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The Syrian conflict hasÌý"severely impacted the availability of and access to sexual and reproductive health services", disproportionately impacting women and girls in the northwest, a report said Tuesday.

Women and girls are also more likely to "feel the effects of attacks on health care" throughout the war, which is about to enter its 13th year.

The report was compiled by aid and campaign groups including the International Rescue Committee (IRC) and Physicians for Human Rights.

"Twelve years of impunity for attacks on health care have exacerbated a sexual and reproductive health crisis in Syria," said Houssam al-Nahhas, co-author of the report released by four groups.

"The fundamental human right to health -- including being able to deliver a baby safely, to bring new life to the world -- has been routinely violated in northwest Syria, where bombs have rained down on hospitals."

A devastating earthquake that killed tens of thousands in Turkey and Syria last month only accelerated "the collapse of the fragile health care system" in the war-torn country's northwest, the groups said.

A surge in displacements and damage to infrastructure and limited health services "will likely impact as many as 148,000 pregnant women, 37,000 of whom are due to give birth in the next three months", they added, citing United Nations figures.

The IRC's Syria country director, Tanya Evans, said the report showed "the disproportionate impact the conflict continues to have on women and girls in northwest Syria".

- Bombings and kidnapping -

Even before the quake, women in northwest Syria reported that "fear or experience of bombings, kidnapping, or exploitation all undermine their ability to access health clinics, leaving them without care" or reliant on informal services, according to the report, which surveyed more than 260 health workers and patients.

"A high number of pregnant women" avoid pre-natal care and prefer to undergo caesarean sections instead of a natural birth in part "to reduce the time spent inside a health care facility", it added.

Only seven percent of the region's 367 functioning medical facilities offer comprehensive maternity care, and fewer than 40 percent offer outpatient reproductive health services, according to the report.

Hospital overcrowding results in "significant gaps in maternal and newborn services", it added, while the violence has contributed to a shortage of midwives and gynaecologists.

Human rights groups have accused the Syrian government and its ally Russia of deliberately targeting medical facilities in rebel-held areas, a claim both Damascus and Moscow have denied.

A ceasefire agreed in 2020 by Russia and Turkey has largely held in Syria's northwest, despite periodic clashes.