The Last Straw

How Chemical Weapons Impact Women and Break Communities

by Inji El Bakry and Tobias Schneider, February 2021
Illustration by Molly Crabapple
This story – and the story of thousands of Syrians who have been caught under punishing bombardment since the start of the country’s civil war – is the story of Umm Mahmoud. In our interviews, we found that Syrian civilians overwhelmingly preferred to remain in their hometowns – despite the constant threat of bombings and other forms of violence. Umm Mahmoud’s story begins this way.
Like many Syrians across the country, Umm Mahmoud chose to wait out the civil war in her hometown, Kafr Zayta. Despite the ravages of war, she preferred the dignity of her own home over the IDP camps on the border to Turkey.
She recalls that, “before [the chemical attack], I honestly used to say, ‘oh well, if a barrel bomb drops on us and – god forbid – we die, I still won’t go to the tents. They have no services, they have no dignity.”
So, instead of leaving for ‘the tents’, she and her family decided to move to a house on the outskirts of town, where they expected to be safe from the continuous bombings.
Our research shows that, although they are rarely active combatants, women and children are overrepresented among the victims of indiscriminate attacks – since they usually remain at home or in town during the day while their husbands, sons or fathers are out working or fighting on the frontline.
On the fateful day that would alter her life forever, Umm Mahmoud and her mostly female neighbors were sitting in front of her home, drinking tea before sunset, while Umm Mahmoud’s husband and eldest son were out filling the car with petrol. The only men around were her elderly father-in-law and her nine year old son.
At that moment, a chemical bomb dropped about 10 meters from where they sat.
Umm Mahmoud experienced one of the first of 18 recorded chemical attacks in Kafr Zayta since 2014.
At first, she did not know what had happened, why her eyes were stinging, or why she couldn’t stop coughing.
She remembers noticing a change in the color and weight of the air.
This attack on Umm Mahmoud’s hometown was only one of at least 349 confirmed chemical attacks in Syria since the start of the war.
Following the attack, Umm Mahmoud was sent to a hospital in neighboring Turkey, where she spent several days recovering in the ICU.
She did not know where her children were, or even whether they were still alive. To make matters worse, her doctor told her husband that he doubted she would make a full recovery.
One of her female neighbors, who was sitting with her at the time of the attack, died in the same ICU as Umm Mahmoud. She remembers thinking she would be next.
As she lay in her hospital bed, Umm Mahmoud felt tormented by anxiety about the future. She wondered whether she would be able to lead a normal life again and already felt like a burden to her family.
She recalls incessantly crying.
The mental stress women experience after going through a chemical bombardment reaches far beyond the immediate aftermath of an attack. And it is often amplified by concerns not only for themselves but for the well-being of their children and families.
Again and again, our interviews revealed that, even in the most resilient communities, chemical weapons are ‘the straw that breaks the camel’s back’.
Despite the steady stream of conventional bombings she had experienced before, Umm Mahmoud had remained steadfast in her refusal to leave Kafr Zayta. After the chemical attack, that changed.
She was forced to submit to a grim reality: It would be suicidal to stay in a place where the threat of a chemical attack is ever-present.
Although Umm Mahmoud had family in Turkey who offered her and her family shelter, she eventually decided that she did not want to burden them. Instead, she moved to an IDP camp with her husband and children.
Ultimately, it was Umm Mahmoud who made the decision to move her family out of Kafr Zayta. Her story is in line with our overall finding that women often have the final say on whether or not they and their families flee their homes.
Over the course of the war, Syrian women have experienced a dramatic expansion of their roles and responsibilities, both inside and outside of the home. Many have transitioned from caretakers to breadwinners – and occasionally even to heads of households.
With men out fighting, imprisoned, injured, or even dead, women have been forced to step up and carry ever greater burdens for their families and communities.
After moving to ‘the tents’, Umm Mahmoud found a job with an international NGO. Around the same time, her husband was bed-ridden for two years with a severe back injury. Even after recovering, he remained unemployed.
Umm Mahmoud’s life after the chemical attack left her chronically fatigued. She would work during the day, only to come home in the evenings to complete household chores and care for her injured husband and growing children.
This forced reversal of traditional gender roles has also put a strain on Umm Mahmoud’s marriage, as it left her husband feeling inadequate for staying at home. She described feeling overwhelming guilt: she fears that she hasn’t been doing enough for her family and always wants to offer more support – by helping her children study, keeping the house clean, and earning a living to ease everyone’s worries. But she also feels terribly sad because there seems to be no one who can help her with her troubles.
Today, almost seven years after the attack, Umm Mahmoud still lives in an IDP camp near the Turkish border with her husband and four children. She remains the only working adult in her household.
Umm Mahmoud’s story mirrors that of many Syrian women since the start of the war. Continue scrolling for an in-depth analysis of how the impact of chemical weapons attacks on women affects the long-term resilience and social cohesion of communities in Syria.
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Executive Summary

The Syrian regime has repeatedly and systematically deployed chemical weapons against civilian populations as a part of its military campaign – a strategy that disproportionately affects women and children. While existing research demonstrates the vital role Syrian women play in the resilience and survival of their communities, little evidence is available on the damaging impact of chemical attacks on women and what that means – both immediately and enduringly – for their larger Syrian communities.

