When women lead in crises, the entire community benefits

by 08th Mar 2021
Staff working at a CARE-supported hospital in Syria Staff working at a CARE-supported hospital in Syria

As a Syrian woman working on the humanitarian response to the crisis in my own country for the past eight years, I have experienced firsthand how the response was not able to meet the needs of women and girls, without the equal participation and leadership of women in the aid sector.

We know from experience that crises impact women and men differently and that women and girls have been disproportionately affected by the conflict in Syria. Consequently, I have always been a firm believer that women must lead our humanitarian work to effectively design inclusive, gendered programmes that benefit the entire community, including women and children.

While the health sector was dominated by male peers, the response was focused on advocacy, governance, training, and providing primary healthcare, including trauma care. We received a huge number of trainings at the beginning of the crisis. Although these were all done well, the result was that sexual and reproductive healthcare, paediatrics, and family planning were all neglected almost entirely.

In 2014, after three years of the beginning of the response, the United Nations Population Fund (UNFPA) introduced the inclusion of reproductive health in the Syria emergency response and provided trainings on the subject. As a result, more focus was put on protection and gender issues and real attention from donors was given to sexual and reproductive health and rights (SRHR). Things started to improve and we began to see hospitals dedicated to maternal and paediatric health services.

Women’s voices ignored, women leaders overlooked

While this was an important milestone, that recognised the importance of women’s leadership in crises in their communities, women leaders were still very few in number. For example, in a health cluster coordination meeting, there could be 100 men and four women representing health needs of those impacted by the crisis.

In many fora, the voice and perspectives of women were not taken seriously. I once attended a high-level meeting where only two female aid workers, including myself, were asked to speak about women’s demands in the response to the Syria crisis. Before beginning to speak, I overheard some fellow male colleagues calling what was happening a ‘masquerade’ and they left the room. They were not accustomed to listening to women speaking about the needs of other women in Syria.

I have experienced a lack of acceptance and respect for the voices and opinions of women in the sector. Some people may not believe that this is the reality that we face. You hear theoretical speech about the equal rights of women, but the reality is very different. In my experience, women are judged and made to feel insecure every time they speak. I remember one instance when a female colleague from a Syrian organisation and I presented about sexual harassment in the workplace to a room full of peers. Many of our male colleagues just laughed during our presentation. I had to raise my voice to ask them quite firmly to listen to us. I felt like they neither accepted nor took what we said seriously.

Meeting the needs of women and girls in humanitarian responses

I consider myself a newcomer to the aid sector. In Syria, I practised as a family doctor for almost 10 years. After the conflict began in 2011, our lives completely changed. Every time I heard a bomb or my husband or one of my children left the house to perform simple daily tasks, such as go shopping or go to school, I was scared for their lives. However, in 2013, the fear and risk of losing a family member became too high. We had to leave and we did. We left everything behind and moved to Turkey.

I started working for an international humanitarian organisation soon after my arrival to Turkey. I performed different roles, where I ensured family planning services were included at primary healthcare facilities, as I believe in their importance in the context of war and displacement, and supported safe spaces for women and children. I provided many trainings on protection, gender, and reproductive health and family planning to staff at health facilities. I defended the provision of aid services, with a special focus on the needs of women and girls, including in healthcare, protection, and water, sanitation and hygiene.

In one of my roles, I also built a strategy for the health sector in Syria. One of the short-term objectives was the health of women and children. A Syrian neurosurgeon colleague of mine tried to tell me that this was not a priority and that there are more urgent issues, such as addiction treatment.

My response was that he was speaking to the wrong person and that, as someone who had given birth to four children by cesarean delivery, I personally know what it could mean to need a such an operation in a war zone. There are an estimated 1.1 million women and girls of reproductive age in northwest Syria, including some 560,000 adolescent girls and 60,000 pregnant women, out of which 8,200 pregnant women give birth on a monthly basis. Their health and the health of their children is a non-negotiable priority.

Speaking up for women and girls

One time, I was working in the office and I stumbled upon a female hygiene kit, which would be distributed in Syria. It was sitting on a male colleague’s desk and I pointed out to him that the quality of the products was very poor. He could not tell because, naturally, he had no experience in feminine hygiene products. I raised the issue and talked to those involved, but they confirmed that the distribution of the kits would go ahead because the contract was already signed. When I was told that there was nothing better available in the market, I went and bought alternative sanitary napkins, which turned out to be cheaper, and I fought against the kits being distributed in Syria, until the contract was changed and we procured higher quality hygiene products that preserve the dignity of women and girls.

