Barely three days after admission to Al-Hikma hospital in the north-eastern Syrian city of Hasakah, Jihan took her last breath to the great astonishment of her family members.

Jihan’s husband, Yasser Mustafa, a man in his forties, could not believe the rapid deterioration in his wife’s condition: “She became sick so I took her to hospital, and on the next day doctors amputated her right foot after a gangrene infection, and then she died” he said in disbelief.

Mustafa tried to save her life by transferring her to the capital Damascus, only to find the doctors telling him “It is too late… there is no hope in saving her life.”

Jihan Mullah Ali was 33 years of age, and had previously taken up a job as a cleaner of operating rooms in the governmental National Hospital in Hasakah, in order to help her husband support their six children. For the next two years she would sterilise and clean operating rooms and doctors’ scalpels while collecting the remains (waste) of surgical operations in bags, according to her husband.

According to doctor Adel Sharif, “Jihan had Lupus, an auto-immune inflammatory disease that attacks the immune system of the body, and this was the reason for her gangrene.” Gangrene is a type of tissue death resultant from a shortage of blood supply or a serious bacterial infection. Sharif proceeds to explain that the nature of Jihan’s work and her exposure to medical waste and remains from operating rooms played a role in her infection.

The medical report on Jihan’s case reveals some further details of her condition: “Ms Jihan Mullah Ali undertook emergency surgery under general anesthesia because of gangrene in the lower-right part of her body as a result of an auto-immune condition (Lupus); she was subject to an endoscopy of her coagulated tissue in her leg and right thigh in the Al-Hikma hospital on the 29^th of October 2018, after which she died a from septic shock.”

Mohammad al-Darwish, a doctor specialising in internal disease, explains there are two main causes of Lupus: the first is genetic, the second environmental – the latter which can be spurred on by certain viruses and medications, which raises the likelihood that Jihan’s exposure to medical waste played a key role in her Lupus infection and subsequent death.

In addition to Jihan’s case, this investigation also documents the stories of five other men and women who work in hospitals and medical centres in north-east Syria, and who were infected with chronic and fatal diseases because of their unsafe exposure to medical waste.

This pattern has taken place amidst a failure by hospital cleaners to follow the preventative and safety procedures for dealing with medical waste, and in the absence of oversight and regulation from above.

Accordingly, the problem has been exacerbated by the failure of the hospitals examined in the investigation in the province of Hasakah to apply the safety procedures stipulated in the “national guide for the safe management of healthcare waste in Syria” relating to the collection, transport, storage and discharge of medical waste, which causes nurses and cleaners to handle the medical waste in the same way that they would ordinary rubbish (litter).

The investigation followed and documented the entire journey which medical waste undergoes, starting from its discharge from operating rooms to its placement in normal plastic bags, disposal in municipality garbage trucks and finally its transport to city outskirts where they are burned in a primitive fashion in random pits.

Furthermore, the detailed standards and criteria stipulated in the Syrian Health Ministry’s hospital guides (which stipulates the conditions for the establishment of hospitals before they are built) lack any mention of the need for a medical waste incinerator at the hospital.

According to Yunis Abu Zaid, who works in a medical laboratory in the city of Qamishli: “There are no warnings in public and private hospitals against the spread of certain diseases,” adding that “hospital cleaners are the most exposed to infection because they are less aware of preventative measures than doctors.”

For his part, Shirzad Yusuf, a specialist in general surgery in Qamishli, explains that infection is transmitted after a wound is contaminated by the substance present amongst the patient’s medical waste which carries the virus, adding that the infection rate in the city is high.

Unsafe exposure to medical waste

The World Health Organisation defines medical waste as “secondary products of healthcare that encompass sharp and non-sharp objects contaminated with blood, body parts, bodily tissue, chemical substances, pharmaceuticals and radioactive materials.”

WHO affirms that the poor management of health-care waste exposes healthcare workers, waste-handlers, patients and the general community to cases of infection and avoidable toxic effects and injuries.

During a few field visits to public and private hospitals especially in the province of Hasakah, researchers met with workers and doctors, all of whom affirmed the absence of medical incinerators either inside or outside these hospitals; the investigator also inspected and observed the mixing of different types of waste with each other, including sharp medical waste that causes injuries and transmits viruses.