Our research reveals that the effects women and children suffer after a chemical attack are not only devastating in their immediate and direct implications, but also have far-reaching, long-term communal and societal consequences. In addition to constituting an egregious violation of international human rights, the use of banned chemical weapons against civilian populations in Syria and their direct effects on women and children have broader ramifications that exhaust community resilience, social cohesion and eventually force migration.

For women in opposition-held areas, chemical weapons have only been the worst form among a barrage of indiscriminate violence unleashed by government forces against communities in Syria. As a final bid for survival, many ultimately chose to leave their homes and move their families to a different location to escape the looming threat of a chemical attack. Our previous report Nowhere to Hide illustrated how the displacement caused by the use of chemical and other indiscriminate munitions has bolstered the Syrian military’s strategy of depriving rebel forces of civilian support and resources as it emptied and impoverished the communities under opposition control.1

The international community could have taken – and could still take – many steps toward supporting and strengthening the resilience of Syrian communities to lessen the direct and indirect effects of these attacks and other forms of indiscriminate violence against civilian populations in Syria, which range from psychological distress to the erosion of social cohesion. Building up the capacity to mitigate the impact of chemical attacks on local communities will require strengthening response capabilities, including maternal and mental health provisions. Additionally, certain women-centered initiatives should be prioritized, primarily those focused on strengthening support networks for women. These programs help to sustain communal resilience and close the gender information gap by capturing the experiences of women who are affected by indiscriminate violence and chemical attacks for future research, policy and accountability efforts.


Eight years after the first recorded chemical attack in Syria, the international community still has not found an effective response to curtail the Syrian military’s repeated use of banned chemical weapons against its own people. In addition, the regime’s costly investment in the production and deployment of predominantly non-lethal chemical munitions against civilians has puzzled military analysts because of the strategic ineffectiveness of these weapons. In 90% of the cases where the chemicals used for an attack were identified, the attacks were conducted with agents that are technically non-fatal, such as chlorine. And they were frequently used behind the frontlines, where the victims were mostly non-combatants. This has disproportionately affected women and children, who at the time of writing account for almost half of the over 20,000 victims of the 349 recorded uses of chemical weapons in Syria since 2012. This raises the question: What is the strategic purpose of such wanton violence that justifies allocating scarce resources in a fight for regime survival?

A closer analysis of the gendered impact of chemical attacks in Syria provides a missing piece to the puzzle. While images of Syrian civilians may occasionally stir public sentiment abroad, the direct and indirect effects of chemical weapons on women and children – and through them on their surrounding communities – remain understudied. In a region such as Northwest Syria, where women and children make up 76% of the population,2 such neglect of the gendered dimension of chemical weapons represents a serious blind spot in our understanding of how indiscriminate violence affects populations during war.

To fill the gender gap when it comes to information on and systematic knowledge about the consequences of chemical attacks in Syria, we conducted an initial analysis of the effects of the use of chemical weapons on women and their significance at the community level. In part one, we show that women not only have a higher mortality rate due to chemical attacks, but they also experience gender-specific physiological and mental health consequences as well as obstacles to care and recovery. In part two, we build on previous research regarding the role of chemical weapons in the Syrian war to trace their broader impact at the community level. In the aftermath of men dying or fleeing war-torn Syria, many families and entire communities became dependent on women as the main breadwinners, heads of households and ultimately key decision-makers when it comes to a family’s choice to either stay or leave following an attack. For this reason, we analyze how chemical attacks and their disproportionate targeting of women ripple through the fragile fabric of Syrian local society, eroding community resilience, driving flight and migration, and thus shaping the larger outcomes of the civil war. We conclude with key takeaways and policy recommendations with regard to both the gendered dimension of humanitarian action and considerations for policymakers responding to future chemical weapon campaigns in Syria and other contexts.

