With the help of a midwife, Reem recently gave birth to her fourth son on an iron bed in a small room inside a former Mosul shop.
The 25-year-old is just one of a growing number of women in the northern Iraqi city who have started relying on midwifery since the extremist Islamic State group took over there, driving doctors away.
It wasn’t her original birth plan, she told NIQASH over the phone, with the sound of her baby crying in the background.
"When I felt the labour pain, I twice went to the al-Batool Hospital, where I gave birth to my other three children. But the doctors refused to admit me, saying that it would be some time before I delivered,” she said. “And it’s not just women who have to, that go to midwives, there are others who now prefer midwives to hospitals too.”
That’s because services in Mosul’s maternity wards have worsened significantly since the Islamic State group, known as IS, took over the city in the summer of 2014. Many specialists have fled. Official figures issued by the Ninawa Health Directorate indicate that 30 percent of the doctors and nurses were displaced during the first 6 months of IS control, and that number has only increased.
One of Mosul’s best-known obstetricians, who goes by his nickname Duha Mahmoud, told NIQASH that, "the most famous 15 obstetricians and gynaecologists in the city have left, in addition to anaesthesiologists and nurses who work in maternity wards.” Most of them were part of either the Christian, Shiite, or Shabak communities — all groups that have been targeted by the extremist militant group.
The problem worsened when the education ministry and the Iraqi Council of Medical Specializations closed medical training centers in Mosul and transferred senior resident trainers to other regions. And because teaching has stopped, new doctors aren’t replacing those who have left.
There are still eight hospitals in Mosul, two of which have maternity wards. But they can’t handle the needs of city with a population of 1.5 million. According to Nineveh Health Directorate figures, the reproduction rate has not fallen under the extraordinary circumstances, either. It reports that there are more than 200 births every day, 50 of them by caesarean section operations.
Reem was lucky. She had a natural birth. She carried a small bag of baby clothes, waddling to the midwife’s modest house in the Zanjali neighborhood like a black duck, her face and body covered as the IS group has prescribed all women must be.
Along with her mother and husband, Reem was received by Um Ali, a woman in her forties who reassured her young patient. “Dozens of women have given birth on this bed,” the midwife said. “And our mothers and grandmothers used to give birth to their children in their homes until very recently.”
Still, Reem’s husband was prepared for an emergency as he waited in the front room while his wife was attended to for the first time by a midwife. Despite Reem’s screams, Um Ali remained calm, even leaving the room several times to care for her disabled husband. She provides for him and five other family members with her meagre earnings working as a midwife, which also includes two shifts a week at the al-Batool Hospital maternity ward, where she makes less than $50 a month. To supplement her income, she also delivers babies in her home.
Like her, a number of other women are becoming midwives to earn a living in the city under IS control. Jobs are scarce since the federal government stopped paying its employees in Mosul. And because there’s now no government oversight of the profession in the occupied city, anyone can learn the trade.
It seems that history is repeating itself. The people of Mosul, trapped in their city for the last 26 months, still recall how this old profession thrived during the economic blockade imposed on Iraq by the international community in 1991. It went on for 13 years, with devastating effects on the healthcare system not dissimilar to those of today.
While Mahmoud, for example, does not recommend that women give birth under the care of midwives who may not be trained to handle complications, some have little other choice. Though hospital births are still relatively affordable, their limitations force many families to seek care at private clinics, where the costs are steeply inflated. At the hospital, a natural birth costs around $10, while a caesarian section costs $60. Costs at a private clinic can reach up to $3,000. Thus, midwives have become an increasingly popular alternative.
In the final stages of Reem’s labor, Ali put a cloth in her mouth to bite on, silencing her cries. After two hours, the cries of her baby filled the room instead. Her husband, still waiting motionless by the window outside, finally took a deep breath.
Normally Ali charges $20 to deliver a baby. But Reem’s husband is unemployed and they are living in harsh conditions, so she accepted $15. As she left to take her newborn home, Reem tucked the money into the midwife’s pocket at the front window, where she stood awaiting her next patient.