“We suddenly woke up to the sound of the earthquake. My children had passed away in their beds, and my grandchildren were trapped under rubble,” says Kıymet.

“I was eight months pregnant. I was so scared. We couldn't stand up, our building was shaking so badly,” says Yonca.

“I woke up to realize that I lost everything in one minute – no home, no clothes, no money, nothing at all,” says Om Mohamed.

The moment of 4.17 a.m. on 6 February 2023 will be etched forever in the minds of millions of people across Türkiye and Syria. It’s when the first of two devastating earthquakes shook the region, with the second coming nine hours later. Thousands of aftershocks arrived in the weeks that followed.

[Pictured above] A woman looks over a scene of destruction in Jinderis, Syria. © UNFPA/Karam Al-Masri

As the scale of the disaster registered around the world, UNFPA launched an emergency response along with its partners.

The goal: to meet the immediate needs of women and girls in the aftermath of the crisis and to ensure the continuation of essential sexual and reproductive health services, including access to safe deliveries and contraception, as well as to protect displaced women and girls from abuse and violence.

Since the onset of this emergency, UNFPA has supported close to 500,000 people in affected areas.

[Pictured above] At a bazaar in Şanlıurfa, Türkiye, where people are sheltering in makeshift structures and vehicles, Gülsüm is among a team of psychologists, social workers and nurses who provide support. © UNFPA Türkiye/Eren Korkmaz

Three months on, the needs of women and girls remain stark.

Some 2.4 million earthquake survivors continue to live in camp settings in Türkiye, and some 1.9 million people in northwest Syria continue to live in camps or self-settled sites in dire conditions.

For millions of people, recovery is not happening quickly enough.

At this crucial stage, investment needs to be not only sustained, but ramped up. A protracted recovery will increase risks for women and girls as well as require more funds.

[Pictured above] A temporary camp on the outskirts of Diyarbakır, Türkiye. © UNFPA Türkiye/Eren Korkmaz

Lale, 22, is living with her family in a camp in Hatay, Türkiye. While she continues to wait for a tent of her own, she sleeps in a makeshift structure with her parents.

“We ran out barefoot in the rain; the babies had no jacket, no blanket,” says Lale, whose twins are six months old. “I have nothing left.”

Lale has received dignity and maternity kits with essential supplies but is still frequently running out of diapers, as well as food.

“I go to bed half full, half hungry, with my babies. We've been out in the rain too long.”

[Pictured above] Lale and her twin babies at an overcrowded camp in Hatay. © UNFPA Türkiye/Eren Korkmaz

For women and girls staying in camps, simply using the washroom can be a source of distress.

Many settlements lack adequate toilets and hygiene facilities. Adding to the problem, it can be difficult to make a bathroom trip after dark, when there is limited or no electricity.

Initially displaced from their hometown due to conflict, Salwa, 14, and Kholoud, 13, have lived for three years at the AlSekka camp in Idlib, Syria – an area affected by the earthquakes.

The two friends received dignity kits – which include supplies such as hygiene products and torches – provided by UNFPA partner Ihsan Relief and Development. “These things help us in maintaining personal hygiene,” says Salwa.

[Pictured above] Friends Kholoud (left) and Salwa look through the contents of a dignity kit. © UNFPA/Karam Al-Masri

In north-west Syria, the earthquakes are a crisis on top of a crisis.

After 12 years of conflict and human rights violations, people are living under untold strain. For many people uprooted by the earthquakes, this is yet another displacement.

“During the aftershocks, people were asking, ‘Is it a missile or another earthquake?’ If it was a mortar attack, people needed to go to the ground floor or basement; if it’s an earthquake, they needed to get out. People didn’t know what to do,” says Kinda Katranji, Communications Analyst in Syria who heard directly from women and girls affected.

[Pictured above] In the Syrian city of Maarat al-Numan, where many houses were damaged by war before the earthquakes compounded the destruction, mobile health teams are providing support. © UNFPA Syria/Massoud Hasan

Sex, periods and births do not stop during a crisis.

UNFPA has distributed tens of thousands of dignity kits and maternity kits since the onset of the crisis to women and girls in cities as well as in harder-to-reach rural areas.