This research is part of the Global Public Policy Institute’s ongoing project on the use of chemical weapons in Syria. Based on an analysis of over 2,000 sources, we previously developed the first and to-date most comprehensive dataset of the use of chemical weapons in Syria, which includes over 35,000 data points. Based on this extensive record, the project’s first publication Nowhere to Hide and its companion website summed up our analysis of the Syrian chemical weapons complex, including its strategic link to the Syrian military’s conventional warfare campaign throughout the war. The project team continues to update and maintain the dataset, which also forms part of the evidence basis for this research.


To trace the gendered impact of chemical weapons in Northwest Syria, we relied on a combination of qualitative and quantitative approaches. Using the aforementioned dataset of chemical attacks in Syria, we chose to focus on a small number of locales that are among those hit most heavily since the first recorded attack in 2012. Overlaying incidents with gender-disaggregated data on casualties, we identified a number of settlements that repeatedly suffered chemical bombardments against civilians over the course of the war. The long history of chemical attacks allows us to better assess their medium and long-term effects on civilian populations. The towns we identified and which ultimately formed the focal points of our research mostly lie within the northwestern pocket of opposition-controlled territory.


Chemical Weapons Attacks in the Northwest Region

Of the 349 confirmed chemical attacks that took place in Syria since the start of the war…

… 281 occured within the northwestern region where we focused our research, specifically in the governorate of Idlib and in northern Hama.

Towns and villages there have frequently been targets of chemical weapons attacks from the early days of the war.​

Of the ten most heavily hit towns across Syria...

Figure: Ten Most Heavily Hit Towns by Number of Confirmed Incidents; Source: GPPi
Figure: Ten Most Heavily Hit Towns by Number of Confirmed Incidents; Source: GPPi

... four lie within the northwestern region.

Survivors of chemical weapons attacks, medical practitioners, and community leaders we interviewed were mostly from Kafr Zayta, Al-Tamanah, Saraqib, and Khan Shaykhun.

Figure: Ten Most Heavily Hit Towns by Number of Confirmed Incidents; Source: GPPi
Figure: Ten Most Heavily Hit Towns by Number of Confirmed Incidents; Source: GPPi

Most people who live in this area are civilians and a large share of them are women and children.

We found that women and children are disproportionately affected by indiscriminate violence, including chemical weapons attacks.

In addition to compiling incident data and extended desk research, we conducted individual interviews with 24 Syrians from the identified focus communities, specifically from Kafr Zayta, Khan Shaykhun, Al-Tamaneh, Idlib, Saraqib, and Eastern Ghouta. Among our interviewees were 14 direct victims of chemical attacks, five responding medical practitioners, and five local community leaders. Over fifty percent of all interviewees were women. In addition, we consulted with subject-matter experts on the specific effects of chemical weapons on women and children to triangulate our results.

Bridging the Information Gap

Investigating the effects that indiscriminate forms of violence like chemical attacks have on women reveals a pervasive, structural gender bias in the reporting and primary data collection on such violations in Syria. Women bear the brunt of the violence, yet they remain underrepresented in accounts of it. This gender bias has led to gaps in the international community’s understanding of the effects of the Syrian conflict, which weakens the effectiveness of targeted policy measures. In addition, informants on the ground – such as journalists, medical practitioners, local authorities, and first responders – are predominantly male. As women in conservative Syria often shy away from discussing vulnerable experiences with men, much of the material we encountered lacked female voices.

Speaking directly to female survivors (through an Arabic-speaking female interviewer, who is also one of the authors of this research), we captured parts of the narrative that had been previously unknown or ignored. To conduct such direct interviews, we frequently needed to gain the trust of the women’s families and communities, which meant engaging with male family members first before starting private conversations with their wives or sisters. Our research clearly demonstrates the need for local and international organizations and courts to actively seek out female perspectives in order to develop a full picture of the use of chemical weapons in Syria.

Since most available research regarding the effects of chemical weapons focuses on its use on male combatants in a military context, one of the largest information gaps we encountered relates to pregnancy and fertility complications following women’s exposure to chemical agents. In this case in particular, we found that the existing literature far from reflects the lived experiences of women and that personal accounts of pregnancy complications were needed to gain a more accurate understanding of the reality on the ground.3 While our findings are insufficient to draw statistically significant conclusions, they highlight the need for more scientific and medical research on this topic.

Direct Impact

Women as Targets of Chemical Weapons

Our initial quantitative research on the use of chemical weapons revealed that women in Syria have suffered more from chemical attacks and the indiscriminate bombardment of civilian settlements than men, despite their predominantly non-combatant role. Existing qualitative research on the gendered dimension of the Syrian war supports these observations.4 According to records from the Violations Documentation Center, women and children account for 43% of all confirmed fatalities from chemical weapons in Syria, but only 5% of frontline deaths.5 In total, throughout the war, 2.6% of deaths among women were due to chemical attacks – compared to only 0.5% among men.6 This outsized impact serves as a starting point for our inquiry into the effects of chemical weapons on women and their surrounding communities.

