It is a rainy morning in the Al-Nahwaran neighborhood of Mosul, Iraq's second largest city, and a group of women are lining up outside a small medical center.
The storm has not prevented them from going.
The bellies of some of them show the reason for their visit.
Maram, a neighbor, stands in front of the maternity unit's ambulance, patiently waiting her turn to enter the building.
She is 20 years old, she is three months pregnant with her third child and has come to our center for her first prenatal check-up.
She tells us that she came here because her relatives told her about this clinic.
Her sister in law came before her and she recommended it to her.
She tells us that news travels fast in Mosul and in recent months more and more women are coming to seek maternal health services.
PHOTO GALLERY
Midwives, mothers and other women of Al-Amal maternity
Located on the western bank of the Tigris River, our Al-Amal maternity center offers routine obstetric care, newborn care, health promotion services, family planning and mental health support.
We opened this unit because there were important needs in the city regarding access to health care in general, and even more so in the field of sexual and reproductive health.
Three years later, many women still need to come here because the city's health system is far from functional.
The war is over, but recovery takes years
In June 2014, Mosul fell under the control of the Islamic State.
In October 2016, a military offensive led by an alliance of Iraqi security forces and an international coalition was launched to retake the city.
The Battle of Mosul dragged on for 250 days and was described as some of the deadliest urban fighting since World War II.
In July 2017, the Iraqi authorities officially declared the city recovered.
However, five years later, many medical facilities damaged in the fighting have still not been fully renovated and made usable, and there remains a shortage of medical supplies.
As a result, thousands of families in and around the metropolis continue to struggle to access quality, affordable health care.
Before 2014, Mosul's healthcare system in the city was not perfect, but it was functional.
Women used to give birth at home or in one of the city hospitals.
But during the military operations of 2016 and 2017, many medical facilities were damaged or destroyed, and their equipment was stolen.
The rehabilitation of the infrastructure took a long time to begin and, although almost five years have passed since the war ended, we still feel the aftermath today.
Most hospitals and health centers are still being rebuilt.
But I look at all these pregnant women and I realize something that is really obvious: they can't wait for these renovations to be completed.
And that is why it is important that we are here today.
Mariam is 20 years old and lives in the Yarmouk neighborhood of Mosul.
She is the mother of two children and in the photo she is three and a half months pregnant, expecting the third. Elisa Fourt (Elisa Fourt / MSF)
In response to huge medical needs, in 2017 we opened a maternity hospital in Nablus, west Mosul, to provide free, high-quality, safe maternal and newborn care for mothers and their babies.
In July 2019, another one of our teams opened another one in Al-Amal inside the Al-Rafadain primary care center, also in the west.
Last year, we attended almost 15,000 births in these two facilities, which means an average of more than 40 a day.
I support the physical and mental health of women
Rafida, 15, recently gave birth to her first child at our Al-Amal maternity hospital after some of her neighbors and relatives told her about our work.
Holding her son Ella Layth in her arms, she tells us how grateful she is for the care she has received.
More than 35 midwives and supervisors work at our center day and night, seven days a week, to help deliver babies.
Rahma Adla Abdallah, our midwife supervisor at the Al-Amal center, tells me that we attend between 10 and 15 deliveries on a normal day, but that it can be 20 or 25 on a busy day.
But unfortunately, we still can't cover all the needs.
We help most of those who come, but we must have admission criteria to maintain the best possible level of care within the limits of our own resources.
Along with other midwives, Rahma tries to help as many women as she can.
Midwives not only assist in childbirth, but also provide prenatal and postnatal care and family planning services, attracting many residents from across the city.
We help most women, but we must have admission criteria to maintain the best possible level of care within the limits of our own resources
Another of our key services is mental health assistance.
Rahma explains that the residents of this community need access to general medical services, but also comprehensive mental health support.
For example, gender violence is a problem that we sometimes witness.
Some of our patients have suffered from it, but they rarely talk about it.
Iraq's public health services have also established specific health services in the city to provide care for survivors of gender-based violence.
But there is still a long way to go before adequate access to health care, both physical and mental, can be guaranteed in Mosul.
Maternal health accessible to all
The stigma around issues like gender-based violence is just one of the many barriers to health care we have here, but the lack of access to sexual and reproductive health services in the city has several causes.
“The environment is particularly difficult,” Bashaer Aziz, another supervising midwife who works with us in Al-Amal, told me a few days ago.
A significant number of women are unable to access health care, either because they do not have the means to pay for it or because they face other obstacles, such as not having official administrative documents, due to the recent conflict or because they have been displaced from their homes. .
So when patients come to our facilities, they are usually very appreciative of receiving good medical and obstetric care.
They have no other places to go;
they cannot afford to pay for services in hospitals or private clinics.
Our maternity unit is a big difference for them.
Shazia works as a manager of midwifery activities at MSF's Al Amal Maternity. Elisa Fourt (Elisa Fourt/MSF)
Finding a place to give birth safely is just one of the many challenges facing Mosul's mothers-to-be, sometimes including proper nutrition for themselves and their children.
Rahma told me that sometimes women arrive at our center and have not eaten anything, or that sometimes it is impossible to know how far along their pregnancy is.
They often come with their daughters and sons, who are very thin or very underweight.
And in those cases, our job here is to offer them an alternative and try to help as much as possible with the services that we can offer them.
Everyone in the team is aware of the positive role that our clinic plays in the neighborhood.
So does Mahaya, 50, who has accompanied her daughter-in-law to give birth here.
They have come from Tel Afar, more than an hour away.
She tells me that, before this maternity existed, there was no medical center available and that pregnant women used to give birth in her house.
She tells me that a traditional birth attendant would come, help deliver the baby and that was it.
There wasn't even a hospital they could go to.
"This place has been a great improvement in our lives," she tells me.
At the end of her shift, Rahma likes to spend time in our postnatal care room.
She just a little while ago, I saw her holding one of the newborn babies, a girl named Rivan.
And even though she only has a few hours to live, her eyes are already wide open.
The baby was looking at her mother, Bouchra, 19, who is recovering in a bed next to her.
"The delivery was difficult, but everything went well and the midwives helped me a lot," the young mother told us.
“Rivan is my first daughter and I am happy to have her.
I hope that the future will become brighter and brighter.
I hope to bring other babies into the world too.
And if I have other children in the future, I will come back here”, she promises us with a smile.
Yousif Loay Khudur
is assistant to the MSF project coordinator at Al-Amal maternity center in Mosul, Iraq.
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