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One year has passed since the utter devastation wrought on February 6��when the deadliest earthquake in the region's modern history struck southern Turkey and northern Syria.

Millions of families and children are still struggling to rebuild lives left in tatters since that day.

For millions of Syrians, who had endured over 12 years of brutal war unleashed on them by the regime and its Russian ally, they awoke that dawn to a new chapter of their tragedy.

The magnitude-7.7 earthquake struck at 4.17 am and was followed just hours later by another magnitude-7.6 quake, as well as hundreds of aftershocks. The impact of the earthquake wasn't limited to the thousands of lives lost and properties destroyed.

It has also created new long-term challenges to recovery and resilience in the region, in light of the fragile infrastructure; weak response mechanisms, lack of recovery initiatives; and continued military attacks.

This is compounded by the exhaustion of the already struggling medical sector as it faces heightened challenges posed by the spread of disease and epidemics.

"Millions of families and children are still struggling to rebuild lives left in tatters since that day"

Rising gender-based violence and early marriage

In addition to all this, scores have been left homeless. One year on, hundreds of thousands of women and girls are still stuck in overcrowded informal displacement camps, with limited access to reproductive health and protection services and scant privacy, where the risks of gender-based violence, exploitation, abuse and early marriages have increased significantly.

Grief etched onto her young face, teenager Amal Al-Hassano (14), recalls the earthquake, through which she lost her entire family: she was the only survivor.

"Those moments were terrifying, it was pitch black and cold. In seconds my life turned into a tragedy of loss, and pain. I could hear the moans of my brothers and parents under the rubble. I felt like we had all died. But I didn't ever expect that I would survive by myself – to face the torture of being alone after the deaths of my parents and four brothers."

Today, Amal lives with her uncle's family in an IDP camp in Deir Hassan in northwest Syria, after her family home in Harem city was destroyed in the earthquake.

Though a year has passed, she has been unable to move on and acclimatise to her new life – especially as she has been forced to stop attending school.

This is because the camp she lives in with her uncle is four kilometres away from the nearest school and she can't walk that distance daily by herself. Instead, she is awaiting her upcoming marriage to someone her uncle has chosen. ��

Amal has no idea what married life will entail, and she was not given the right to any say in the matter, as her uncle thinks he knows "what is in her interests," she says.

She says she is still suffering deeply from her loss and the absence of her family, despite a year having passed since the earthquake.

Situations like Amal's are widespread and their increase is linked to the earthquake, which cast its shadow over the region one year ago, imposing a reality which has restricted the future of many girls and teenagers to early marriages – stealing from them their childhoods and rights to education.

Loss of childhood

Another particularly vulnerable group whose lives were shattered in the wake of the earthquake are children. Many lost family members, or their entire families, and loved ones, and witnessed their homes, schools and local communities obliterated – turning their young lives upside down.

"Today, the children languishing in the informal IDP camps have simple dreams. All 10-year old Haneen Mar'i wants is to live in warm and dry conditions, rather than a tent which leaks when it rains, leaving her blankets drenched"

Around 3.7 million Syrian children need ongoing humanitarian assistance, and face extremely challenging living conditions in light of the loss of their homes and the realities of life in the camps.

These include difficulties accessing education (or being capable of learning if education is available); having to leave school to work to support themselves and their families, and lacking the most essentials of normal life like food, parental care, and time and space to play and have fun.

Today, children languishing in the informal IDP camps have simple dreams. All 10-year-old Haneen Mar'i wants is to live in warm and dry conditions, rather than a tent which leaks when it rains, leaving her blankets drenched. Haneen, who lost her leg after her house collapsed on top of her and her family during the earthquake, wishes for an end to the hardships of life in the camp.

As though talking about an impossible dream, she says she used to want to be happy and complete her education – which she had to stop after moving into the camp – but now all she wants is to go back to a normal, calm, and safe life.

Raw'a Al-Jabali (9) struggles to sleep after having witnessed the collapse of other houses around her, and the deaths of many who had lived in her neighbourhood, which has left her traumatised. ��

"I have had nightmares ever since that day. I don't like to remember that terrifying night," she says. Now, Raw'a lives in an IDP camp, due to her house being partially damaged. Despite the deprivation in the camp and the difficulties of life there, she sees the tent they live in as a haven after what she saw that day.

Risks around pregnancy and childbirth

Though the destruction left in the wake of the earthquake undoubtedly impacted everyone in northwest Syria, there have been additional consequences for women – especially about pregnancy and reproductive health.

According to the UNFPA (United National Population Fund) aside from killing over 50,000 people, and the extensive damage to basic infrastructure in both Turkey and Syria, the 6 February earthquake had added repercussions for pregnant women.