Since frontline combatants are almost exclusively young men,7 the remaining civilian population in opposition-held areas consists mostly of women, children and the elderly. In addition, a much higher portion of those who have fled Syria8 since the start of the war are men,9 leaving behind a population that predominantly consists of women and children. Local medical practitioners interviewed for this research estimated that women and children accounted for as much as 60-80% of the victims treated in the aftermath of chemical attacks in Northwest Syria. Local residents largely echoed this account: women, who tended to stay close to their homes during the day while their male relatives were away fighting or working, were more likely to fall victim to chemical munitions, which are generally targeted at opposition settlements and dropped from helicopters. Many of the first-hand accounts by survivors further illustrated this point. In one conversation, a survivor recounted sitting outside her home on the outskirts of town surrounded by neighboring women and children, chatting and drinking tea, when a chemical attack hit the village. From this group, two women were later admitted to an intensive care unit in Turkey for treatment, where one died within a few days due to her exposure to the chemicals used in the attack.

Physical Effects

Beyond the higher mortality rate from chemical attacks among women, women who have been exposed to chemical munitions also suffer graver medium and long-term health effects,10 most notably in the realm of reproductive and maternal health. However, very little research currently exists on the implications of exposure to chemical weapons for maternal health and fertility.11 Most scientific studies of chemical weapons use have historically focused on male combatants, not civilians. As such, it is difficult to assess the true risk of exposure to women’s bodies, especially when it comes to less lethal choking agents such as chlorine.

  • play_arrow Table: Typical Physical Symptoms Experienced by Victims of Chemical Weapons Attacks

    The physical effects of chemical weapons depend on a number of factors, including the type of chemical agent used in an attack, the degree of a victim’s exposure, the length of time that has passed before the chemical was washed off, and the time elapsed before a victim receives medical treatment. Most of the symptoms appear immediately, with a few lingering on as medium or long-term complications. More severe symptoms may emerge if the victim already had previous contact with chemical weapons.

    Acute respiratory distress syndrome (ARDS)fiber_manual_record
    Bilateral crepitations in the pulmonary lobesfiber_manual_record
    Burning sensation in the eyesfiber_manual_record
    Burning sensation on the facefiber_manual_record
    Foaming at mouth/mouth secretionfiber_manual_recordfiber_manual_record
    Increased nasal discharge/rhinorrheafiber_manual_record
    Increased tracheal secretionsfiber_manual_record
    Itching/exposed skin in the nosefiber_manual_record
    Loss of consciousnessfiber_manual_recordfiber_manual_record
    Muscular weaknessfiber_manual_record
    Pain in the throatfiber_manual_record
    Rapid pulse and palpitationfiber_manual_record
    Redness/itching of eyesfiber_manual_record
    Shortness of breath/tachypnea/dyspneafiber_manual_recordfiber_manual_record
    Skin turns bluefiber_manual_record
    Teary eyes/lacrimation/blurred visionfiber_manual_recordfiber_manual_record
    Tightness of chestfiber_manual_recordfiber_manual_record

    Source: Organization for Prohibition of Chemical Weapons Fact-Finding Mission (OPCW FFM, reports from 2014 through 2020)

In our interviews, we found a notable disconnect between male medical practitioners’ awareness of the potential impact of chemical weapons on female reproductive health and the personal experiences of female victims. Women consistently reported incidents of miscarriages both for pregnancies that were still ongoing at the time of an attack and those that took place after an attack, as well as suspected fertility loss. A plausible cause for this are the stigma and shame that surround pregnancy complications,12 which often make women reluctant to share their experiences outside of their closest circles. Given the lack of awareness and education on the subject among both affected women and non-specialist medical practitioners, women often struggle to make sense of their own condition in the aftermath of chemical attacks. As a result of this ambiguity, women have been largely unable to access adequate care for reproductive health complications, which are not only physically but also mentally burdensome.

On a larger scale, our interviews revealed that women have had to face a higher risk of severe complications from chemical agents because they would often receive slower medical attention in the immediate aftermath of an attack, when time is of the essence. According to first responders, the first step in attending to a victim of a poison gas attack involves removing their chemical-soaked clothing and rinsing them with water to break the contact between the agent and the skin. In the chaos of an attack’s aftermath, this often occurs outside, in front of hospitals or even at the scene of the attack itself. However, given the social norms against the undressing of women in public, first responders and civilian bystanders resisted doing so in several cases, even in the wake of a chemical attack. At the same time, there were few female nurses, particularly at the start of the war. In combination with the higher number of female victims, this lack of female nurses has led to a clear gendered imbalance of emergency care following chemical weapons attacks and frequently left female nurses wholly overwhelmed.