What has changed me and made me stronger in the past eight years is that I am no longer ashamed of speaking about breastfeeding; I am no longer ashamed of discussing female sanitary napkins in public and pushing for the distribution of decent quality feminine hygiene products; I am no longer ashamed of speaking about potentially embarrassing personal stories that benefit advocacy efforts for women and girls; I am no longer ashamed of saying that I was divorced twice, despite the stigma; I am no longer ashamed of saying that my mother had 14 children, whom she breastfed and was responsible for their care, because she was not advised on family planning.

I have experienced male peers telling me that what I am saying is impolite and that I should speak respectfully and not so bluntly. These rules only apply when a woman speaks about issues such as feminine hygiene products, breastfeeding, cesarean deliveries, rape, and sexual harassment. These are a taboo, especially for a Syrian woman. I am routinely faced with men arguing against what I am saying and correcting me, while actually re-framing what I am saying in different words.

Supporting women leaders

I started working for CARE International in 2019. This was the crowning of my medical and humanitarian career. I was given the trust, space, and tools to excel and lead. Being the “Sexual and Reproductive Health Adviser” was my gate towards providing the very much needed health, protection, and gender-based violence (GBV) services to women, adolescents, and children living in northwest Syria (NWS).

On my first day at work, I met the Country Director. Although she did not know who I was, she stood up, came to the door, shook my hand, looked me in the eyes, and said, “you are welcome to CARE”. Immediately, I felt safe and empowered – I felt like this was a place that appreciates their staff, regardless of their background. Within the first week, my manager informed me that I would go to Jordan to join a training on sexual and reproductive health for adolescents. After less than six months, I went to Canada to attend the Women Deliver conference, where I spoke in three separate events. They put their trust in me, gave me huge responsibilities, and built my capacity.

At CARE, I manage different sexual and reproductive health programmes, with protection and gender-based violence components. This includes running al-Amal Hospital in NWS, which provides maternity and paediatric services for women and children, as well as the adolescent mothers against all odds (AMAL) initiative that is dedicated to adolescent and first-time mothers. Through the initiative, they are educated about sexual and reproductive health, receive life and negotiation skills, as well as family planning methods. In addition to women and girls, we have a primary healthcare facility, serving men and boys.

We also support an ambulance network, working in five different locations in NWS. During the COVID-19 health crisis, the ambulance service played a major role in transferring COVID-suspected or confirmed cases to health facilities. We dedicated a number of ambulances to the COVID response and trained staff and provided them with protective gear.

Women on the frontlines of service delivery

Looking back at the years spent in responding to the health needs of Syrians, I see that what kept the health sector from collapsing or even vanishing is the determination, hard work, and perseverance of the concerned humanitarian workers, donors, and decision makers, many of whom are women. I need to mention here that the enormous efforts done by the courageous health staff working in the field and on the frontlines trumps all other efforts. They are the ones defying all kinds of difficulties and oppression in order to serve better. We cannot fail them, and they cannot function independently without our assistance.

Nothing inspires me more than the work of female health staff, particularly midwives, in Syria. They have resisted, fought, and overcame huge challenges to be able to do their jobs. They are the main champions behind the AMAL initiative. They provide precious preventive work through education and raising awareness among adolescents, community members, and healthcare providers. This is very important because when the community is enlightened and aware of the risks related to early child and forced marriage, and less girls are married early, we can prevent a huge amount of complications, injury, death, and misfortune.

Investing in women-led crisis response

I was born and raised in the city of Aleppo. I had a supportive mother and father and, in comparison, my situation enabled me to get to where I am today, but for these women, it is completely different. I believe that investing in women-led crisis response and supporting female healthcare staff in Syria is the only way to effectively meet humanitarian and recovery needs. It is crucial to keep the healthcare sector alive and able to provide services. However, this needs the same continuous commitment already shown by donors and decision makers, so that we do not fail Syrians who have shown incredible strength and resilience throughout this decade of conflict.

Dr Ihlas Altinci

Dr Ihlas Altinci is Sexual and Reproductive Health Advisor for CARE Turkey, and leads CARE’s SRHR work in Northwest Syria.

Dr Ihlas is a Syrian family physician from the city of Aleppo. She left Syria during the war in 2013 and settled in Turkey with her family. She has been working with CARE since 2019, managing sexual and reproductive health programmes, including protection and gender-based violence.