According to Abu Zaid, “the disposal of medical equipment such as needles, scalpels, arterial catheters and laboratory glassware in a rubbish bin without abiding by the safety precautions can lead to injuries and infections being transmitted to patients,” while adding that it is necessary for every hospital to have an incinerator.

It should be noted that healthcare management in the north-eastern region of Jazira (encompassing the provinces of Raqqa, Hasakah, and Deir al-Zor east of the Euphrates) is split between the Syrian government – comprised in the Health Ministry – and the Kurdish-led ‘Autonomous Administration’, with both parties sharing authority in the aforementioned geographical expanse.

The co-president of the “Health Authority” of the Autonomous Administration in the city of Qamishli, Dr Abir Hassaf, admits the existence of a major problem because of the absence of medical waste incinerators, declaring: “The only incinerator is in the city of Derika (Al-Malikiyah), which was installed in 2018 with the aid of an international organization, and is only sufficient for the hospital in that area and the medical centres in its environment.” Hassaf adds that the price of an incinerator is $23,000 US Dollars – or more than 14 million Syrian Liras.

Hassaf justifies the absence of an incinerator by stating that the hospitals in question were built before the establishment of the Autonomous Administration, and therefore the Health Authority is not at fault for the absence of medical waste incinerators. Yet a field visit by the head of the investigation revealed that the eye and heart hospital in the city of Qamishli, managed by the Autonomous Administration’s Health Authority and which opened early on this year, also lacked a medical waste incinerator.

In February 2019, the investigation followed a municipality car collecting and transporting waste starting at Qamishli – after he received a tip that medical waste was disposed of alongside the ordinary rubbish which the car transported.

A cleaner in the ‘National Hospital’ in Hasakah told Raseef22 that medical waste, including bags of blood, empty and used syringes, body parts, soiled dressings and scalpels used in surgery were collected in specific bins placed in the hospital’s corridors, before the bins are emptied in a dumpster whose contents are then thrown in the back of municipality garbage trucks without wearing any gloves; the municipality’s cleaners than mix the medical waste with general waste inside the garbage truck. Finally, the waste is transported and incinerated.

The garbage truck’s journey ended in the ‘Nafkari’ landfill near the city of Qamishli, after having passed through several hospitals and medical centers to collect their medical waste, which is then piled up, accumulated and intermittently set on fire, so that the fire is not extinguished. Even after the combustion process was over, the investigator found the remnants of medical waste in the landfill, including catheters, vaccines and bottles of medication, amongst others.

From Cleaning the Nephrology Units to Kidney Failure

42-year old Wa’il al-Salem cleaned units at the nephrology department in al-Hasakah’s National Hospital  between the years 2015-2017. He would receive 70,000 Syrian Liras ($120 US Dollars) every month for his work in order to support his family of eight only to eventually succumb himself to kidney failure and lose his job.

“I used to clean the floors of the nephrology department in the hospital, and often collected waste without wearing medical gloves, while I sometimes wore [medical] face masks” al-Salem says.

After a period of time, Wa’il started to feel exhausted and was unable to go to work; he returned to the same hospital he worked in to undergo a medical examination, only to discover that his kidneys were failing and he additionally had high blood pressure and a calcium deficiency, according to the medical report examined by the investigator.

During the investigator’s meeting with Wa’il, he noticed that he appeared very weak and also had rashes on his skin, which meant that he had to undertake repeated dialysis sessions.

Wa’il explained that most of the rubbish which he collected as a cleaner in the nephrology department contained bags of serum, needles, soiled dressings and blood-soaked cotton.

Faisal Askar is a specialist in internal medicine; he believes that the country’s conditions following the outbreak of the Syrian war in 2011 led to a decline in health and cultural standards, and consequently to the appearance of certain septic diseases such as brucellosis, typhoid and hepatitis A, B and C – which often in turn led to patient dehydration and acute kidney failure, both in the general public and to those working in the medical field.

Askar called for the “necessity of reviewing the training of medical cadres to avoid any medical defects.