One of the female nurses interviewed for this research, who was present at the 2013 Eastern Ghouta Sarin attack, explained the struggles of attending to hundreds of victims as one of only two female nurses working at her specific medical point:

format_quote Female nurse, Eastern Ghouta, 2013
The day the chemical attack hit in 2013, there was only me and another woman. The rest [of the nurses] were all men. (…) I can’t explain the immense number of people (...). My job was to place an intravenous catheter in the female victims [to administer the medication] with extraordinary speed. You’d need to open an intravenous route for 20 women in about 15 minutes or even less – 10 minutes – because you didn’t have any time to wait. 13

Especially at the start of the war, this meant that women received slower care and absorbed higher doses of chemicals. In this way, greater exposure in the aftermath of an attack resulted in more severe medium and long-term consequences, including respiratory and reproductive health complications. Coupled with insufficient programs for training more female Syrian nurses, local populations in Northwest Syria – where 73% of the population are women and children – have been left doubly vulnerable.

Psychological Consequences

In addition to the described physical effects, women also carry a heavy mental burden and the additional stress of their demanding roles in families and communities. Historical case studies of communities affected by chemical warfare, and in particular of Iranian families coping with the aftermath of the Iran-Iraq War in the 1980s, help us understand the detrimental, long-term mental health effects that follow exposure to such attacks.14 As the caretakers of affected family members, women inevitably suffer secondary post-traumatic stress: by internalizing the suffering of their loved ones, they often develop symptoms of PTSD even in instances where the attack did not affect them directly.15 In addition, women interviewed for our research reported experiencing a great deal of stress and anxiety from trying to balance their own health and recovery with their physically demanding care obligations to their loved ones.

According to mental health experts, different traumatic stress disorders commonly occur together and can also exacerbate other psychiatric disorders, such as depression, anxiety and substance abuse.16 Reviews of the general mental health situation in Syria painted a bleak picture even before the widespread use of chemical weapons: one 2013 assessment of IDP populations found “heightened levels of distress, anxiety, fear, frustration, grief, fatigue, and depressed mood.” One International Medical Corps review found that 61% of patients using the organization’s facilities inside Syria suffered from severe emotional disorders.17 Other studies among refugee populations in Turkey and Germany show an even higher prevalence of mood and anxiety disorders. Against this backdrop, it is clear that experiences of extreme violence have a devastating impact on the ability of individuals, families and entire communities to cope with the pressure of life in war-torn Syria.

Indeed, the disproportionate impact of chemical warfare on women goes far beyond the sheer number of victims. As one survivor, who suffered from weak lungs after the attack but needed to continue caring for her family, described: “I would carry [the oxygen tank] in my hands or under my armpit, put the mask over my mouth, and go on with my household chores.”18 Her words illustrate a larger point: while chemical weapons indiscriminately hit entire communities, their short, medium and long-term effects on women – and therefore on those dependent on women’s care and labor – is considerably greater.

Lasting Effects

Women’s Expanding Roles

How does the disproportionate impact of chemical weapons on women affect Syrian communities as a whole? How do chemical attacks impact communities’ support for armed resistance or force families to abandon their homes? Answering these questions starts by understanding that the role of women within their families and larger communities has expanded considerably over the course of the Syrian war. At the same time that women were becoming the backbone of their communities, they have also had to face the devastating consequences of chemical attacks. As a result of women’s essential role in local society, the impact chemical weapons have on them has not remained confined to the humanitarian sphere – it has also developed into a strategic tool: Women have been left in charge of many key decisions, including on whether to relocate their families after a chemical attack. By choosing to flee, women effectively wield the power to make choices that ultimately erode the legitimacy of and local support for insurgent groups – an outcome that benefits the Syrian regime. Conscious of this, it began a terror campaign against civilians, primarily through killing, injuring and traumatizing women to achieve its political objectives.

Dissecting the experiences and choices of women throughout the Syrian war is key to understanding the fates of families and communities. In unpacking the migration patterns associated with the use of chemical weapons, we found that educated, more socially involved women were quicker to flee, thus setting in motion a snowball effect of ‘brain drain’ and eroding community resilience.

