Displaced and pregnant: The expectant mothers of southern Lebanon

This report comes as part of the "Not on the Margins" project, which sheds light on freedoms, and sexual and reproductive health and rights in Lebanon

“This is the hardest period of my life. I've never before experienced days like these,” says Abeer (pseudonym)*, a 30-year-old pregnant mother of two. She has recently fled from Yarin, in southern Lebanon, with her two children to a shelter in Tyre, in search of safety amid the Israeli shelling in south Lebanon.

Abeer fears that her children will face a fate similar to that of the children in Gaza, because, according to her, the enemy “shows no mercy”. She is especially fearful that her unborn child, due in ten days, will be born into a center with no access to basic essentials and necessities of human life.

During our conversation, we heard the sounds of an Israeli enemy reconnaissance plane overhead. After a few moments of shocked silence, Maryam hesitantly spoke, “I barely sleep two hours a day, I am constantly stressed and anxious. I'm afraid of losing the fetus"

Suffering

Abeer speaks with Raseef22 from the shelter, the only place she was able to seek refuge with her family under the difficult economic conditions, “My husband works in another area and visits us on Saturdays. So the responsibility on my shoulders has become greater, especially here without the support of family or friends.”

She catches her breath and continues, “There is a significant shortage of personal hygiene products and laundry detergents, and due to a lack of means, I was unable to buy my own supplies. For a few days, the water was cut off, exacerbating the problem of personal hygiene, especially since the bathrooms here are shared by everyone.”

Abeer also faces difficulty sleeping. The mattresses at the center are thin and uncomfortable, but given the circumstances and lack of alternatives, Abeer knows that her only option is to endure these conditions. Communication with her doctor has also been cut off for some time, and Abeer is concerned about the health of her unborn child, “I need follow-up. She was supposed to help me regularly check on the health of the fetus at the very least.”

Despite receiving aid — some medications have been donated and the costs of her upcoming childbirth have been covered – Abeer is overwhelmed with a daily state of fear and tension, which has led her to being admitted to the hospital twice. She explains, “I am terrified of any loud sounds we hear. In recent days, I've been very stressed and suffered from problems with blood pressure – the environment here does not help. Everyone is on edge. My nerves got the best of me and I lost my composure twice, and so the Red Cross took me to hospital.”

High numbers and limited aid

Abeer is just one of around 10,000 people from southern Lebanon who have been displaced from their homes to various shelter centers, as estimated by the Information International researcher, Mohammad Chamseddine. Another 65,000 residents of the south have had to relocate to houses they own in other regions, or were forced to rent houses, or move in with relatives and acquaintances. “These numbers, from November 12, are likely to increase if the situation at the border escalates,” Chamseddine explains, expressing concern over overcrowded shelters if the situation deteriorates and the Israeli bombing reaches areas farther from the border, such as Nabatieh and Tyre.

Around 10,000 people from southern Lebanon have been displaced from their homes to various shelters, while another 65,000 residents have had to relocate to houses they own in other regions, or move in with relatives and acquaintances, and “these numbers, from Nov 12, are likely to increase if the situation escalates"

There are now 12,877 people, comprising 2,706 families, who have been displaced to Tyre from the southern border towns and villages, according to the Disaster Risk Management Unit of the Union of Municipalities. Hassan Hammoud, Deputy Head of the Union of Municipalities (UoM) in Tyre, states that äll these people are living in difficult conditions", and that poor economic circumstances prevent these displaced people from gaining access to more comfortable housing. “Most of them work in agriculture and do not have sufficient savings to deal with such emergencies.”

“There are around 800 displaced individuals distributed among 4 shelters in Tyre,” Hammoud explains to Raseef22, “while the others are scattered within surrounding villages, either in unfurnished houses provided to them or with relatives and acquaintances.”

Assistance from the Ministry of Social Affairs, the Council for South Lebanon, and the Higher Relief Commission has been too limited to meet the current demands, according to Hammoud. “We suffer from shortages. Today, we need a large number of blankets and mattresses to be able to adequately meet the needs of the displaced. All we can offer so far is three meals a day for the people in the shelter centers, some mattresses, blankets, and hygiene products. Meanwhile, those distributed in the villages have not benefited from any assistance despite their urgent needs,” laments Hammoud.

Exact data regarding the number of pregnant women is lacking, although their presence is prominent, according to Hammoud. Despite attempts by certain associations and organizations to provide medicine and medical care to the displaced, including pregnant women, access remains limited.

“I'm afraid of losing the fetus, and I fear the situation will escalate. I don't know how I will move then, because I'm too heavy from my pregnancy. In the event of an emergency, I will ask my husband to save himself and our daughter, and not worry about me”

"Death would be kinder"

Abeer was able to benefit from some assistance in the last month of her pregnancy. However, Maryam (pseudonym)*, currently four months pregnant, has not received any financial or medical support. She tells Raseef22, “I thought about buying nutritional supplements, but they require consultation, and this is difficult. I am trying to find a new doctor, but I am unfamiliar with the town my husband and I have taken refuge in with our young daughter, on top of the difficult economic situation everyone is suffering from. We left behind our money and belongings, and only brought only a few clothes and personal items.”

