Beirut, Lebanon - Due to the prohibitively high cost of childbirth in Lebanon, many pregnant Syrian refugees are returning to their war-ravaged country to give birth.
While no exact figures on the trend are available, Marjorie Middleton, a midwife at Medecins Sans Frontieres (MSF), said, "Pregnant refugees in Lebanon are going back to Syria to give birth. It is very common. Women are on their own here. The situation is brutal."
"The World Health Organisation and the United Nations, on a global scale, have both said the number-one way to save maternal lives is to provide access to safe delivery," she told Al Jazeera. "This is not happening. The costs for refugees are simply not feasible. "I met so many women on their way to and from Syria carrying tiny little babies. They don't know that services do exist and in other cases, they just can't afford it. They can get it for free in Syria."
According to the UN Population Fund, about 200,000 Syrian women will become pregnant by the end of this year.
While the United Nations High Commissioner for Refugees (UNHCR) covers 75 percent of childbirth costs for registered refugees, the average cost of childbirth in a Lebanese hospital is about $350.
Roberta Russo, a spokeswoman for the UNHCR in Lebanon, said pregnant women were fast-tracked for registration so they could seek medical support.
However, for those like Khaled Al Othman, finding the funds is impossible. His wife is due to give birth in two days' time.
Many cross the border to get medical services for childbirth, renal disease and those suffering from chronic diseases such as cancer and diabetes.
"I am worried because I don't have any money to support my wife and our baby," he said, while waiting with his wife for medical assistance at Rafik Hariri University Hospital in the outskirts of southern Beirut.
"We need to cover 25 percent of the childbirth costs. But I cannot work - I am disabled, and the baby will need clothes, nappies and food. We have four more children at home and we cannot afford to send them to school. We can't even afford rent."
Sabine Arnaout from Makhzoumi Foundation, a Lebanese NGO that provides healthcare services to Syrian refugees, said there were simply too many pregnant women requiring help.
"The number of refugees requiring assistance is the problem," she said in a room full of refugees needing assistance at their office in the hospital. "Pregnant families are concerned. They need to stay in Lebanon and give birth. This is the only way."
Returning home due to high costs
But for some, making the risky journey back to a country where hospitals are being targeted is their only option.
"If women can't afford to give birth in Lebanon, they go back to Syria and that's just bloody dangerous," Middleton said. "The second option is to gain or raise funds within the local community. But we've discovered that in the last six months, the Lebanese population just have nothing left to give."
A recent survey by Amel Association International found that some pregnant Syrian women in Lebanon were going back home to give birth. "It is particularly worrying that some participants felt it necessary to risk returning to Syria to give birth," the report noted. Of the 13 women who had given birth, two said they had returned to Syria for the birth. The report also said that the high cost of childbirth in Lebanon was the driving factor in their decision.
The report added that only five participants had indicated their childbirth costs had been covered by an organisation.
Lena Ghosn, health technical adviser at the International Medical Corps (IMC) in Lebanon, agreed that such a phenomenon was concerning. "It is true that some Syrian women are returning back to Syria to give birth," she said. "I agree that it could be risky given that some areas do not have a health infrastructure. Security is also the issue. However, this was happening before refugee registration started and among those who are still new to the country and not aware of the services provided to pregnant women."
Ghosn stressed that childbirth services were "affordable", but added that a lack of information about available services was a problem.
Other health issues
However, Professor Fouad Mohammad Fouad, from the American University of Beirut's Department of Epidemiology and Population Health, said the costs were too much for refugees to bear, adding that others were crossing the border for other health-related reasons.
"Many cross the border to get medical services for childbirth, renal disease and those suffering from chronic diseases such as cancer and diabetes. Those people don't have any kind of support and the UNHCR doesn't pay for such services."
While pregnancy happens in every community around the world, the grim reality is that pregnancies in a conflict zone or refugee setting are more likely to be difficult because access to prenatal care is limited.
And the refugee situation in Lebanon is no exception, Middleton said.
"The situation in Lebanon is unique because there're no camps. It's really difficult because at least in a refugee camp you can identify those in need. There's a shortage of services and a huge communication gap. It is very difficult for pregnant women to find us or [for] us to find them."
Middleton said that Syrian women did not want to become pregnant in such an environment.
"They aren't really wanting to have babies right now. But it's not necessarily a choice they have. Many of them are actively trying to get contraception but access is difficult."
She added that a lack of income was resulting in women taking other extreme measures such as giving birth in tents or forgoing their UNHCR registration card.
"Women are actually starting to give birth in tents. I've met Syrian midwives crossing the border and delivering babies. But what happens if something goes wrong?
"Also, in a lot of cases, refugees who cannot afford childbirth, the hospitals are taking their refugee cards so they cannot get access to food vouchers. They tell them that they can have it back once they pay the fees," Middleton said.