As a result of the war, Syrian women have found themselves bearing increased responsibility19 as they helped their communities adapt and thrive even amidst the instability of conflict – what we refer to as community resilience 20. This has led to a profound transformation in gender roles.21 On top of their traditional caretaker duties from before the war,22 many Syrian women for the first time took on additional, usually informal jobs while their husbands were away from home to supplement the family income23, particularly in the conservative northwestern region. In focus groups conducted in Northwest Syria, 13% of women identified as the primary breadwinners of their family24 (estimates suggest that 12% to 17% of households in Syria today are headed by women).25

Outside of the home, Syrian women have stepped up to fill roles that provide stability in their communities.26 As public services like education and water management began to crumble, women organized home schools and carried water and fuel, often for miles.27 In the face of chaos and destruction, women also led initiatives to increase cooperation, awareness and safety within their communities.28 In many places, an informal humanitarian sector and local economy have sprouted, both of which heavily rely on the contribution of local women. As one interviewee put it:

format_quote Male medical practitioner, present for several chemical attacks
“As a result of the war, many women lost their husbands. They found themselves as the sole guardians of their families, and so I imagine they were pushed to work. Of course, before the war, there was also work for women, most of it being administrative or educational (…), but after the war they started to do everything.”29

As a result of the heavy economic toll inflicted by the war, which has pushed more than 83% of Syria’s population below the poverty line, an increasing number of women are not only taking on additional community roles but actively participate in their family’s struggle to survive financially. While some studies for Northwest Syria reported that only 5% of women engaged in formal work, agricultural assessments showed that women were often compensating through informal farm labor, representing as much as 90% of all agricultural workers in some opposition-held areas.30

Despite contributing through mostly informal channels, women across Syria – and especially those in opposition-held areas – rose to meet the challenges facing their overextended families, communities and local economies. Their contributions at home, to formal and informal education initiatives, humanitarian and care work, and agricultural labor have been essential to sustaining local life under the adverse conditions of war. However, this increasingly central position of women in society has been continuously contested at the local level, including inside families themselves. Women’s expanding roles in upholding their societies have also flagged them as increasingly attractive targets for government attacks which seek to ‘break the backs’ of local communities that are still holding out in the face of the Syrian military’s assaults.

Chemical Weapons and Forced Migration

Our interviews revealed that chemical warfare has a greater psychological impact on local communities than conventional bombings. During ‘traditional’ bombing campaigns, civilians can seek shelter in bunkers; however, these very same underground shelters can quickly turn into death traps during a chemical attack, as the poisonous gas – which is heavier than air – sinks down into them.31 Helicopters are the main vehicles used to deliver chemical munitions. Whenever helicopters were heard overhead, civilians were forced to gamble with their lives by choosing to either descend into the bunkers or climb to the roofs. Several of our interviewees described the anxiety they felt when hearing a helicopter after they had experienced a chemical attack:

format_quote Male medical practitioner, present for several chemical attacks
After some time, I realized that the feeling of terror had increased with regards to helicopters (…). Of course, our fear of helicopters, we had slowly gotten used to that (…). During the [conventional] strikes, people became accustomed to moving to the shelters, but after the chemical attack occurred (…) they became afraid of the shelters themselves. People felt torn: should they go up on the roofs or down to the shelters? 32

Similarly, in interviews we conducted for previous research, survivors of the 2013 siege of Eastern Ghouta reported receiving text messages from loyalist forces threatening them with chemical attacks as they sat helplessly in bunkers. This led these survivors to favor surrender over an agonizing death underground. Correspondingly, following the Duma chemical attack in April 2018, representatives of the local delegation that was tasked with negotiating with assaulting Russian and Syrian forces cited pressure from civilians as the reason for eventually entering into a surrender agreement with the government.33 These examples give a glimpse into the psychological toll that chemical weapons take on their target populations.

The pervasive feeling of vulnerability and uncertainty induced by the threat of chemical attacks can cause even the most resilient locals to flee for their own survival. While incidents of forced migration within and from Syria have consistently correlated with periods of heightened indiscriminate violence,34 we found that exposure to chemical weapons has played a particularly important role in cementing families’ decisions to relocate. Time and again, our interviews highlighted the determination of civilians to withstand explosive bombardment – until they were faced with chemical attacks. Almost all our interviewees cited chemical warfare as one of the key factors driving relocation.

format_quote Male medical practitioner, present for several chemical attacks
The effects of conventional attacks – explosives with barrels or rockets – are limited to the areas they target. However, when chlorine gas is used, it spreads over large distances (...). It was used to spread panic and fear, so that people would migrate immediately after a chemical attack (…). The effect of chemical weapons on the community was mass migration. That was the biggest cause – chemical weapons, and especially chlorine gas. 35

Women play a critical role in the decision-making processes that lead to relocation. Of the families displaced by the most recent government offensive in Northwest Syria in the spring of 2020, 94% were headed by a woman.36 Even in households where the husband was present, women frequently hastened the decision to leave their homes out of concern for their children’s safety, or for fear that their sons and husbands would be recruited to participate in the fighting.37

On average, we found that women were quicker to make the decision to flee after a chemical attack, whereas men were more reluctant to forgo work and the dignity of life in their hometowns. While both men and women interviewees explained that husbands usually made the final call on migration, the former often left the choice up to the wives. A number of interviewees also noted that even when husbands disagreed with the decision to migrate, some women would nevertheless take their children and leave.