Lack of Prevention

Aisha Helal – 39 years-old – has worked as a cleaner in the emergency department in the National Hospital in Hasakah for the past three years. She earns a salary of 80,000 Liras ($150 US Dollars) monthly to support her special-needs husband and four children. However, as with others she began to suffer a severe difficulty in her breathing and a fast heart-beat during her work. She says that she has since spent 200,000 Liras on treatment.

Explaining how she contracted her illness, Helal said: “Every day I carry the bins that are filled with medical waste from the emergency department to the main rubbish containers in the hospital, and I clean the floors from medical waste and blood, needles and other things.” Helal goes on to confirm that she did not wear gloves or medical masks during her work, stating that she did not feel comfortable when doing so and never even tried it, despite their availability in the hospital.

According to Abdul Rahman Amin – Aisha’s doctor – the patient had a chronic allergy that was exacerbated when exposed to dust, cleaning substances and waste from surgical operations.”

As with the case of Aisha, most cleaners inside hospitals and medical centres do not wear precautionary gloves or masks, a reality also extending to the approximately 2,000 municipality cleaners who handle the waste outside of hospitals, according to Tariq Mohammad, who works in the Environmental Office in the Municipalities’ Committee in the Municipality of Qamishli.

These workers are often exposed to medical waste without taking any preventive or precautionary measures. The compiler of the investigation similarly found that municipality workers did not wear medical gloves designed to prevent the spread of viruses despite their availability in hospitals, and in the absence of any oversight or regulation that compels them to wear it.

We put these findings to the head of the Autonomous Administration’s Health Authority Hassaf, who responded: “Gloves are available in hospitals, and if they are not worn by cleaners then they are not following hygiene standards.” As regarding the municipality’s cleaners, Hassaf blamed the health department in the municipalities for not enforcing regulations on their workers.

No Vaccines, No Tests

Sulaiman Ahmed, a doctor in the province of Hasakah, stresses the need for workers to undergo medical tests before being accepted for work, in order to make sure that they were not infected by certain diseases, such as tuberculosis and hepatitis, noting that these are necessary tests because of their contagious nature which can be transmitted through blood or breathing.

As for the post-recruitment stage and how to deal with medical waste once inside work, Ahmad states that the workers are obligated to undertake a periodic test to check for communicable diseases, not least because of the fact that medical waste is contaminated with diseases – with various diseases being transmittable through needles, syringes and scalpels, and through piercings and wounds.

Ahmed stresses that hepatitis vaccines have to be taken over several intervals, in the event that a person did not have Hepatitis B. The first vaccine dose is followed by a second after a month, a third after six months and a fourth after four years – after which it is possible to take a supplementary supportive dose.

Through its co-president Abir Hassaf, the Autonomous Administration’s Health Authority admits that it has not conducted hepatitis tests for hospital workers, attributing the reason to the absence of vaccines – with the World Health Organization only providing the Syrian government, and not the Autonomous Administration, with vaccines as the only ‘recognised’ authority in Syria.

Hassaf clarified however that an understanding has since been reached with the World Health Organization by which vaccines would be provided; however, medical tests for workers have to be conducted before the immunisation can take place, a process which Hassaf says has so far not happened, alluding to the fault of local municipalities.

The head of the investigation attempted to reach the World Health Organisation on the 16^th and 28^thof March 2019 by email, in order to further examine the case and its findings, but did not receive a response up to the publication of the investigation.

Unenforced Laws

Amongst the most prominent reasons for the establishment of hospitals without medical waste incinerators is the failure to enforce the Syrian hygiene law which obligates the acquisition of these incinerators – the absence of which have led to most hospitals in the al-Jazira region dispose of medical waste in an unsafe manner.

Accordingly, the fifth chapter of the Syrian Hygiene Law (no. 49 for the year 2004) set out the mechanism for dealing with medical waste – however, this mechanism remains unenforced in the country’s north-east.

Article 23 of the law stipulates that owners of medical facilities have to segregate the different types of medical waste (non-hazardous from hazardous), with each labelled accordingly and placed in specific rubbish containers.

Article 24 of the law meanwhile obligated those transporting medical waste to not mix it with any other rubbish, and to subject it to hygienic and safe treatment; Article 25 delineates the need to provide cooling (refrigeration) units for the medical waste in the event that they are stored for 48 hours – a requirement which the investigation showed has not been followed.

