her 13-year-old daughter translated for us in broken English, but good enough to show how desperate they are. Feiza and her children – their father has been waiting for them in Germany since January –are living in a small tent near the camp’s broken fence. The camp is widely considered a dangerous place, especially for women and kids. Cases of rape and other sexual violence have been reported, and fights frequently break out. Feiza lives here with four girls and a baby boy.
“We are afraid to go out. During the night, we do not leave the tent at all, and during the day, if we have to leave, we never walk alone”, she told us. Inside the tent, there is one bigger bed where she sleeps with the baby. The rest of the kids sleep on thin mattresses on the wooden floor. They are afraid of snakes and other animals entering the tents, and are petrified by the violence around them.
Feiza’s story is just one illustration of difficulties women refugees encounter during their journeys. There are many others. According to UN Population Fund, over 55% of people arriving in Europe in January 2016 were women and children, compared to only 27% in June 2015. Many come with children or are breastfeeding newborns. Doctor Without Borders estimates that nearly one in 10 women who are rescued from smugglers’ boats are pregnant.
The dangers of childbirth
Health care is not often mentioned when it comes to refugees, even though it is one of the most fundamental needs a host country could possibly provide. According to pilot research conducted by the NGOs Hellenic Action for Human Rights (Pleiades), Human Rights in Childbirth, Are You Syrious?, and a group of volunteers, the situation for women giving birth in Greece is dire. The situation in other countries along the Balkan Route, as well as in European countries where large numbers of refugees are present, could be similar but there are no available data.
The research was conducted in refugee camps and squats in September and October 2016. Of the 29 women who were interviewed, 20 had recently given birth, and one suffered a miscarriage. One of the newborns also died shortly thereafter.
I panicked and started screaming from the pain and the fear, so much that I tore the belts that kept my hands.
Out of the 20 women who had given birth, only one reported that the ambulance came fast enough for her to reach the hospital in time for the labour. Furthermore, 60% of the women interviewed were subjected to cesarean sections without them being informed or providing valid consent. One woman from Syria described her panic after learning what was about to happen to her. “After 12 hours of trying to give birth naturally, they told me they will give me a cesarean section. I was still awake and bound on the bed when they started cleaning the area of my abdomen with alcohol”, she said. “I was scared and I asked the anaesthesiologist for sedation, saying in Arabic ‘khadirini’ (anaesthetise me). The anaesthesiologist started laughing and telling me ‘no khadirini’. I panicked and started screaming from the pain and the fear, so much that I tore the belts that kept my hands. Luckily, at that moment, the doctors came in and started talking to me and relaxed me”. A lack of translators also resulted in many of these women receiving total anaesthesia even though no medical history was ever taken. As for women who did give birth naturally, many reported receiving no pain medication at all.
Karin Tschare-Fehr, an volunteer doctor from Austria, described the conditions earlier this year to Are You Syrious?, and in the interview she called particular attention to the use of cesareans on women who are living in unhygienic conditions. She has examined women who told her that doctors in hospitals are using this method for almost all the women, regardless of their choice. “The EU is responsible”, she said. “Not only for refugees but also Greeks who are in this desperate situation, (where) they cannot provide basic heath care for themselves, and can hardly give anything extra.”
When home is a refugee camp
Women also spoke about inadequate accommodation after giving birth, lack of safety, sanitation, and hygiene, insufficient medical support, lack of female doctor personnel, no legal assistance and the worrying lack of information or inability to access information, including being denied access to – or a general lack of – translators.
The quality of the medical services inside many of the Greek camps is startling. Some camps have medical teams providing only the most basic services between 8 a.m. and 5 p.m. Outside of business hours people have to rely on the Greek healthcare system, which can be very slow in responding to the needs of refugees. Indeed, some reports indicate that it can take up to 12 hours for an ambulance to arrive after a call has been placed.
Stories abound. One 19-year-old from Afghanistan who was living in the Elliniko hockey stadium when she gave birth said, “I have such a bad pain in my head sometimes I feel like banging my head against the wall. But the doctors told me it's normal and it will pass”. Another spoke of neglecting her post-natal medications in order to better cope with the realities of camp life. “I had a powder to drink to facilitate going to the bathroom”, the 32-year-old from Afghanistan said. “I stopped having that because I was scared to go to the bathroom at night when single men were awake and around”.
The research found out that even though many of the women interviewed were recognised as pregnant by the authorities upon arrival, they did not receive the special care stipulated by international, European and Greek law. As the report indicates:
“The main problem they report is the low quality of food. As many indicated even though they resided in different camps all around Greece, they could not eat the food because it was not cooked, stale and dirty. When they found the money, they would always buy food from outside. Also, there was no special provision for extra quantities given their condition. Fresh fruit, vegetables, meat and fish were rarely provided. Thus, all of them report being malnourished during pregnancy, which led to anemia and low blood pressure. Less than half received supplements (vitamins and iron) and the ones who did had to pay for them”.
Living in difficult conditions, mothers often forget to take care of their own health. Researchers found that women who underwent cesarean sections frequently did not return to the hospital to have their stitches removed because of the difficulty of getting there. As a result, two of them report having open wounds after more than a month after the operations were preformed, which they try to treat by changing their bandages daily.
Additionally, children who are born are reported to suffer from yellow fever, meningitis, vitamin D deficiency, neonatal sepsis, and tuberculosis, all of which are almost unheard of for Greek children. These diagnoses are often not explained to the mothers due to a lack of interpreters. “Another noteworthy finding is the lack of regular monitoring of the children’s health and vaccination progress”, the report says. “Many mothers were not aware of their babies’ weight at the time of the interview, and 3 babies have not been checked by a doctor at all after their exit from the hospital. Some mothers reported that even if there are medical NGOs in the camps they live, they were always unavailable”.
So far, such findings and warnings by different organisations have gone largely unnoticed by the authorities in Greece or any other country. The media also avoid talking about this issue, and once again, women and children remain the most vulnerable group whose rights are forgotten.