Hoda (far right) during a soial counselling group session.
Hoda  is a social worker in the Al-Qahtaniya district of rural Quamishli, in north-east Syria. She runs group and individual counselling sessions for female patients who initially came to the Reproductive Health Clinic for treatment. When there is a large group of women gathered in the clinic’s waiting area, Hoda uses this opportunity to raise awareness about breast cancer and other illnesses that affect women.
She explained: “I encourage my patients to work on many of the issues facing us Syrian women in the group counselling sessions. And I assure them that the counselling sessions are confidential, private and safe.”
Prominent topics in the local community include the impact and repercussions of the Syria crisis on children, and the emotional deprivation they inevitably suffer. Hoda is also working to identify the key issues of interest to women in her community in Al-Qahtaniya. “Stress, psychological disorders, tension and permanent anxiety are just some of the factors that affect women’s health, particularly women who are internally displaced,” she said.
Hoda explained that the clinic is one of the few places in the area working to increase the availability and accessibility of essential health services to vulnerable groups of women and girls, and to survivors of gender-based violence (GBV). “The women who seek out counselling often have no one to turn to, such as the 22-year-old mother of two who I am currently seeing. She was married at 14 and is beaten by her husband and mother-in-law. She has had multiple miscarriages,” said Hoda.
Reproductive health section of the clinic.
To ensure the well-being and safety of women and girls affected by the crisis, the Syria Humanitarian Fund, supported UNFPA, is funding and establishing the gynecology/reproductive health and counselling sections and pharmacy. The project benefits some 3,800 families, including an estimated 1,400 internally displaced families in Al-Qahtaniya. The project is implemented by UNFPA in collaboration with local non-governmental organization Al-Birr. It provides free health services at the clinic in addition to basic medical care to communities in the surrounding areas.
Inside Syria, an estimated 398,808 Syrian women are pregnant. Of those women, some 75,000 will require emergency obstetric care to manage a complication. “Too many women and girls in Syria have survived or witness terrible violence first-hand, including gender-based violence and forced marriages,” said Hoda.
Providing comprehensive and survivor-centred response to GBV in Syria remains challenging due to the limited number of organizations, the limited accessibility of many areas and the lack of trained experts on the ground. Geographical coverage of GBV services, which currently are mostly concentrated in urban areas or in shelters for internally displaced people, is minimal in rural and hard-to-reach areas.
But insecurity and the stigma around GBV still create barriers to accessing these services, even when they are available. The fear of reprisals alone presents a major impediment to survivors seeking life-saving support. Partners report the extreme difficulties for survivors accessing services and the dangers service providers face if they are openly recognized as supporting GBV survivors. Moreover, the limited safety options for survivors and the weak legal framework in most of Syria mean that GBV response will remain partial.
Despite these challenges, much can still be done to expand and improve case management, psychosocial support, medical response and prevention activities, as well as the response services provided by dedicated staff such as Hoda.
Photos: Al-Birr NGO/AlQahtaniya/AlHasakeh/2017
 Not her real name