As for the means of disposal, the Syrian Health Ministry stipulated six methods, the most important of which was to burn them at high temperatures in specific medical ovens.

It should be noted that the city of Qamishli contains 10 private hospitals and one public (governmental) hospital, as well as tens of medical centres, according to a chart published by the Syrian Health Ministry.

According to a 2015 report by the Roj Centre for the Protection of the Environment, hospitals leave behind almost two tons of medical waste every week, with a small hospital of 25 beds producing approximately 10 kilograms of waste.

Environmental Damage

The negative impacts of incinerating medical waste in landfills do not only encompass workers being infected with disease, but also includes the environment through the emissions produced by the unsafe incineration of medical waste.

According to Dilibirine Mohammad, a member of the board of trustees of the local Keskayi Organisation for the Protection of the Environment: “Dumping medical waste with general rubbish leads to the altering of the composition of the waste by changing its contents – thus transforming it from normal substances to toxic substances which are hazardous to both humans and the environment.”

Mohammad explains that the primitive incineration of medical waste releases a huge quantity of pollutants, including heavy metals such as arsenic, chromium, brass, mercury and lead which accumulate in drinking water, soil, plants and animal bodies – adding that the imbibing of high concentrations of these minerals by humans has toxic effects, especially lead and arsenic.

According to a 2018 study by the World Health Organisation titled “Healthcare waste”, the unsafe burning of medical waste and inappropriate substances leads to the release of pollutants into the atmosphere and the release of ash residue, explaining that the burnt substances that include PCBs (polychlorinated biphenyls), dioxins and furans are cancerous substances which have been linked to an assortment of damaging effects to human health.

The study further illustrated that medical waste landfills can poison drinking water if they are not safely constructed, stressing the need to use modern incinerators that operate at a high temperature ranging between 850°-1100°C, and equipped with special equipment to discharge gases safely; these alone fulfill international standards on dioxin and furan emissions, with the burning of medical waste constituting one of the main sources of dioxins, according to the United States Environmental Protection Agency (EPA).

Dioxin is the common name given to a group of 75 purely toxic chemicals which form from the combustion of waste that contains chlorine or through the production of products that contain chlorine.

Ultimately, despite it being more than a year since Jihan Mullah Ali’s passing, her husband still digs up her old pictures, reminiscing on their nine-month long engagement and the beautiful days they spent together. Today, Jihan’s husband worries about the future of his x children who were deprived early on in their lives from their mother’s care, who went from being a worker who helped people to survive with their lives to a victim that lost her life as a result of their medical waste.

*This investigation was accomplished with support from (SIRAJ), and under the supervision of  Ahmed Haj Hamdo. Published on Raseef22

The post Death From Human Waste in Syria’s Hospitals: an Investigation appeared first on SIRAJ.

Inside the maternity ward of the public “Dugum” hospital in Gaziantep, Turkey, the Syrian refugee Nour Shabaan, aged 17, lies in a bed for pregnant women, getting ready to give birth to her baby.

The parents are overjoyed at the coming baby, perhaps it will make them forget the bitterness of displacement and moving away from their homeland since they settled in the Turkish town of Gaziantep 3 years ago fleeing the horrors of the Syrian war.

Nour delivers the baby, and things go smoothly but then the hospital refuses to give the baby to the parents on the pretext that the mother’s refugee ID has a wrong age, because she was married under the legal age of marriage (18 years). The hospital decided to keep the baby, and refer the mother to trial at once.

When Nour delivered the baby, she was 17 years old. When she got married, she was 16. In both cases, she was violating the Family Law provisions on marriage, that bans the marriage of girls under 18. This violation is described by the law as “a crime of sexual exploitation”, punishable by prison terms ranging between 8 and 15 years, according to Articles 103-105 of the Turkish Penal Code.

Although the law banning marriage of children in Turkey applies also to other foreigners living in the country, including Syrian refugees, the lack of knowledge about it, and lack of awareness about the consequences of early marriage (beside the lack of NGOs and societal oversight) led to the spread of these early marriages among the Syrian community.