[Pictured above] Dignity kits are distributed in the Sheikh Bahr camp in the countryside near the town of Armanaz in Syria. © UNFPA/Karam Al-Masri

Reports of gender-based violence, exploitation, abuse, child marriage and forced marriage have all increased following the earthquakes, at a time when services are overstretched.

In Syria, many safe spaces were damaged, like this one in Suran. So the teams went mobile, visiting women and girls at home and in temporary camps, to assess and support both psychological and practical needs.

UNFPA supports 52 safe spaces for women and girls across Syria, along with a helpline, as well as 23 safe spaces in Türkiye.

[Pictured above] A UNFPA safe space is no longer able to operate from its premises in Suran, Syria. It is among 12 safe spaces damaged in north-west Syria. © UNFPA/Karam Al-Masri

Hayfem and her husband and five children are Syrian refugees living in Şanlıurfa, Türkiye. They are sheltering in their vehicle, which they have parked at an outdoor bazaar for safety, along with other families.

A team dedicated to supporting migrant women and young people has mobilized to meet people’s needs following the earthquakes. The team includes psychologists, nurses and social workers.

[Pictured above] Hayfem and family have moved into their vehicle for safety. © UNFPA Türkiye/Eren Korkmaz

Mobile teams have also brought maternity services, including postnatal check-ups, to the camps.

Cahide gave birth shortly before the earthquakes struck. After being displaced, she arrived at a temporary camp in Şanlıurfa, where she was provided with a tent and received a medical check-up and maternity kit.

Across Türkiye and Syria, 60 mobile teams and 60 static clinics provide reproductive health and protection services, including emergency obstetric care, to some of the hardest-to-reach women and girls.

[Pictured above] In Şanlıurfa, Türkiye, UNFPA’s mobile team visits Cahide, who gave birth just before the earthquakes. © UNFPA Türkiye/Gözde Kumru

Baby Hala was born at Idlib Maternity Hospital in Syria. Her mother, Fatima, went into labour early.

“There are premature births due to anxiety, terror and psychological exhaustion that pregnant women experienced because of the earthquake,” says midwife Suad Muhiy-Aldeen. “There are cases of children with a very low weight.”

Hala was monitored in an incubator for the first few days of her life and thankfully now is healthy.

UNFPA-supported facilities have supported more than 1,350 safe deliveries and 400 C-sections in north-west Syria since the earthquakes.

[Pictured above] Fatima and her newborn daughter, Hala, at Idlib Maternity Hospital, run by the Syrian American Medical Society and fully funded by UNFPA. © UNFPA/Karam Al-Masri

Six days after the earthquakes, in the countryside around Aleppo, Syria, Khawla gave birth to quadruplets, who were all delivered safely at Al Fardous Hospital in Daret Azza.

Dr. Bushra Al-Khattab, who was trained by UNFPA, performed the Cesarean section.

As part of an inter-agency response, equipment and supplies have been delivered to health facilities, including equipment for C-sections.

[Pictured above] Khawla’s quadruplets are delivered by Cesarean section at Al Fardous Hospital, run by Syria Relief & Development with support from UNFPA.  © Ahmad Aljarban, SRD/UNFPA

“My joy is indescribable,” says Khawla. “I received services in this wonderful hospital for free. I thank the organization, the hospital and the medical staff for the services they provided me with and the warm welcome.”

The 25-year-old mother and her two older children, who are two and three years old, had been displaced by the earthquakes before she gave birth to her quadruplets. Khawla will be returning to tented accommodation – now with six children – and with uncertainty about what the future holds.

[Pictured above] Khawla with her four newborn babies. © Ahmad Aljarban, SRD/UNFPA

The immediate rescue efforts may be over, but there is still so much more that can and must be done.

With more clinics, mobile health teams, safe spaces and supplies, UNFPA can reach every woman and girl in need, but funding appeals for Türkiye and Syria remain woefully under target.

With additional funding, UNFPA will do whatever it takes to make sure that women affected by the earthquakes can give birth safely, manage their own reproductive choices, and live free from violence.