Maryam and her family currently share a house with a family they have known for a while in Borj Rahal in the Tyre district. Despite being safer than staying in their home in the border town of Markaba, where the shelling continues, the situation is perplexing and exhausting, “I barely sleep two hours a day since we've been displaced,” shares Maryam, “I tense and cramp up a lot, I am constantly stressed and anxious. I cannot get the necessary rest, the family we are living with is large, and the place barely fits us all.”

During our conversation, Maryam heard the sounds of an Israeli enemy reconnaissance plane overhead. After a few moments of shocked silence, she spoke, hesitantly, “I'm afraid of losing the fetus, and I fear the situation will escalate. I don't know how I will move then, because my movements are very heavy due to my pregnancy. In the event of an emergency, I will ask my husband to save himself and our daughter, and not worry about me.”

With great pain, Maryam concludes, “Honestly, we have begun to wish for death because it's kinder. Those with a strong sense of pride feel it's shameful to ask for help when in need. My husband's work and business has come to a halt, my daughter hasn't been able to attend her school, while other children here are still attending theirs. I hold onto my stomach all the time, as I fear what is happening.”

Raseef22 spoke with Dr. Lara Haydar, a specialist in obstetrics and gynecology. She emphasized the correlation between stress and a preterm birth, as well as the increased risk of miscarriage. Maternal stress can also impact the child once born.

South Lebanon's pregnant displaced women face numerous risks

It's become evident that displacement has exacerbated the challenges for pregnant women, especially those facing difficult economic conditions. Forced displacement whilst pregnant can impact access to essential healthcare services and expose the mother and unborn child to stress and compounded risks due to the tense atmosphere at the southern borders.

A study published in the medical journal JAMA Open Network, explores the relationship between heightened maternal anxiety and disruptions in the fetal brain's functional connectivity.

Raseef22 spoke with Dr. Lara Haydar, a specialist in obstetrics and gynecology. Dr. Haydar emphasized that the stress that displaced women are experiencing today can increase their risk of a preterm birth, due to heightened tension, as well as an increased risk of miscarriage. Moreover, maternal stress can impact the child once born, leading to psychological problems including stress, anxiety, depression, ADHD, autism spectrum disorder, among others, due to the impact of fetal brain development by the stress experienced by the mother.

Dr. Haydar also points out to Raseef22 that a lack of continuous or reliable medical care, as in the case of these displaced pregnant women, delays or prevents the detection of diseases or congenital deformities. Diabetes, hypertension and preeclampsia are relatively silent diseases, and it is therefore essential to regularly examine pregnant women in order to identify potential health issues.

According to Dr. Haydar, there are three key doctor appointments that pregnant women should not neglect. The first appointment occurs in the third month “where the fetus’ neck is measured to ensure no deformities.” The second appointment takes place in the sixth month, also to “confirm the absence of deformities, especially those in the heart and brain.” Different tests are also conducted, such as screening for diabetes. The third essential appointment takes place "in the eighth month, during which the growth of the fetus is measured".

“Honestly, we have begun to wish for death because it's kinder. Those with a strong sense of pride cannot ask for help when in need. My husband's work has come to a halt, my daughter cannot go to school, while I clutch my stomach out of fear of what's happening”

The doctor goes on to stress the importance of certain dietary supplements for pregnant women, especially folic acid, an essential supplement said to reduce the risk of congenital deformities in the fetus. Iron is also essential, as pregnant women are more susceptible to anemia, which can lead to preterm labor. She also stressed the importance of maintaining healthy dietary habits and adequate water consumption, which is crucial to avoiding urinary infections.

Dr. Haydar highlighted some of the dangers pregnant women living in unfavorable living conditions face. “Overcrowded living arrangements with shared bathrooms, for example, can expose women to the risk of urinary tract infections if they hold urine for long periods. Poor hygiene levels may lead to the spread of scabies, lice and other diseases, making these women more susceptible to influenza due to a weakened immune system. The lack of adequate sleep for pregnant women can also increase the risk of preterm labor, and affect the growth of the child at birth.” According to Haydar, the displacement crisis places pregnant women at risk of having to give birth in unequipped clinics or medically unsafe locations, rather than in hospitals.

To reduce the severity of the risks, Dr. Haydar recommends that the displaced pregnant women walk for 30 minutes a day, as physical activity helps alleviate conditions such as toxemia and diabetes, and also reduces anxiety and stress. She emphasized the importance of maintaining regular check-ups with a specialized doctor and the ability to access a psychologist if needed. It is important to note that access to medications for pregnancy is widely available.

*Abeer and Maryam both used pseudonyms to protect their identities.