Samar* was only 14 when her father forced her to take pills in their tent in Salqin in northwest Syria. 

“Once I had my period, I was forced into marriage,” the now 16-year-old girl told TinyHand in a phone call arranged by a midwife. “My marriage lasted for almost 1.5 years. I got pregnant but lost the baby. My husband then divorced me.”

The phone call had to remain secret, as this investigation deals with a taboo, something many people avoid talking about. We interviewed several girls and mothers, whose daughters were exposed to “forced puberty:” the practice of giving pills to or injecting young girls with hormones to induce puberty.

We discovered that the phenomenon is widespread and pushed the health directorates in Aleppo and Idlib to ban the sales of hormonal drugs. This report unveils the full story of coercing young girls to take those drugs, as well as beating their backs to accelerate puberty and marry them off. 

To ensure our sources’ safety, we have used pseudonyms (*) in most cases.

It All Started in 2020 When Inaam* Found a Clue 

The story was made public thanks to Inaam, who for safety reasons wished to stay anonymous. Since 2015, Inaam has been a humanitarian worker in Syria, focusing on sexual violence against women. 

In 2020, she joined a sexual and reproductive health workgroup when she accidentally came across a case of forced puberty. A midwife told her the story of a 12-year-old girl, whose father forced her to take pills to speed up her period.

“That child’s story could have been a mere passing to-be-forgotten chat,” Inaam told TinyHand. “But I brought up the story in a meeting with the anti-violence team. Her story turned out to one of the undisclosed and, until then, undiscovered cases of sexual violence against women. We started looking for similar cases. Then came the shock: there were many young girls forced to take pills to induce puberty.”

Inaam found that parents in camps for the displaced in northwest Syria did not just force their daughters to take pills, but also beat their backs, thinking they could speed up puberty that way.

It became clear to Inaam that the practice was widely spread in the camps of northern Syria, especially in the camps of Atmeh, Salqin and Harem.

Most cases Inaam encountered concerned the Salqin and Atmeh camps, including the case of two sisters of 12 and 14 years old. They were being beaten on the back by their father in addition to being forced to take medicine. 

“It is believed that beating accelerates menstruation,” Inaam explained. “That man was not the only one. Many others in the camps think that way.”

In the opposition-controlled areas of northern Syria, there are over 1,400 camps, inhabited by some 321,000 families.

Idlib and Aleppo Ban the Sale of Hormonal Drugs 

On June 29, 2020, the United Nations Population Fund (UNFPA), issued a press release based on the research conducted by Inaam and the reproductive health team, stating: “Gender-based violence continues to rise, with new forms of violence increasing in their intensity and effect, such as forced puberty —  which involves injecting young girls with hormones to induce puberty for the purposes of child marriage or sexual exploitation.”

The statement highlighted that of the nearly 12 million people in need in Syria, some 5.9 million are women and girls, many of whom report that gender-based violence continues to plague their daily lives. 

Some four months later, the health directorates of Aleppo and Idlib banned supplying and taking medication that contains hormones such as testosterone, progesterone and oestrogen without a prescription stamped by a health facility and signed by a doctor. 

“We consider these decisions a success for the mission we carried out,” an UNFPA official told TinyHand. 

The UNFPA sexual and reproductive health workgroup had approached the health directorates in Aleppo and Idlib with data and its report on forced puberty. We obtained copies of the bans issued in Aleppo and Idlib.

The Aleppo Health Directorate told all hospitals, health centers, private and mobile clinics, psychological treatment units and pharmacies that it is forbidden to disburse and trade hormonal drugs, especially those containing progesterone and estrogen, without a prescription stamped by a health facility and signed by an attending physician.

It was hoped the bans would put an end to the circulation of these drugs. But did pharmacies stop selling? Did parents stop forcing their daughters to take such pills?

The Answer is NO …

While Inaam* was unable to provide a clear answer about the extent of compliance with the ban, she confirmed that she still encounters cases of girls taking pills.

Yet, for us it was not hard to get an answer. It only required trying to purchase the drugs without a prescription, which turned out to be easy. Our last purchase was on May 18, 2023.

No pharmacy refused our request to purchase the medicine. This applies to pharmacies in the countryside of Idlib and Aleppo. We bought Progestan 100mg, which contains 30 pills, for $6.

“Imported medicines are not subject to price control,” said pharmacist Ahmed* in an interview. “Every pharmacist sells it for whatever price he wants. However, usually pharmacists add 33% to the original price.”

