— LONDON -- Every morning, Fatima Mustafa boils rice for her 1-year-old daughter to eat for breakfast. Once in a while, she’ll have a little bread that she’ll give her as well, along with a cup of tea. “I don’t want her to be hungry,” Mustafa, a mother of two, told ABC News. She breastfeeds her youngest daughter, a newborn, but says it’s not enough.
“I have to eat and get nutrition before I can breastfeed properly. My youngest daughter is not getting full from my milk and there is no milk in the stores,” Mustafa said. “I feel disappointed and depressed because I am unable to secure the most basic rights for my children like food and diapers, and the reason is the conditions we live under because of the horrible war.“
The family lives under siege in east Aleppo, where many mothers have little or no access to basic products such as baby milk and diapers. When Mustafa first ran out of diapers two months ago, she didn’t know what to do. Today, she takes her husband’s old undershirts, cuts them into the right shapes and uses them as diapers for her daughters, 1-month-old Raha and 1-year-old Masa. She then washes the dirty cloth by hand -- with soap because laundry detergent isn’t available -- and reuses them.
Shortages of Key Supplies
Six months ago, 486,700 people in Syria lived under siege, according to the United Nations. Since then, the U.N. estimates that the number has doubled. Today, nearly one million Syrians, about half of them children, are living under siege, which is imposed mainly by the Syrian government and its allied forces, according to the U.N. Some besieged communities have barely received any aid in almost two years. In addition to the dangers of bombardments, residents live with little access to food, water, fuel and healthcare. For many mothers with infants and toddlers, this means that they have to find alternatives for diapers and milk.
“There have been quite a lot of shortages of baby formula both in Aleppo and other besieged areas in Syria,” Misty Buswell, Save the Children's regional advocacy director for the Middle East, told ABC News. “Even when formula is available, a lot of time it is being diluted, which can also lead to diarrhea and malnutrition.” Other times, the bottles aren’t sterile and the formula is mixed with contaminated water, which can also make the babies sick, she said. Save the Children has also heard reports of baby formula being removed from aid convoys going to besieged areas -- but it is not clear who is removing the baby milk and why, said Buswell.
Even before the war, only about 43 percent of Syrian mothers were breastfeeding exclusively for the first six months of their infants' lives, which is the recommended time, said Buswell. Today, more mothers struggle with breastfeeding.
“If women are malnourished, they might not think that it’s possible to breastfeed,” Buswell said. “Even in the best conditions, breastfeeding for the first time can be very difficult. In siege conditions, without enough medical support and without enough nutrition, it’s even more difficult.”
As a substitute for breastfeeding, when no formula is available, women sometimes give the babies water mixed with sugar -- or milk from goats and cows, which isn’t sanitary.
Maha, a teacher and mother of five in the besieged opposition-held part of Aleppo, has some baby milk but few diapers left for her youngest children, a 3-month old and a 1-year-old. So she uses women’s sanitary pads with the diapers.
“That way, they will last longer,” Maha, who didn’t give her last name, told ABC News. “But many other mothers ran out of diapers a long time ago.”
Malnutrition Is Widespread
Around 200 miles away, in rural Damascus’ besieged rebel-held city of Douma, mothers are facing similar struggles.
Ulla, a 24-year-old mother with three young children, breastfeeds her youngest child, a 1-year-old daughter. But after a recent miscarriage, she’s been feeling weak and dizzy after breastfeeding, she said.
“It’s difficult to breastfeed. My body is very tired,” Ulla, who requested that her last name not be published, told ABC News. “I get dizzy and tired easily after what happened. But if I stop breastfeeding, what will I give my daughter? We don’t have milk now and very few meals.”
She says her children have been getting rashes from the pieces of fabric and old clothes she uses as diapers because she doesn’t have any disposable ones left. The water she uses to wash the cloth is not very clean, and they don’t always have water at home. So sometimes she has to wait for her husband to come home with water pumped from a tube well outside.
The only way to heat up the house is with firewood, but this year the wood is more expensive than usual and they can’t afford it, she said -- Ulla doesn’t have a job. Her husband worked as a mechanic before the war but is currently unemployed. At the same time, their house has been damaged from four attacks, she said. They have sealed the windows and door with silicone, but every time there is an airstrike nearby, it falls off, the house gets colder and they have to reseal it. The children get sick often and easily because their house is cold and she can’t give them nutritious food, said Ulla.
“I wish I could change this situation for my children,” she said. "I was hoping they would have a better life than this. I feel very sad that I can't bring them the things I was dreaming of and that I can't protect them. Sometimes I just feel like sitting by myself and not seeing anyone because I'm so sad."
Amal, another resident of besieged Douma, has five children -- two teenage sons, an 11-year-old, a 7-year-old and a 1-year-old. She says there's a huge difference between being a mother now compared to before the siege, which was imposed in 2013. When her 7-year-old was a toddler, she had disposable diapers, milk and a washing machine for dirty clothes. Today, she uses old sheets as diapers and washes them by hand because there’s no electricity. She has little access to baby milk.