The World Health Organisation estimates that there are 16 million girls around the world between 15 and 19 years old, and one million girls under 15, who give birth each year.

According to World Bank statistics for 2017, the rate of pregnancy of girls between 15 and 19 years old in Syria is around 39 cases in each 1,000 girl.

Nour is one of a great number of Syrian refugees who live in Turkey as refugees and who got married under 18 either on Turkish soil or in Syria, and then entered Turkey refugees after their marriage or having given birth in hospitals under the legal age of marriage.

According to Haydar Houri, a specialist lawyer, without being aware of the consequences of underage marriage, the fathers of the girls encourage their marriage to older men (over 18) and become legally accountable after managing the marriage. This issue is spreading throughout Turkey.

The law classifies a minor as anyone under the age of 18, according to Ghazwan Qoronful, head of the Syrian Lawyers Collective in Turkey (a group of Syrian lawyers who provide legal aid to refugees in courts of law). He adds that under the Syrian Personal Status Law, Article 85, a minor does not reach the age of eligibility until they reach 18.

According to law number 5395, covering children in Turkey, a minor is considered to be anyone below the age of 18, added Qoronful.

While early marriage is defined as the marriage of a person under the age of 18 year, according to Qoronful “This marriage in the eyes of the Turkish law is not marriage. It is categorized as sexual assault against a minor.”

The consequences of this “assault” is usually to refer such cases (usually captured at hospitals during delivery or when a girl is discovered as pregnant and her age turns out to be under 18) to the public prosecution office, that in turn moves the case on to the courts. The husband and girl’s parent are arrested. Sometimes, the girl herself is arrested, and they all are turned over to the court, according to Qoronful.

DNA test for the child

Gaziantep’s hospital decided to let Nour go, after she recovered from the delivery. The baby stayed at the hospital. The hospital ordered a DNA test to confirm his identity as to whether he’s indeed her son, and the mother found herself in another pitfall.

Nour confessed to the investigator that she forged her age and real name. She said, “for this case, I used the help of a Syrian lawyer to oversee the test procedures, and for taking a blood sample from the baby for the test. The lawyer wasn’t able to help, however. So I hired a Turkish lawyer. Now, I am waiting for the results, to see if they will allow me to take the baby home. They allow me to see him, however. I go see him every 3 days, because the hospital is away from where I live. It is a long distance that I cannot commute through daily.”

Nour’s baby came to the world 2 months and 5 days before I interviewed her on 25 January 2019. Since then, nothing has changed. She is still waiting for the DNA test’s results, and is waiting for the baby to come home. But she’s “optimistic”, and waits for the day the baby will return to her.

In case he doesn’t return, she said, the lawyer told her he will file a case against the hospital. This is what gives her hope and keeps her going.

“I know a girl who had been through this before me. She delivered her baby 7 months ago, and the tests results showed up few days back”, said Nour, “So now she can take the baby from the hospital.”

The test done through the Ministry of Health’s budget was a relief for the mother, since she didn’t have to pay for it. The lawyer’s fees, however, reached 7,000 Turkish Liras ($1200). The family had to go into debt because they didn’t have even one single Lira to start with, according to Nour.

A love story

Nour regrets forging her name and age. But her motive for this was being afraid of having her real age discovered, because she did this in order to marry her cousin (20 years old), after a love story, she claims. She lives with her in-laws now, while her parents and siblings live in Adana, southern Turkey.

“I am sad because my child is not with me, but what can I do. God willing, in a few days he will return to me. They care for the babies at hospital. Every time I go visit I see he’s clean and well-fed”, Nour said, “I couldn’t breastfeed him because right after delivering the baby I had to go to court each day, and I wasn’t able at that time to go visit the hospital as well to breastfeed him.”

“At the hospital, they said that my boy looks like me. But they need a legal proof. I feel so sad because I couldn’t breastfeed him. I begged the hospital to let me do that, but each time they deny my request.”

At the court

Marwa Alyoussef is 17 years old. She has been married to her cousin, who works as a tailor, for two years now, since she was 15 years old. Her story is not so different from Nour’s, but she endured different kinds of suffering that were reflected on her life in Turkey as the country she fled to from Syria.

