Jamila was 24 when she found out she was pregnant with her first child. She was planning to deliver the baby at home, like most of the women in her remote village of Alshraqi in Yemen’s Hajjah Governorate.

But in her eighth month, she started to feel pains in her abdomen. There was no local gynecologist who could examine her and the nearest hospital was 9 miles (14km) away.

“The pain was unbearable. I felt like I was going to die, but I was determined to deliver at home. It was too far to travel to a hospital and we could not afford the cost of hiring a car,” she recalls.

Hiring a car would have cost Jamila 20,000 Yemeni rial (about $80). Since the outbreak of the civil war in 2015, her husband’s work as an unskilled laborer had dried up and the cost of petrol had skyrocketed.

After four days, the pain wouldn’t stop and Jamila knew she had to get to a hospital. Her husband managed to borrow the money from a neighbor and they traveled to al-Jumhori Hospital in Hajjah city. When they arrived, she was told that she needed an emergency cesarean section and was operated on immediately.

Yemen is one of the poorest countries in the Middle East, with one of the world’s highest rates of maternal mortality. In 2015, 17 percent of deaths among women of reproductive age were caused by complications during pregnancy and childbirth. Almost 70 percent of women living in rural areas deliver their babies at home without a midwife.

The main drivers of the high rates of maternal death are poverty, limited access to healthcare services and lack of awareness among women of the importance of having a certified midwife during childbirth. But the situation has worsened with the civil war, as it’s more difficult for women who need medical care to access it.

“In times of crisis, whether women live or die often depends on whether they can get basic sexual and reproductive health services. The needs are rising almost daily but the capacities and funds to meet them remain limited,” says Abdullah al-Hadad, reproductive health coordinator for the United Nations Population Fund (UNFPA) in Yemen.

Since the outbreak of fighting, more than 274 hospitals have been damaged or destroyed and, according to the World Health Organization, fewer than half of the medical facilities in the country are still functioning. Of these, only 37 percent provide a full package of healthcare services, including antenatal and post-partum care, safe delivery and emergency obstetric care.

Hospitals that have escaped damage face shortages of critical medical supplies, insufficient staffing and the persistent threat of airstrikes. Dr. Essmah al-Absi, a gynecologist at al-Jumhori, says that the hospital now depends on the support of NGOs such as Doctors Without Borders to keep its doors open.

“The government has stopped paying salaries for health workers. These agencies are helping us to stay at work and save lives,” he says. But the aid is not enough to meet the needs of patients. Because of a lack of essential supplies and medicines, doctors at al-Jumhori are forced to refer critical cases on to bigger hospitals in the capital Sanaa.

Sawson Wehaan, a midwife at al-Jumhori, has seen a rapid increase in the number of maternity patients at the hospital due to the influx of internally displaced people who have fled from neighboring governorates where airstrikes have intensified. “We have to refer patients to other hospitals, which delays the treatment for the patient and increases the costs they have to face. Most of the patients really cannot afford it,” she says.

Last year, UNFPA reached 500,000 people with mobile reproductive health clinics and provided equipment to nearly 200 facilities, including al-Jumhori. But the worsening security situation and damage to infrastructure have made it difficult to access communities in need. It estimates that more than 50,000 women will have an increased risk of death during childbirth in the next nine months because of a lack of available care.

Now back home with her son, Jamila knows how lucky she was to get the life-saving C-section at al-Jumhori. “I got full care and attention in the hospital during and after delivery. I was really worried but thanks be to God, my baby and I are doing well,” she says.

“I hope that services will be made available in areas like my village someday, but mostly, I wish for this long and sad war to end.”

This is the first in a three-part series on women in Yemen.