"My children’s bodies are tired and I'm tired," Amal, who didn’t want her last name to be published, told ABC News. “I breastfeed my youngest son, but his body is weak. He gets infections and a fever easily and medicine is expensive. I wish I didn’t have this son because he’s suffering a lot.”
She said she doesn’t think her milk is nutritious because she doesn’t get enough vitamins. Some fruits and vegetables are available, but they are very expensive because of the siege, especially in the winter. One day, she bought a banana for her 1-year-old son. He kept having diarrhea and some friends told her that feeding him banana would help. It cost around 700 Syrian pounds, approximately $3. For that price, she said, she could have bought more than two pounds of rice, enough to feed the whole family.
“When the other children saw the banana they wanted bananas too, but I can’t afford that,” she said, adding that she was forced to only feed her other children bread with olive oil and thyme that day.
Her husband was a construction worker before the war but he can no longer find work. She has started to work as a seamstress to provide for the family but her income varies from day to day. Some days she has no customers at all.
"On a good day, we can have two meals -- either breakfast and lunch or breakfast and dinner," she said. "Other days we only have one meal at around noon.” She added that on days with little or no income, the family’s diet consists of only tea and bread.
In besieged Madaya, a small rebel-held town surrounded by government forces in the countryside of Damascus, an estimated 40,000 residents, mostly women and children, live in hunger. Some there have starved to death.
Syria's most vulnerable: Kids caught in conflict
Hala, a mother of two and one of Madaya’s residents, tries to feed her baby daughter rice because she doesn’t have enough baby milk, she said. When her 12-year-old daughter was an infant long before the siege, she was able to breastfeed her, but now she has very little milk for her youngest daughter who does not get full even after 30 minutes of breastfeeding. Hala said that her own body is very weak, but that her daughter’s health is even worse.
“My daughter is getting weaker and weaker in front of me and I can’t do anything,” Hala, who didn’t give her last name, told ABC News. “I can’t give her the nutrition she needs like any other child so that she can grow in a normal way like her older sister did.”
Some pregnant women in Madaya are so desperate that they try to self-abort.
About a year ago, Salimeh, 25, a resident of Madaya, started feeling dizzy and weak. In a short amount of time, she lost 50 pounds, she said. When she didn’t get her period for three months she assumed it was because of malnutrition. That happened to many women in Madaya, she said, because they have so little food -- mainly rice and bulgur, almost no vegetables or proteins. But when she started to feel an intense stomach ache, she went to see the local midwife.
“She told me that I was pregnant,” Salimeh, who didn’t give her last name, told ABC News, adding that she doesn’t have access to birth control. She didn’t want to keep the baby but also couldn’t get medicine that would induce an abortion or see a doctor who could perform the procedure. The three doctors at Madaya's only hospital are a veterinarian and two dentists who haven't graduated yet and there is little medical equipment, said Muhammad Darwish, one of the two dentists at the hospital. So Salimeh looked for alternatives.
“I tried to jump from high places to get rid of the baby because of our situation and how difficult it is,” said Salimeh.
But she didn’t lose the child. Many babies in Madaya are born unhealthy or with deformities because their mothers are malnourished, locals and charities say. Some are born prematurely and die right after the birth. So when Salimeh gave birth to a healthy 7-pound boy three months ago, she was surprised.
“I was surprised that he was in really good health,” she said. ”But unfortunately, I wasn’t able to breastfeed my son because I didn’t get milk at all due to malnutrition. And I had no formula milk I could give him to make sure he wasn’t hungry.”
She now has a little baby milk but not enough. So sometimes she gives him milk, other times boiled rice with sugar. She says the boy is getting sick from the lack of nutrition.
“It’s very important to me that my son is healthy and healthier than me,” she said. “I was very tired and suffered for nine months and tried to abort this child. But I don’t ask about my own health because it doesn’t matter to me as much as my son’s health. I wish to see my child healthy because then I will be fine.”
Mona, 23, a newlywed, is two months pregnant and says she is trying to do everything she can to lose the baby.
“I’m jumping from high places, pumping water from the well, doing physical work that men aren’t even doing because I want to lose the baby, but it hasn’t happened yet,” she told ABC News. She said she went to see one of Madaya's doctors and asked for any type of medicine that could help induce an abortion. The doctor told her to get a drug called Cytotec, which Mona hasn’t been able to find in Madaya. She's tried to get it from smugglers or anyone who might be coming into town but so far has failed, she said.
“I am still hoping that I will lose the baby,” she said. “I don’t want to live through the suffering that other mothers have had to live through. Often, children are stillborn or deformed. I am scared to have a baby that I will not be able to give a good life because of the siege. I have suffered and I don’t want my child to suffer.”