Marwa who came from the famous al-Midan neighborhood, Damascus, didn’t notarize her marriage (that was conducted in Syria) at the Turkish authorities. Therefore, she lacks reliable documentation about her social status in Turkish governmental records. She had a baby from her marriage. The baby is now one year old.

Marwa said, “I delivered the baby at the Bagajlar public hospital in Istanbul. I wasn’t interrogated or asked any questions during the delivery. However, one year after the delivery, the police came and asked me to go visit the station. I went, and they held an investigation for me. They reviewed my documentation, and gave me a date to go visit the court, 4 months later.”

When Marwa entered the courtroom at Karakoy, Istanbul, after referral from the police, she found a translator, a psychiatrist, a judge, and a public writer. She said, “They asked me so many questions about my personal life. Questions like, ‘do you regret your marriage? Do you love your husband? Did someone coerce you into getting married? Do you currently have a job?’. These were important questions for them because they do not allow married women my age to work outside the household. They also asked me to refrain from pregnancy for 3 years.”

Until now, Marwa doesn’t know what she did wrong, because “marriage at that young age is so widespread in Syria, not only within my family. I married before I come to Turkey. I have papers to prove it. There is nothing wrong with me getting married”, Marwa said.

According to her, she knows about “so many marriages of girls at 12 and 13 years old. I mean once the girl reaches puberty she would get married, nothing is wrong with that”.

“I have many friends with the same issue. They can face imprisonment. They went to court many times, because they get a ruling of being innocent from accusations against them. They also paid lots of money, reaching 20,000 Liras ($3660) in some cases, and as low as 5,000 Liras ($915) in other cases, as fees for lawyers, commute, and other costs related to the court.”

Meanwhile, she also fears the repercussions on her husband if the authorities discover their early marriage and how they had a baby while they were both minors, under the age of marriage. She waits for the next court hearing in late April 2019.

She said, “I am afraid that they might take my husband. I love him so much. In case the court decides to put him in prison, we might go back to Syria, although he was summoned there for military conscription.”

Marriage in Turkey

• Marriage in Turkey is civil marriage. Turkish family law organizes marriage, and its provisions do not rely on religions [sic].
• Age of marriage: 18 years old.
• Exceptions from the age limit:
  • Persons at 17, with the consent of parents.
  • Persons at 16, after consent from the judge at family court.
  • People with special needs who are 18 or older, can get married after consent from the family court’s judge, based on medical reports about their capacity to get married.
• No polygamy in Turkey.
• Any marriage concluded outside municipalities’ marriage offices is not legal.

Source for the infographics: Syrian lawyer Haydar Houri

A widespread phenomenon

The phenomenon of early marriage among minor Syrian girls in Turkey, and in other countries of destination for Syrian refugees, is like a snowball that keeps rolling and getting bigger. It persists in the absence of awareness about the risks and dangers, and in spite of the grave psychological problems it produces for the family (parents and children alike). This phenomenon has become well known from the media focus directed at it, in order to help spread awareness about it, and to try and find a solution that might help control this phenomenon.

In an investigation report by ‘Al-Arabi Al-Jadid’ entitled “Underage mothers in Turkey” on 15 March 2018, it was pointed out that the reception at one hospital, during the first five months of last year, had visits from 115 pregnant children. Police were not notified about them. They included 39 Syrians, and the rest were Turkish. Among the 115 cases, 38 were minors under 15 years old.

This is what led the Turkish authorities to open two separate investigations. The first is related to public servants accused of negligence. The second is related to the exploitation of children.

Public Prosecution managed to investigate the cases of 20 of the accused, and to conduct investigations related to 50 minors, in the presence of a psychiatrist. Investigations had shown that all pregnant minors live in neighborhoods and municipalities of Istanbul with high population concentration of people who moved there from Eastern and South Eastern Turkey.

In the same context, in Sweden, the country that received around 110 thousand Syrian refugees, representing the second biggest migrant group in the country,132 minor refugees were married to adults according to UNHCR’s statistics until 2016, although the numbers didn’t specify their gender. This has led the Swedish Tax Authority to strengthen the rules of evaluating and registering child-marriage cases, even if other authorities allowed such marriages.