The Erosion of Community Resilience

Further, we found that community members with a higher social standing, i.e., those with wealth and social connections, tended to relocate sooner: not only did their social capital allow for easier movement inside war-torn Syria,38 but our research showed that their higher levels of education afforded them greater flexibility in finding work in new locations. In our interviews, women from farming households, whose livelihoods were tied to the land, showed a greater reticence to leave their homes than those with some educational background. And indeed, women trained as nurses or teachers had more success in finding work with international NGOs in displacement camps – sometimes due to what they perceive as gendered hiring practices – where they would often work in the areas of child protection, women’s rights, or education.

While many educated women found work in displacement camps, their husbands usually remained unemployed. Some women interviewed for this research spoke candidly about the stress this reversal of the conventional ‘breadwinner role’ brought to their marriages. At times, a few of our interviewees implied experiencing pressure or guilt because of their husbands’ feelings of inadequacy. In some interviews, women even explicitly stated that recruitment policies favoring women – which were designed to empower them – actually left them shouldering a double burden at work and at home. Meanwhile, many interviewees with less transferable skills from farming households – both women and men – were usually unsuccessful in securing employment after leaving their hometowns.

As educated women are among the first to relocate, they leave behind communities that have been deprived of the essential human capital that sustains local society and fosters community resilience. When teachers, activists and nurses – who provide essential services in their neighborhoods – flee an area, other residents seeking the well-being of their children also depart at an increased rate. This sequence of forced migration illustrates the importance of ensuring the safety of certain professions and institutions that are central to keeping a community’s fabric intact. This applies not only to hospitals, but also to schools and community centers.

While chemical weapons have killed fewer Syrians than explosives and other forms of indiscriminate violence,39 they have succeeded in exhausting targeted communities and draining the will and capacity of locals to remain and resist – with the impact on women being a fundamental factor in that process. By using chemical warfare to target civilian populations, and women in particular, the Syrian government strikes community resilience at its very core.40 Chemical attacks not only terrorize local residents psychologically – they also weaken the social and economic networks that are necessary for their survival. By causing educated and proactive community members to flee their homes and leave behind depleted and fragile towns,41 the Syrian regime has been achieving this goal.

With a better understanding of the vital role that women play in the resilience and survival of their communities, the strategic rationale and logic behind the Syrian regime’s use of chemical weapons against civilians comes into clear focus. By specifically targeting women with largely non-lethal chemical munitions, government forces have in many instances succeeded in breaking the will of local communities and driving out the opposition.


Unsurprisingly, the effects of chemical attacks do not stop with the dispersion of the gas and the treatment of victims. Chemical weapons have far-reaching implications for the communities they target. We found that women have disproportionately fallen victim to chemical weapons in Syria, and that they also face greater physical and psychological consequences after experiencing a chemical attack. By specifically targeting women, the Syrian regime takes aim at entire populations on a fundamental level. In Syria, the ubiquitous distress that has followed chemical attacks has led to increased rates of migration, with women frequently being the ones to call the shots in their families on whether to flee. Since educated women have often resolved to migrate sooner than less educated women, many local communities have seen a form of ‘brain drain’. Chemical attacks have thus effectively left the remaining residents in an even more vulnerable state.

To implement effective policy to address the use of chemical weapons in Syria, we must appreciate women as the de facto centers of their communities. While the protection of women remains paramount in its own right, in this case it is also intrinsically linked to keeping families in their homes and avoiding flows of forced migration. In the same way that chemical weapons can cause physical harm to an individual, for instance in the form of choking or suffocation, without leaving actual physical marks on their body, these weapons silently exhaust entire communities by draining populations of their capacity for resilience – all under the watchful eyes of the international community.

Policy Recommendations

  • play_arrow 1. Build up capacities to mitigate the impact of chemical weapons on local communities.

