AMMAN: Something didn’t feel right.

Umm Marah, three months pregnant with her second child, was at her home in the encircled Syrian town of Madaya two weeks ago when she began to feel unwell.

“I felt severely weak and nauseous since that morning,” Umm Marah told Syria Direct. “I was doing housework when the room suddenly started spinning and I fell to the ground, passed out.”

Umm Marah’s husband rushed her to the only women’s clinic in the town of 40,000. The clinic is staffed by a single OB/GYN who had not yet graduated from medical school when the conflict broke out in 2011.

“When I woke up, the doctor told me that I lost my child,” said Umm Marah. “She said my body and mind were exhausted, which doesn’t allow for the development of a healthy fetus.”

“I felt as though I had lost a part of myself.”

Umm Marah is one of dozens of Madaya women who have suffered miscarriages in recent months due to poor nutrition and the stress of being trapped in an encircled town, Dr. Mohammed Darwish, one of the town’s few remaining medical professionals told Syria Direct.

“Since late December, there have been 30 miscarriages in Madaya,” Darwish told Syria Direct. Darwish, who works at the Madaya field hospital, was a dental student when the conflict began. “Since the beginning of July alone, there have been six miscarriages, a stark increase from past months.”

“Untitled.” Image courtesy of Anas Salameh and Creative Memory.

Darwish attributes the rise in miscarriages so far in July to the accumulated “impact of months of malnutrition” in Madaya, under siege for one year, in addition to “the psychological pressures of war and siege.”

Syrian regime forces and their ally Hezbollah encircled the Outer Damascus town of Madaya, 40 km northwest of Damascus, last July during a battle for control of neighboring rebel-held Zabadani, a gateway to key smuggling routes into and out of Lebanon across the Qalamoun mountains.

Since last summer, 40,000 residents of Madaya and neighboring Baqin have been among an estimated one million people currently living under total blockades in Syria, according to the Siege Watch monitoring organization.

In December 2015, the airtight encirclement of Madaya—reinforced by thousands of landmines laid around the town by Hezbollah—led to mass starvation, with residents of the town, less than an hour’s drive from Damascus, surviving on grass and leaves.

Despite international outrage and several aid deliveries, at least 86 encirclement-related deaths occurred in the town as of May 2016, Physicians for Human Rights (PHR) and the Syrian American Medical Society (SAMS) stated in a joint report earlier this month.

In Syria, “siege impacts women severely and disproportionately,” according to a 2016 report by international NGO Women’s International League for Peace and Freedom. “While women do the vast majority of work finding and preparing the scarce food, they are the last to eat and eat the least.”

The lack of adequate nutrition and healthcare under the blockade hits pregnant Madaya women particularly hard, as their bodies are already under additional stress.

“Pregnancy in general can take a large toll on a mother, in terms of psychological and physical health,” Madaya doctor Darwish told Syria Direct.

Syria Direct cannot independently confirm the cause of the reported increase in miscarriages in Madaya. However, the United Nations and other international organizations have tied the physical stresses of living under siege in Syria to higher rates of miscarriage and other pregnancy complications since at least 2013.

Doctors Without Borders reported in 2013 that pre-term births and miscarriages in Syria were “on the rise because of the stress caused by the conflict.”

Two years later, “a majority of pregnant women in the besieged areas suffer from anemia, and cases of miscarriage and birth defects have increased notably,” concluded a 2015 report by the UN’s Independent International Commission of Inquiry on the Syrian Arab Republic.

Miscarriage is one of the most common pregnancy complications worldwide, affecting an estimated 14 to 20 percent of pregnancies. However, environmental factors such as stress, poor nutrition and exposure to chemical and explosive weapons have also been linked to increased rates of miscarriage.

In Syria, “a lack of water and food is having a tremendous impact on pregnant women and lactating mothers,” according to a UN OCHA Humanitarian Bulletin issued in May 2015.

“Most importantly, a pregnant woman should have a diverse diet, which ideally includes fruits, vegetables, dairy products and eggs,” said Madaya doctor Darwish. “None of these foods is available in Madaya. Our diets are limited to aid packages containing bulgur, rice, beans and chickpeas.”

“During my pregnancy, most of my food, when I could get it, was from the aid,” Umm Marah told Syria Direct.

“Unfortunately, there’s no food containing the calcium and vitamins that are essential for pregnant women, except at exorbitant prices,” said Darwish.

In Madaya, a one-kilo plastic bag of shelf-stable milk sells for around SP40,000 (approx. $185.27), according to Darwish. Cucumbers and zucchini cost SP4,000 per kilo (approx. $18.53).

Pregnant women, alongside other Madaya residents, suffer from “general weakness” and “constant dizziness as a result of the lack of vitamins in the available food,” says Darwish. Vitamins and essential medicines are “all but used up,” he says.

“No aid has come since about two months ago,” Hussam Madaya, a local council member and aid activist in the town told Syria Direct. “The food the UN brought has started to run out.”

For the mother publicly speaking out about the pain of her miscarriage, the misfortunes that come with being a civilian trapped inside Madaya have not killed her hope of conceiving again.

“When I saw him, I broke down crying,” said Umm Marah, recalling seeing her fetus after her miscarriage. “His apparent features and tiny size crushed my heart. A mother has maternal feelings.”

Umm Marah’s miscarriage impacted her husband as well, she says.

“My husband was struck by despair,” said Umm Marah. “He had been waiting for a son to carry the family name.”

“I haven’t lost hope of having another child,” she added, “but I’m haunted by fear when I remember the sight of my fetus, who died.”