In Germany, which hosts 699,000 Syrians, representing the third biggest migrant group in the country, the Federal Statistics Office in 2018, and the Federal Ministry of Homeland Security, estimated that 1,475 minors registered as married, including 361 girls under 14. This led the Ministry of Justice to introduce a bill, by which the German government will not recognize marriages documented through foreign marriage certificates, in case one of the couple is under 18.

Birth, but under conditions

When Israa Muhammad (15 years) decided to go to the public hospital in Kilis, Turkey to give birth to her first child, the hospital denied her entry. She decided to go to a private hospital, but she didn’t make it through the door there either.

“The doctor shouted at me, saying you are young, and the child is small”, said Israa, “I cannot take responsibility in case one of you dies, which is very probable.”

She added, “At that time, I was in great pain, giving birth, and the baby was almost fully born. We didn’t know where to go, but God put in our way a legal midwife, who agreed to do the operation. She said she will do it on condition that she will not be held responsible if something happened to me or the baby. We could only accept, because we didn’t have any other options.”

Dr. Sawat Irchahin, the head gynecologist at Medical Park in Istanbul, said, “Early marriage has a negative influence on the health of mother and child. Symptoms appear early in the pregnancy, with nonstop vomiting, anemia, as well as the possibility of miscarriage and early births. This is because of female hormones at this early age, or because the uterus is not ready yet for pregnancy. This leads to spasms that might lead to hemorrhage, and thus early births happen. The young girl can also suffer high blood pressure, leading to kidney failure, internal hemorrhage, spams, and the need for cesarean operations become more likely.”

The doctor confirmed that early pregnancy “increases the likelihood of suffering bone deformations in the pelvic area and the spine. It can also negatively affect the embryo’s health. The embryo can suffocate inside the mother because of a likely severe shortage in the blood circulation feeding him.”

Early birth can also lead to a shortage in the respiratory functions, because the embryo can be born without fully formed lungs. The child can suffer problems in the digestive system, and a delay in physical and mental growth. The child can also suffer brain paralysis or hearing impairments, according to Dr. Irchahin.

Getting pregnant once again

The pain and suffering Israa had been through didn’t stop her from getting pregnant one more time. She didn’t think about how her early marriage would  be discovered when she went to the hospital to give birth to her second child. At the time, she was 16 years old.

“When I was pregnant with my second child, I went to the Kamil public hospital,” said Israa. “There, they had to receive me, because the baby’s head had already emerged. They quickly put me in the delivery room. After the baby was born, they registered my personal data, and soon enough the police came to interrogate me. They kept me at the hospital for 12 days.”

During that period, her daughter was inside an incubator in the hospital. The mother went through investigations and interrogations. They took her fingerprints, and in the end allowed her to leave the hospital with her baby girl.

She said, “I felt I was a prisoner released. I told myself I will not get pregnant again until I am 20.”

How the prosecution proceeds

• The case starts during child birth, or during consulting the doctors while monitoring births in public hospitals and clinics.
• Police are notified by the doctor, because failing to inform the police is considered a crime.
• The Supreme Criminal Court in Turkey manages these cases, because the penalty is over 5 years of imprisonment.
• Penalties, based on the judge’s discretion can reach 10 years in prison, according to the Turkish Penal Code.
• The case starts without the need for someone filing it.
• The case is referred to prosecution, that demands verdicts against the husband and the minor’s parent.

 Source: Haydar Houri, Syrian lawyer.

The Social-media’s market

Some groups and pages specialized in matters related to women and girls on social media provide a forum for discussions about child marriage and refugee affairs in host communities in general. Some of these pages also provide information for arranging marriages.

A woman for example would say she needs a wife for her son or another relative, with specific demands, like her age, height, where she lives, etc, and proposals start coming her way.

This investigator witnessed several cases, where she contacted the people in question, but it is hard to expose their real names because the topic is sensitive. Samar (not her real name) says she got married at 14, and delivered her first baby at 15, at a private hospital in Istanbul. She didn’t go to a public hospital fearing the procedures. But she had to go to public healthcare facilities to vaccinate the child.

There, officials initiated an investigation into her about her marriage and when it happened. The police also interrogated her the next day.