[Pictured above] UNFPA provides support at a temporary camp in Şanlıurfa, Türkiye. © UNFPA Türkiye/Eren Korkmaz

Meet Natasha, 21. On 27 February 2022, she walked for 12 hours in freezing temperatures to seek safety, with her three-year-old in tow. She was seven months pregnant.

It was just three days into the full-scale Russian invasion, and her home city of Kharkiv was a major target.

Natasha fled, first by over-crowded train, then by taxi, before heading to the Moldovan border on foot. “Nobody cared that I was pregnant and tugging my daughter along. I can’t be angry at those who didn’t stop for us though. Most of the cars were full.”

She made it to a refugee camp in Moldova, then to a hospital in need of emergency prenatal care, where UNFPA supported her.

© UNFPA Moldova/Eduard Bîzgu

A year of relentless bombardment across Ukraine has caused appalling human suffering.

Nearly a third of the population – roughly 14 million people – have been forced to flee their homes since Russia launched its full-scale invasion of Ukraine on 24 February 2022.

© A still from the documentary Lust for Life, about women who have given birth during the war.

As men who are eligible for military service are required to remain in Ukraine, the refugee crisis is overwhelmingly a migration of women and children.

Here, on 12 March 2022, women who have said goodbye to husbands, partners, sons and other loved ones cross the border with young children – wrapped in aluminum blankets for the journey – to seek safety across the border in Moldova.

UNFPA provides safe spaces for the protection of women and children, and access to essential services.

© UNFPA/Siegfried Modola

Refugee camps were set up overnight, including this one at the Manej Athletics Sports Centre in Chisinau, Moldova, which housed 650 people while longer-term solutions were sought.

UNFPA was on site to provide information, supplies and services.

© UNFPA Moldova/Eduard Bîzgu

Pregnancies and births do not stop during war. Family-planning needs do not stop during war. In fact, these services become even more vitally important so that women can give birth safely and make decisions about their reproductive health amid the crisis.

Dariya (right), from Odesa, received antenatal care in Moldova.

© UNFPA Moldova/Adriana Bîzgu

Dr. Tetyana Postolovska works in Vinnytsia from one of UNFPA’s mobile reproductive clinics.

There are currently 20 mobile clinics across Ukraine – stocked with medicines, equipment, contraceptives and tests for HIV, hepatitis and sexually transmitted diseases. They were set up in April 2022 to meet the needs of internally displaced people.

“The number of miscarriages have increased by 10 to 15 percent compared to the pre-war period,” says Dr. Postolovska, an obstetrician-gynecologist. "We need to be as accessible to people as possible…and every family [should have the] chance to give birth to a healthy child at the expected time.”

© UNFPA Ukraine/K. Hryshko

Over the past year, UNFPA has delivered reproductive health supplies and equipment to hospitals and mobile teams sufficient to cover the immediate reproductive health needs of 7.2 million people.

Here, in April 2022, a humanitarian cargo delivery of UNFPA emergency reproductive health kits arrives at a maternity hospital in Dnipro.

© UNFPA Ukraine/Mark Kachuro

Valentina, 29, during labour at Chisinau’s Municipal Clinical Hospital No. 1 in Moldova on 1 March 2022.

A few days earlier, a heavily pregnant Valentina, who is a veterinary surgeon, urgently drove herself and her mother from the Ukrainian city of Odesa in search of safety. They found shelter with a local family across the border.

“I regret that my husband is not close with me,” she says, noting that this is her first child. “We planned this moment for a long time and dreamed it would be different.”

© UNFPA Moldova/Eduard Bîzgu

In 2021, there were just over 270,000 births in Ukraine. In 2022, this fell to 195,000, due to the war and with many women leaving the country. All women, no matter where they are, must have access to safe births.

Nataliia’s son Artem was born three months prematurely. Mother and child required care at Kyiv’s Perinatal Centre, which has received emergency medical supplies from UNFPA.

“He was so very tiny, [just] 1.6 kilograms — I am afraid to hold him and hold his hand because he is fragile and very small,” says Nataliia.

© UNFPA/Serhii Tymofieiev

Dr. Olena Samoilenko is head of the neonatal department at Mother and Child Medical Centre in Kyiv.