Around "133,000 pregnant women, as well as breastfeeding mothers, and menstruating girls" in northwest Syria, are struggling to access vital healthcare services due to the dire state of the health sector, which was lacking incubators, medicines and staff even before the earthquake.

"Idlib maternity hospital's administration, which is supported by SAMS (the Syrian American Medical Society) stated that between 5-10% of premature babies were dying due to the lack of access to incubators and ventilators"

These issues have been majorly exacerbated. The UNFPA estimated that around 6,600 of these women would suffer complications in pregnancy and childbirth.

The number of miscarriages and threatened miscarriages registered at Idlib's maternity hospital, since the earthquake, has been 122. There have also been 56 premature births. All of this is happening against a backdrop of poor facilities, with a stark lack of essential equipment in maternity centres across the region. ��

Idlib Maternity Hospital's administration, which is supported by SAMS (the Syrian American Medical Society) stated that between 5-10 percent of premature babies were dying due to the lack of access to incubators and ventilators.

Since being pulled out from under the rubble of her home, Manal Al-Hamido (26) has had problems with pregnancy and childbirth. She lost her first unborn baby shortly after the earthquake, and she has suffered a string of miscarriages since. She believes this is due to the unsanitary and unsafe living conditions in the IDP camp she has lived in since.

Dark days ahead for Syria's earthquake-hit northwest

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Raw'a has had similar problems. She was sleeping when the earthquake struck and woke up to pitch darkness, unable to move.

"In those moments, I couldn't breathe, death surrounded me and my husband on all sides, and we couldn't move. The few hours I spent under the rubble felt like an eternity until the civil defence teams pulled us out – and we could breathe once more...we were still alive."

Raw'a was pulled out with two broken feet, but the only thing that concerned her was her unborn baby and that it would survive. However, she soon miscarried, in the fourth month of her pregnancy. After her health improved, she and her husband went to one of the shelters where families impacted by the earthquake were placed, and from there, they went to an IDP camp.

She has become pregnant again three times, but miscarried every time, after just a few months. She doesn't know the cause but puts it down to the camp conditions, as well as the lack of security, privacy and medical care.

Iman Al-Jundi is a doctor specialising in women's diseases. She says the danger of miscarriage and premature births in northwest Syria among pregnant women had noticeably risen after the earthquake, adding that babies born before 34 weeks are at increased risk of health problems, and 75 percent of these births end in death.

She mentioned the dangers miscarriages and premature births can pose to the mother – rendering her more vulnerable to developing heart and arterial diseases in later life.

She attributed the rise to life in camps, where the environment was unsanitary. For instance, there were no proper sewage systems, which increased the spread of infections in women which itself led to an increase in premature childbirths. She also pointed out that the psychological state of women in the camps was dominated by fear, insecurity and unease, which was added to the material lack of food, medicines and services.

Added to these were spikes in contagious diseases and bugs – all of the above were risk factors for pregnant women, and could cause complications, including affecting hormone levels, which could induce miscarriages and early births. ��

In light of the above Dr Jundi stressed the importance of an improvement in reproductive health services and their provision, adding that mobile medical teams should be increased to provide services as well as awareness-raising initiatives focused on maternal health. In addition to this, the issue of gender-based violence desperately needs response and prevention efforts.

Mental health catastrophe deepens

The psychological toll left by the earthquake in a region where mental health resources were already depleted, and society was already mired in multiple humanitarian crises, is another story.

Psychosocial counsellor Selsabil Qaterji says over one million people in northwestern Syria are estimated to require psychosocial support.

Qaterji explained that the humanitarian crises have deepened in Syria following the earthquake, while at the same time, northwest Syria is witnessing an ongoing decline in international support, funding and donors.

She pointed out that mental health support was long neglected in the region, where around six million Syrians live. The majority of the population is below the poverty line, and there are high levels of post-traumatic stress disorder (PTSD) as well as other psychological problems which predated the earthquake, resulting from the series of traumatic experiences many in the region have endured, like displacement and asylum. The earthquake has only exacerbated people's already-existing scars and suffering.

She added that many of those who had been rescued from the rubble of their homes had been through unimaginable experiences, for instance with the crushed bodies of their loved ones beside them, and this has left enormous, deep, and continuing psychological problems, including severe depression and PTSD.

Hadia Al Mansour is a��freelance journalist from Syria��who has written��for��Asharq Al-Awsat,��Al-Monitor,��SyriaUntold�����Ի���Rising for Freedom Magazine

Article translated from Arabic by Rose Chacko