“One of the first victims of war is the health care system itself,” said Marco Baldan, the chief war surgeon for the International Committee of the Red Cross. Violence directed at health facilities and workers is common in conflict, despite international laws protecting medical personnel, facilities, and transport vehicles during war.

How much time passes between a laboring woman’s decision to seek care and her arrival at a health facility? Transportation for emergency obstetric care should be swift and timely, but for many refugees in the world’s conflict zones, it is not.

An analysis of refugee maternal mortality in 10 countries found that transportation problems contributed to more maternal deaths outside of refugee camps, which tend to have better access to emergency transportation services.

How much time passes before a woman—or her relatives—decide to seek care or emergency medical services during pregnancy? It often depends on how much they know about the services available.

This information may be hard to come by in conflict-affected areas, especially among internally displaced women. According to a retrospective study of health care during the 2006 war in Lebanon, 80 percent of Lebanese pregnant women before the war sought antenatal care, while the share of displaced women seeking care was only 34.5 percent.

“This is a woman who did exactly what she was supposed to do; she did exactly what we encourage pregnant women to do,” said Amy Dempsey of the Population Council at a recent Wilson Center event on World Preeclampsia Day. The Ethiopian woman was suffering from preeclampsia—a preventable condition—but like many pregnant women in low- and middle-income countries, she did not receive the treatment needed to stop it. “Pregnancy was the first time she had ever stepped foot in a health facility,” said Dempsey.

“How do our interventions provide an opportunity to really work at some of the core drivers of instability or lack of resilience?” said Larry Cooley from Management Systems International at a recent Wilson Center event on scaling up reproductive, maternal, newborn, child, and adolescent health interventions.