    Our interviews uncovered major gaps and inequities in the training of first responders and health services staff in regions that had been consistently bombed with chemical weapons over the course of the war. Unsurprisingly, this has affected the quality of care available in these areas. International donors looking to strengthen response capacities in Northwest Syria in the wake of chemical attacks should expand on previous programming to build up core capacities in chemical, biological, radiological, and nuclear (CBRN) defense and response among first-responders to ensure that existing trainings include more than just a token number of women rescuers and nurses. In addition, to support medium-term resilience in the face of the gendered effects of chemical weapons, donors should support training on maternal health issues for general medical practitioners who may treat victims of chemical weapons attacks. Further, donors should invest in dedicated trainings for specialized maternity care providers on the long-term effects of exposure to chemical weapons.

    The provision of mental health services in Northwest Syria remains woefully inadequate considering the extent and depth of the trauma experienced by local populations. This includes services for healthcare workers themselves. Dedicated mental health support for first responders – even if provided remotely – would improve the resilience of the strained healthcare system in Northwest Syria and may help slow regional ‘brain drain’.

    In the medium term, mental health services in the region, particularly for women, must be expanded across Syria to mitigate the threat of passing on second-hand trauma to future generations. While social stigmas concerning mental health and general restrictions on women’s mobility remain a major obstacle to access, a plethora of local NGOs and medical charities stand ready to expand opportunities via dedicated safe spaces and ‘snowballing’ approaches to local community outreach. Our interviews also suggest that there is a growing demand for such services among residents of Northwest Syria.

  • play_arrow 2. Strengthen communities by empowering women’s support networks.

    Our research highlights a direct link between the disproportionate effects born by women in war-torn areas of Syria and the erosion of resilience and cohesion in their communities.

    Women’s support and information networks – women helping other women cope with the stress of life in a conflict zone – are essential to sustaining community resilience. Existing evidence suggests that social support networks and safe spaces help mitigate post-traumatic stress and allow survivors to feel safe and connected.42 International donors should support existing community and women’s centers in expanding their services to cover new responsibilities, including long-term care for injured and traumatized relatives of women. Such spaces may improve local resilience, help distribute the burdens of care, and slow relocation.

    However, the reach of these centers remains inherently limited, especially for the most vulnerable or those living in more conservative environments. Thus, more relevant Arabic-language information materials on CBRN protection and response should be made available and proactively distributed via messenger and social media channels (particularly via WhatsApp and shareable Facebook posts) as well as through word of mouth. Some women’s networks already participate in door-to-door information campaigns on issues such as de-radicalization, vaccination and protection, and should expand their efforts to include information on responding to chemical attacks. At the same time, the efficacy of public information campaigns should be tested more rigorously, for example through on-the-ground random sample surveys.

  • play_arrow 3. Address the glaring gender information gap in human rights violations reporting.

    To correctly inform the international response to the use of chemical weapons in Syria, and to support future accountability initiatives, local and international stakeholders need to accurately record the impact of violence on womeny. While efforts to compile statistics on women casualties are currently underway, qualitative reporting remains overwhelmingly focused on men. At a more fundamental level, donors need to move past the ‘gender marker’ approach to representation, which considers women’s experiences and roles as a sub-category, and appreciate that the security of women is security. In practice, given the restrictions on reaching out directly to women that exist in Syria’s conservative society, this will require developing dedicated strategies for capturing women’s experiences and perspectives, including by training Arabic-speaking women information officers.

    To overcome capacity gaps and support groups which conduct most of the reporting on human rights violations in Syria, local NGOs should work to improve information sharing and collaboration with local women and women-led NGOs. International donors and accountability mechanisms, particularly the UN Commission of Inquiry and the UN International, Impartial and Independent Mechanism (IIIM), can encourage these developments by emphasizing the need for in-depth reporting on the perspectives of women at the project design stage and by allocating dedicated resources and information officers to work with local partner organizations on building research protocols and training women staff.

    Finally, international and national bodies seeking accountability for chemical attacks, including public prosecutors and NGOs bringing universal jurisdiction cases to court in Germany and other countries, should ensure an adequate representation of women victims among the complainant. The attention and legitimacy afforded through such efforts may encourage more Syrian women to come forward with their personal experiences of violence and incentivize local NGOs to adequately represent them.

  • play_arrow 4. Promote gender analyses in civilian protection programming.

    Finally, while there are no programming shortcuts to the protection of civilians in conflict, many mitigation interventions could be optimized by including gender as a component of conflict sensitivity analyses. For example, when it comes to early warning ahead of airstrikes, women are more likely to be closer to their homes and near children, and thus ought to be prioritized when it comes to warnings. However, in conservative sections of Syrian society, women may have less independent access to messenger apps or social media – an asymmetry that requires dedicated mitigation efforts to improve our ability to protect communities from air bombardment and chemical weapons campaigns.

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