Horeh was five months pregnant with her second child when an airstrike destroyed her uncle's house in the Amran Governorate in western Yemen.
"It was very loud," the 30 year old remembers. "The explosion was very close." Then she heard the screams of women in the neighborhood. "I heard my neighbors outside shouting that my family had been hit. My brothers came to my house with blood on their faces and hands. They told me my uncle's house had been destroyed and a whole innocent family killed. "
Terrified and in shock, Horeh began bleeding. The next day, she miscarried.
For the last two years, Yemen has been in the throes of a brutal civil war between the US and Saudi-backed Yemeni government and Houthi insurgents. According to the UN, at least 13,000 civilians have been killed in the conflict. Thanks to a naval, land, and air blockade imposed by Saudi Arabia, 18.8 million people currently need food assistance, and more than 7 million people don't know where their next meal will come from.
In a country that is being slowly starved and bombed to death, pregnant women and children are among those suffering worst.
"The healthcare system has completely collapsed, and mothers and children are becoming sick," explains Dr. Mariam Aldogani, a reproductive healthcare specialist employed by Save the Children in the capital of Sana'a. As a result, pregnant women are dying or losing their babies for entirely preventable reasons.
"Before the conflict, the majority of pregnant women had normal deliveries. Now, many women give premature birth or have cesarean sections," says Hanan Saleh, a 33-year-old midwife. "Pregnant women usually attend at our clinic with multiple complications—top of which are bleeding, vaginal and urinary infections, high blood pressure, oedema [fluid retention], thalaessemia [a blood disorder], and anemia," she explains.
Malnutrition is a major problem, causing women to miscarry or deliver low birth-weight babies. Aldogani says that her colleagues in remote rural areas often meet families subsisting on one meal a day, which has caused pregnancy complications to increase. By the time the family scrapes together the money to travel to a medical facility, it's often too late. "It feels especially depressing when a woman arrives at our clinic in a critical condition and her family cannot take her to a hospital because they do not have money," Saleh explains.
According to Aldogani, Yemen's health care system is also in a state of crisis: Doctors in government hospitals haven't been paid for over six months. Instead, they must drive taxis to put food on the table, meaning that hospitals are even further understaffed.
The conflict in Yemen began in 2011, during the Arab Spring. In the wake of Tunisia's uprising, Yemeni protesters called for the removal of authoritarian president Ali Abdullah Saleh, who is thought to have stolen up to $60 billion through corruption while in power. Saleh's deputy, Abdu Rabbu Mansour Hadi, took over as president in 2012, but Hadi's government has been beset with difficulties. Parts of the military remain loyal to Saleh, while food shortages and unemployment destabilized the country. In the north, a Shia Muslim-led Houthi movement took advantage of the situation to seize territory and took control of Sana'a, causing Hadi to flee abroad in 2015.
Since then, a Saudi-led coalition of Arab states has aimed to restore Hadi to the presidency. The US, UK, and France have backed this campaign, despite UN warnings that attacks carried out by the military coalition "may amount to war crimes." While the Saudi UN ambassador has denied the allegations, a leaked UN report found evidence of "widespread and systematic" Saudi-led bombing attacks on civilian targets in contravention of international humanitarian law.
Twenty-five-year-old Arwa has miscarried twice since fighting broke out. "The first time doctors told me it was because of an infection," she says. At the time, Arwa had toxoplasmosis, a parasitic disease that has become common among pregnant women in Saa'na. The last time Arwa miscarried, it was because she didn't have enough food to eat. When they have money, Arwa, her husband and their three daughters eat tomatoes and potatoes. Most of the time, they can only afford bread and tea.
"The last miscarriage happened while I was in the house and I was bleeding badly," Arwa remembers. "I could not go to the health facility because I didn't have any money to pay for transport." Knowing that her husband was under huge financial pressure, Arwa stayed silent. He was eventually able to take her to a clinic, but it took five days to raise the funds necessary. Arwa miscarried anyway.
"After the miscarriage I spent five days lying on the bed, not moving because I couldn't stand up and walk," she remembers. "I felt so scared, I thought I was about to die."
Malnutrition and infections such as toxoplasmosis all raise the risk of miscarriage—but women in Yemen also have little control over their own reproductive choices, as contraception is scarce (Aldogani says there is a "huge shortage" of supplies, particularly of long-acting contraceptive implants).
Just months after losing her last baby, Arwa is pregnant again—and understandably terrified for the future. "I'm still too thin," she says. "I feel so scared it will happen again."
Even if the pregnancy is carried to term, women still have to survive childbirth in harrowing circumstances. "When I was giving birth to [her first son] Fouad, I thought I was dying," Horeh remembers. She went into labor during an air raid in the first month of the war. "I was in extreme pain for a day and a half. They couldn't take me to the hospital because the bombardment that night was very intense and we were scared to leave the house."
Terrified of the bombing, Horeh gave up. "I told them I would stay inside whether I lived or died." Amidst the chaos and the panic, an untrained neighbor came to her aid. "She wasn't really a midwife, she was just an old woman," Horeh says. "No one else agreed to come. But she was kind and calm."
There is little help available post-birth for the fortunate mothers and babies that make it through childbirth. "In one hospital," Aldogani recounts, "I saw babies sharing incubators because there weren't enough to go around. In some hospitals, there aren't any incubators at all."
Aldogani speaks from personal experience. She was 32 weeks pregnant when she went into premature labor during an airstrike in September 2015. If she hadn't been able to afford private healthcare, her baby would certainly have died.
"I thank god everyday that my baby is safe," she says tearfully, "but I can tell you, I know how it feels to be a pregnant woman in Yemen. She's afraid she will lose her baby, and she's afraid of what will happen to her kids if she dies." She tells me there are two types of women in Yemen: those who've lost babies because of the war and want to conceive again to lessen their loss, and those who are too scared.
"Personally," Aldogani tells me, "I don't want to get pregnant again until the war stops, because of the suffering. It's too much for my blood pressure."
And all across Yemen, you'll find deeply traumatized children who have only ever known war and hunger. At night, Horeh's son Fouad screams at loud noises, fearful of planes flying overhead. It is a brutal but appropriate fear for a child born during an airstrike.
Adults struggle with the terror of the bombings, too. Horeh says that her partner has become abusive: "My husband used to be nice to me, but the war has changed him... Sometimes he hits me. I get very frightened of him."
Unable to turn anywhere else for help—her father is blind and her brothers, all unemployed, have their own families to look after—Horeh is trapped. "Sometimes I go back to my husband," she says, "and try to endure the screaming and violence just so my family won't have to worry about me and my son."
Meanwhile, Aldogani has turned from medical science to prayer. "When I see a pregnant woman now," she says, "I pray she gets a safe delivery for her and her baby."