Müzeyyen lay inside a car scared, in pain, and days away from giving birth. Anyone who could help her was buried under the rubble. Her hometown, Hatay, is unrecognisable after the devastating earthquakes that hit south-eastern Türkiye and north-western Syria in February.

“There are no hospitals, no doctors, we are in God's care now,” Müzeyyen said. She’d been living in the front seat of her brother’s car with her seven-year-old child and another family crammed in the backseat and trunk.

The most vulnerable group of people in the quake zones are pregnant women and mothers and their children. The United Nations Populations Fund (UNFPA) estimates there are more than 214,000 pregnant women in the quake zones, 24,000 of whom are expected to give birth this month.

But according to the Union of Health and Social Service Workers (SES) in Türkiye, there is “almost no public institution left to provide health services” in Hatay.

In text messages shared with openDemocracy, several pregnant women and mothers in the quake zones said they fear that a deficit of medical care as well as the lack of clean water, food, shelter or heat, will doom them and their children to death.

In Türkiye alone 48,448 people – including health workers – were killed by the earthquakes as of 13 March, according to the Turkish interior minister, and more than 230,000 buildings collapsed or were severely damaged.

“Public health institutions are at the forefront of institutions that need to survive in natural events such as earthquakes,” SES said in a press release on 22 February, two days after a second pair of less powerful quakes hit Hatay. It added that the safety of health workers has been "disregarded".

The lack of health workers, equipment, and facilities disproportionately impact women and children after disasters, says Dr Aral Sürmeli, founder of the Turkish Medical Rescue team MEDAK and the US-Turkish nonprofit HERA, two organisations working directly with women and girls on the ground.

“Even in normal conditions, women are part of vulnerable groups, but after natural disasters, it becomes worse,” Sürmeli said. “It’s hard to make sure that sexual reproductive health services and maternal and child services are provided.”

Urgent need for reproductive health services

Müzeyyen was later transferred by relatives to a hospital in Ankara, where she gave birth to a healthy baby girl named Sevinç, which means ‘happiness’ in Turkish. She’s now living in a shared flat with another family in the Turkish capital.

But tens of thousands of pregnant women, such as Gülçin, can’t afford to be evacuated from the quake zones.

Gülçin is in the East Anatolian ancient city of Malatya, once renowned for its apricots but now devastated by the quakes. All of Gülçin’s medication is under debris. Without enough food or nutrition, she worries that she and the baby she’s carrying won’t survive. While she knows that the intense stress she’s experiencing will affect the child negatively — the more she thinks about it, the more stressed she gets.

“I used to be afraid of giving birth,” Gülçin said. “But now, I am afraid that I won't be able to give birth.”

There’s a high demand for folic acid, food, diapers, blood work, and vaccines for their newborn babies by mothers and pregnant women in the affected areas, Leyla Kalin, a nurse at SES, told openDemocracy. She added that most women don’t have vaccine records, many of which were lost in the earthquakes.

Sürmeli has been working to resolve this issue through his non-profit HERA’s mobile health app that helps women keep vaccination records together in one place on their phones.

The app opened up to displaced women in Turkish quake zones for the first time last month after having exclusively served mostly Syrian refugees in Türkiye since its launch in 2018.

After disasters, women are exposed to long-term impacts, including vaccine-preventable diseases, pregnancy-related deaths, newborn deaths, and gender-based violence that require “constant support” and “check-ins”, said Sürmeli. He believes in providing basic digital infrastructure to help women get connected with local health services as one of the main solutions.

Currently, HERA is working to develop a helpline coupled with an AI chatbot to assist women in quake zones navigating sexual reproductive health services by sharing their location via WhatsApp.

HERA, MEDAK, and the Turkish non-profit Development Workshop also created a live online disaster map last month alerting women of the nearest health centre locations, updated every 10 minutes by field workers and volunteers on the ground in Türkiye. Since launching last month, the portal has been used over 4,000 times, according to Sürmeli.

Psychological impact on women, children, and health workers

Sürmeli has been personally impacted by the earthquakes, too. He hails from Hatay, approximately the size of Norfolk in England. “I went to my hometown and it’s completely gone,” he said.

He admits that he’s learned to put personal grieving aside.

“It's not always the healthiest thing to do,” Sürmeli said. “But you have to find a way to survive in the field to keep working.”

HERA, MEDAK, and the Developmental Workshop are offering health workers psychological screenings to determine whether they’re fit to work. There are also rotations in the field and opportunities to take time off.

The Turkish health union SES said it has repeatedly called for the Turkish Ministry of Health to work together with health labour and professional organisations “to meet the needs for health services in the region” to no avail.

“[Health workers and victims] never had the time to mourn because the [state never created] an area where they could heal,” said Kalin who has been working in a women’s health unit built by SES and the Turkish Medical Association (TTB) in Hatay.

In the southernmost Turkish city reduced to ruins and tents, Esra is trying to rebuild her life. At the same time, she’s not only trying to protect her own mental health but that of her four children. Amidst all of the rubble, missing people, death, and injured relatives — it’s not easy.

“The children wake up every night startled by the sound of a car — ‘is it a new earthquake?’,” Esra said. “My son cries to me, 'Mum, please don't walk away anywhere, don't let anything happen to you, I can't be without my mum.’”

Esra and her children are now living inside the family car, whilst her husband is abroad, relying on limited supplies of petrol for heating. Other families are living in tents or in partially ruined buildings. The mum of four counts every droplet of clean water given to them by humanitarian aid workers. She rations food for her children. She reuses and hand-washes her children’s diapers with any water she can find, despite the risk of diaper rash.

“It is very difficult to change diapers in this cold,” she said. “We leave our discomfort aside and try to protect our children.”

HERA, MEDAK, and the Developmental Workshop have signed a lease agreement for at least another five years.

“The effects of the earthquake are going to take at least 10 years,” Sürmeli said. “We need to stay here and keep working for women and children because they’re the most vulnerable.”

A version of this article originally appeared in Turkish written by Birgül Çay for Birgün Newspaper on 15 February 2023.