The sisters decide that they would like to use the condoms. They begin to giggle as Munira asks them if they know how to use them. As the giggling continues, she unwraps a condom and demonstrates its use. They promise to go home and explain it all to their husbands. I give each of the women a blue card with their names, serial numbers, the date, and the item they received from us. If the women return to us, they can give us this card and we will know what form of birth control we have given them in the past and that they have already been counseled on its proper use. When the two sisters leave us they are still giggling a little.

The next patient is a pretty girl of 16. Her hijab perfectly matches the teal of her outer robe. Her makeup is immaculate. She has been married for a little more than a year. She has one baby at home and has come today for a pregnancy test. She is one of many teenage girls in the camp who are wives and mothers.

“Ya habeebti (oh, my darling),” says Munira to our patient, “Do you want another baby when you have one so young at home?”

The girl shakes her head. “No, but my husband wants one.”

When asked, the Syrian women tell me that marriage between the ages of 15 and 18 is common and expected in Syria. They also say girls are married even younger in the camp. Here, the social structure that existed in Syria is almost entirely broken down. In the midst of a fragmented society, women are not surrounded by a large protective extended family. They live in very close quarters to men who are not related to them. There is little security in the camp, and much fear of rape. Therefore, many parents feel that they need to protect their daughters by marrying them off as soon as possible. Because the family’s former social structure has been broken, the family may no longer have the option to marry a girl to a relative or someone they know well.

Early marriage in the camp not only exposes girls to men who may or may not be known by the family, it also exposes them to pregnancy at an early age. Once a girl is married, it is expected by her family, her husband’s family, and society in general, that she will begin having babies.

Munira reaches out and takes the girl’s hand.

“You are so young now, and so is your baby. If you are pregnant now, then congratulations, you will have a new baby. But if your pregnancy test is negative, and you are not ready for another baby you should try some birth control. Your body is so young, you are still growing. Try to wait a couple years before you have another baby.”

The girl nods her head.

“You can send your husband here,” says Munira. “If he does not understand I will explain to him.”

I hand the girl a pregnancy test. And explain to her how to use it. She promises to come back after she sees the results.

I spend some of my days working on the other side of the camp at a second reproductive health clinic. Two doctors and one midwife sit around a desk in one of the caravans. A wardrobe full of medicine stands to their right, and an exam table with an ultrasound machine to their left. A second caravan houses a small delivery room staffed 24 hours a day by a doctor and midwife.