Her father was arrested, and police searched for her husband, who is on the run until now, according to her post.

Social expert Adel Hanif Ughlu, who worked in 2012-2013 on documenting 11 child marriage cases of girls, including 9 cases ending in kidney failure, says, “Syrian families hide this affairs very well. Even those who have Turkish nationality have their daughters married while still minors, even though they know this is a crime under Turkish laws.”

Official statistics and numbers

* 405,521 Syrian children have been born in Turkey in up to November 2018.

Source: Minister of Interior, Süleyman Soylu, 22 February 2019.

* Urfa province in southern Turkey is among the provinces with highest occurrences of Syrian births.

* 400 Syrian children are born in Turkey each day.

* Urfa’s share of that number is 50 to 55 per day.

Source: Head of Migration Research Center, Muhammad Murad Erdogan, 25 October 2018.

* Over half a million Syrian children are born in Turkey and who are under 4 years, do not possess any nationality (stateless).

* Current number of those registered as deserving temporary protection is 3.5 million.

* The number of stateless newborns and children under 4 in Turkey is 535,826.

Source: Turkish Migration and Refuge Authority, and the Ombudsman office, 25 August 2018.

Endless psychological problems

Early marriage doesn’t leave its mark on the girl’s physical health only, but it also leads to deep psychological crises that become hard to get through with the passage of time, for the girl and for her children. Psychiatrist Omnia Turk says that this early marriage “denies the girl the kindness of her parents, and her right to choose a husband herself. It also means denying her living her full childhood. The girl doesn’t understand married life, or the responsibility on her shoulders, leading to huge pressures in some cases. Also, she suffers problems in her sexual life, because she doesn’t understand married or sexual life. This leads to breakdowns between the couple, and the inability to adjust with the problems of marriage.”

Another aspect negatively affecting the children, is that they do not understand that the mother herself is a minor, and “that leads to unsound and unwise decisions, because the minor doesn’t care for giving her children education. She didn’t acquire the ability to discipline or raise the children, let alone being denied herself the right to education, which negatively influences her and the children.”

She added, “When she grows up, the minor discovers that she married the wrong person, or not the person she wants to continue her life with. She discovers that she was used as if she was an object for sale.”

Early marriage in religion

Marriage cannot happen unless the couple are on equal terms. In Sharia, this equality is required. Here, Dr. Muhammad Nadir, a lecturer at Karabük University, Turkey, says, “If the girl marries a person who is not equal to her, without her consent, the marriage is considered null and void, according to most Ulama (experts in religious law).”

According to Dr. Nadir, “The couple being on an equal footing is an inherent right for the woman. She cannot be coerced into forfeiting that right. It is a condition for marriage, and marriage of minors is void of this quality. Sharia might grant the minor a separate/independent financial capacity, overseen by her parent, in her interest. Her money cannot be spent except in her interest. Interest in marriage is even more important than finances, because honor is more important than money.”

Solutions to the phenomenon

Faced with this reality and in the absence of sufficient solutions for the problematic phenomenon of early marriage in Turkey among the Syrians, and regardless of if that marriage was conducted in Syria or Turkey, the future of such marriages is vague. Against the strict Turkish Law, Nour and Marwa will keep waiting for the results of their prosecution, anxiously waiting for the influence on their future and lives. Here, the Syrian lawyer Haydar Houri recommends to avoid marriage before 18. This marriage, according to him, is problematic, because, “There are many cases of prosecution in Turkey.”

When the minor girl is discovered as being married, one of two methods is used. Either to refer her to a shelter for minors, or return her to her family home, and make the family promise not to send her ever again to the husband.

Houri, on the other hand, recommends that any person married to a minor girl in Turkey, should try to document his marriage in one way or another in Syria, to avoid penalty. This is because once the marriage is documented by Syrian Sharia courts, this documentation can be used in the prosecution to avoid penalizing the husband, because the act is a crime in his country.

*This investigation was conducted under supervision of the Syrian Investigative Reporting Unit – SIRAJ, within the context of “Syria In Depth” project, conducted in cooperation with the Guardian Foundation, with support from IMS. 

The post “Mothers before their time” appeared first on SIRAJ.