Despite attacks on more than 760 health facilities — including maternity hospitals — during the past year in Ukraine, she has stayed on to provide the specialist care that pregnant women and new mothers and babies need.

Almost a third of the 195,000 women who gave birth in Ukraine in 2022 delivered at maternity facilities supported by UNFPA.

© UNFPA/Serhii Tymofieiev

From safe births to safe spaces, UNFPA works around the clock to sustain life-saving services for women and girls.

At a Safe Space for women who have experienced violence in Lviv, Ukraine, a basement has been converted into a bedroom, supporting women who need a refuge from violent partners and those who have experienced physical and sexual violence carried out by soldiers.

For these women and their children, they need qualified, sensitive support to deal with a crisis within a crisis.

© UNFPA Ukraine/Oleksandr Sorokin

For Kateryna, the war brought her back into contact with her ex-husband.

“When the war started, people started to get closer. My ex-husband began to visit our child,” she says. “Violence returned to our lives.”

The city of Kherson was under Russian military control at the time. “I was afraid to leave the city,” she says. “We had strengthened the basement, plastered it. We were preparing to spend the winter in the city. The crisis that forced me to evacuate was domestic violence.”

Kateryna and her three children are receiving protection and support in a UNFPA-supported Safe Space.

© UNFPA Ukraine/Volodymyr Ovsychenko and Anastasia Saprykina

“Puss in Boots” and a story about “Fluffy and Stripey” are among the books on hand for children at the Safe Space in Lviv.

UNFPA has established more than 48 centres for survivors of violence and women at risk across Ukraine, including shelters, crisis rooms, a national hotline and more than 100 mobile support teams.

© UNFPA Ukraine/Oleksandr Sorokin

While UNFPA provided safe spaces and refuge for thousands, we were aware that many other people remained trapped in occupied areas – including in Mariupol, where civilians and soldiers took shelter in underground bunkers at the Azovstal steel plant for 80 days.

In May 2022, survivors evacuated the steel plant. Here, families leave the plant and head to Zaporizhzhia.

UNFPA was there to greet and support the evacuees, providing four psychosocial support mobile teams and 750 essential packs to help women and girls with basic needs.

© UNFPA Ukraine/Olha Opilat

Initiatives supported by UNFPA are helping people deal with the invisible scars of war.

“Art helps us all to cope with our pain, the injustice of losing friends and normal life,” says 18-year-old Sabina (seated, second from right), who is from Melitpol, a city which remains under Russian occupation.

Sabina is a youth volunteer at a youth centre in Gratiesti, Moldova, supported by UNFPA.

“I am not the only one who lost friends or family in the war,” she says. “Many of the young refugees here are struggling with stress and depression.”

© UNFPA/Siegfried Modola

Psychologist Victoria Semko has returned to Irpin, and is helping to re-establish community connections.

"When I first came back to Irpin, it was scary. There were shot cars and burnt tanks on the streets. The city was emptied. Absolutely everything was different. The city seemed like a ghost,” she recalls.

“I took matters into my own hands and started a psychological support group. Later, I was invited to work in the UNFPA socio-psychological assistance mobile teams." says Victoria. 

She describes supporting people through immense psychological pain, including a woman who was unaware the city had been returned to Ukrainian control, as she had remained in hiding, traumatized by the atrocities she had seen.

“It is extremely pleasing when I see positive changes in the people I work with," says Victoria.

© UNFPA Ukraine/Roman Buchko

A big wedding, a house by the sea and a family business. These were Anastasiia’s plans before the war.

In March 2022, Anastasiia left Berdyansk, as she could not access the prenatal medical care she required in the occupied city.

She gave birth to twin boys in June 2022. “We had to endure so much,” she says. “My sons have withstood everything. We must stay strong for their sake. Because children are our future, they replace those who, unfortunately, passed away.”

With the conflict ongoing, UNFPA continues to invest in vital services to protect women and girls from violence, and to ensure they can make their own reproductive decisions, access safe births and fulfill their potential.

© UNFPA Ukraine/Eugen Hoptynskyi