Sahar Salem says her husband immediately sought to divorce her when he discovered she had become incontinent after giving birth.

Salem had developed obstetric fistula, a medical condition that causes a hole to develop in the birth canal as a consequence of childbirth, leaving women incontinent and often leading to shame and social ostracisation.

The 31-year-old, who lives in the port city of Aden in Yemen, says it was after marrying her husband that her problems started.

“I found out that I was pregnant,” Salem tells The Independent. “I told my husband but he was not happy. He cut his communication with me and then reached out to me telling me that he divorced me. Then, after two months, he returned and wanted me back.”

“My parents were afraid that if he took me back to [the southern province of] Al Dhale, he would continue mistreating me there. I stayed in my parents’ house until I gave birth and got obstetric fistula.

Brutal effects of Yemeni war Show all 12 1 /12 Brutal effects of Yemeni war Brutal effects of Yemeni war Yemen organised by the UAE's National Media Council shows a Yemeni woman holding a child diagnosed with malnutrition at a hospital in the southeastern port city of Mukalla, the capital Hadramawt province AFP/Getty Images Brutal effects of Yemeni war Mohamed, 2, is treated for Malnutrition in Mukalla, the capital Hadramawt province, Yemen Bel Trew Brutal effects of Yemeni war a trip in Yemen organised by the UAE's National Media Council (NMC) shows a Yemeni woman holding a child diagnosed with malnutrition at a hospital in the southeastern port city of Mukalla, the capital Hadramawt province. AFP/Getty Images Brutal effects of Yemeni war UAE's National Media Council (NMC) shows a Yemeni woman sitting next to a child diagnosed with malnutrition at a hospital in the southeastern port city of Mukalla, the capital Hadramawt province. AFP/Getty Brutal effects of Yemeni war A picture taken on August 7, 2018 during a trip in Yemen organised by the UAE's National Media Council shows Yemeni women attending to children diagnosed with malnutrition at a hospital in the southeastern port city of Mukalla, the capital Hadramawt province. (Photo by KARIM SAHIB / AFP) (Photo credit should read KARIM SAHIB/AFP/Getty Images) AFP/Getty Images Brutal effects of Yemeni war Mohamed, 2, is treated for Malnutrition in Mukalla, the capital Hadramawt province, Yemen Bel Trew Brutal effects of Yemeni war A Yemeni child suffering from malnutrition is weighed at a hospital in the northern district of Abs, in Yemen's Hajjah province AFP/Getty Images Brutal effects of Yemeni war A Yemeni child suffering from malnutrition awaits treatment at a hospital in the northern district of Abs, in Yemen's Hajjah province AFP/Getty Images Brutal effects of Yemeni war A Yemeni child suffering from malnutrition awaits treatment at a hospital in the northern district of Abs, in Yemen's Hajjah province AFP/Getty Images Brutal effects of Yemeni war Yemeni nurses weigh a malnourished child at a hospital in the northern district of Yemen's Hajjah province AFP/Getty Images Brutal effects of Yemeni war A Yemeni woman carries a malnourished child as she waits during food distribution in the province of Hodeida AFP/Getty Brutal effects of Yemeni war A Yemeni child suffering from malnutrition is measured at a hospital in the northern district of Abs, in Yemen's Hajjah province on August 18, 2018. (Photo by ESSA AHMED / AFP) (Photo credit should read ESSA AHMED/AFP/Getty Images) AFP/Getty Images

“When I told him about my health condition and explained to him that I might go to have surgery abroad, he abandoned me. He did not support me financially or emotionally. He said he would divorce me.”

Salem, who alleges her husband subjected her to domestic violence during their marriage, said she developed obstetric fistula due to not receiving proper treatment in the hospital while giving birth. She said she was in such excruciating pain that she could not sleep.

“There was no anaesthetic and I was bleeding,” the mother-of-one says. “I waited impatiently for a long time for them to take me into the operation room. I was in horrible pain and I wanted it to be over. After I left the operation room, the effects of the anaesthetic had worn off and the pain came again and it was even more awful. I was moving left and right screaming in pain.”

The World Health Organisation estimates more than two million young women in Asia and sub-Saharan Africa live with untreated obstetric fistula.

Salem, who now works as a midwife helping local women in her community, describes that period of her life as her “dark days” – saying she was deeply depressed. But things began to feel more hopeful after she managed to have surgery, after learning about an organisation which treated women who have obstetric fistula.

“My husband divorced me so he could escape from his duties like looking after me and paying for the cost of operations,” Salem adds.

“When I was with him in Al Dhale, he used to tell me ‘My fear is that you may get sick’. When he learned that I was cured, he came back apologising, and said he wanted to live with me again. He said he was mistaken but I refused to go back to him.

“He wasn’t there when I needed him the most and he treated me badly. I did not feel that I was his wife. I always felt that he married me for his pleasure only.

“This time, I asked for the divorce. He asked for money in order to divorce me. He left me for months, not divorced nor married. He did not even send money for his daughter. Finally, we spoke to a religious leader who saw me and my daughter and I told him that I want to be divorced. In the end, my husband sent a message via WhatsApp that he divorced me.”

Ms Salem is not alone in her struggle to access healthcare. The United Nations Population Fund (UNFPA) warns a troubling dearth of funding for sexual and reproductive health services is placing the lives of women and babies in the war-ravaged country at grave risk.

The UNFPA, which has lent its backing to 268 reproductive health clinics in Yemen, was forced into shutting 100 services at the end of August and will have to close an additional 75 this month. They say 650,000 women and girls will subsequently be left with no way to reach life-saving services.

The UN organisation, which strives to improve reproductive health across the world, says it has already stopped being able to obtain medicine for those services that are due to close.

The UNFPA estimates there to be six million women and teenage girls who are of childbearing age in the poorest of the Arab countries and more than one million pregnant and lactating women in dire need of “immediate treatment for acute malnutrition and further medical assistance”.

The agency is currently experiencing a funding gap of $77m (£61.7m) for its 2019 Yemen humanitarian response, having only managed to obtain $33m.

The conflict, which has lasted more than four years and claimed tens of thousands of lives, has prompted what has been described as the world’s worst humanitarian crisis by the United Nations.

In November, UNFPA and the governments of Denmark and Kenya are holding an international summit in Nairobi, which will try to find ways to fund and support sexual and reproductive health care in humanitarian contexts like Yemen.

Anjali Sen, the UNFPA’s representative for Yemen, said: “The closure of the facilities is very worrying. We have seen the collapse of the economy and social services during the conflict. Women and girls are bearing the brunt of the war. It has been particularly harsh for them and they remain the most vulnerable at risk group of people in the country.”

The humanitarian worker, who has been based in Yemen for the last two and a half years, added: “We are talking about a country where every two hours a woman dies from complications with pregnancy and childbirth, while another 20 suffer injuries, infections or disabilities that could have been prevented.