Regarding the decision of the health directorates, he said he had never heard of them. According to him, the surveillance process is merely a formality, as the representative only collects the prescriptions, without comparing them to the volume of medicine sold.

“With money you can purchase whatever you want,” said pharmacist Abdullah* in Idlib. 

Morals and Fines

According to our information, a large number of pharmacies have not stopped selling the medication. However, the quantity in circulation varies, as there is no control and regulation of sales. 

A source at the Health Directorate in Idlib explained that the Ministry of Health in Idlib has been in charge of monitoring pharmacies, while the role of the directorate is limited to monitoring public hospitals. 

The source added that, while there are attempts to control sales, there is still a “major shortcoming due to people’s lack of awareness,” which is needed to help control sales of medicine without a prescription.

Dr. Radwan Kurdi, Head of the Health Directorate in the Free Aleppo Governorate, confirmed that the directorate had warned pharmacists against selling medicines without prescription. 

“[But] a mere warning is not sufficient to set things straight,” he said. “The circulation of these drugs is linked to the physicians and pharmacists’ ethical and professional conscience.”

“It is important to impose financial and moral fines, which could include suspending pharmacists’ license in the event of repetition of such violations,” he added. “Physicians and pharmacists know very well what sex hormones are and what their side effects are.”

What is The Situation in the Camps? 

Fatima* is a woman in her fifties who has been working as a midwife for 21 years, the last 6 years of which she spent in the Syrian camps for the displaced. She helped us meet a number of girls who took pills as well as mothers whose daughters did. 

Most of the girls were second wives, orphans, or daughters of poor families. 

What they have in common, said Fatima, is “their parents’ desire to reduce the economic burden” imposed by their daughters and “speed up their marriage” by using medicines. Fatima said she receives at least 10 cases a month. 

One of the cases she presented was Jamila,* a now 17-year-old wife, who took pills 3 years ago to induce an early menstrual period. This led to her getting married. But she has not been able to conceive since. 

Consequently, she visited Fatima for assistance. Her mother, who accompanied her, talked about Jamila’s father who forced her and other daughter to take medication. 

“Their father was very difficult,” she said. “He prevented them from going to school and sought to marry them off at a young age. The first got married when she was 14 and the second when she was 15.”

Umm Youssef* had a different point of view. She supported giving medicine to young girls and marrying them off at a young age. Her daughter was 13 when she took the drugs and became pregnant 3 years later. 

“They have children and grow up together,” said Umm Youssef, who got married at a young age herself. “It’s better to get married early before it’s too late. Today, Youssef is like a friend to me, as he is closer to my age.”

Not Only Pills. Injections Too 

According to Fatima, the signs of menstruation appear after taking 3 or 4 pills. If there is no response, some girls resort to using ovulation inducing injections, which are considered more effective than oral medication. 

“Unfortunately, such injections are available in pharmacies,” said Fatima.

Any licensed midwife can prescribe such medicines and injections. However, Fatima explained they can be obtained without a prescription as well. She pointed out that some midwives brag they were the ones behind some girls’ pregnancies. 

Samar*, a 14-year-old girl from Salqin camp, was not so lucky. She had taken pills at her father’s request and her menstruation started. She got married and got pregnant. 

“[But] I lost the baby and got divorced after a year and two months,” said Samar.

And with those words she concluded her conversation on Fatima’s phone, disclosing what many consider a taboo that cannot be shared. 

Death Threats

Once a father found out that Amira*, a humanitarian worker, had shared the story of his daughter who had taken pills. He went on to send her death threats. 

Amira, who works on fighting sexual violence against women, had met a 12-year-old girl in one of the support centers. During a workshop, the girl had talked about being beaten by her father, who also forced her to take pills to speed up her menstruation.

“When her father, through a neighbor, found out she had visited the center, he came to us and threatened us with death,” Amira said. “He asked us not to reveal what she told us.”

Testimonies from Aleppo and Idlib

The following are quotes from a United Nations Population Fund (UNFPA) report on forced puberty, which TinyHand was able to obtain in full.

“The mother came asking for medicines for her 12-year-old daughter to speed up her period and get her married. I met three similar cases,” said a gynecologist from the Idlib region

“In a group session, women spoke to each other about the possibility of inducing precocious puberty by taking certain hormonal drugs without showing any symptoms,” said a psychological support worker in the Idlib region. 

“A mother came asking for medicines to speed up her daughter’s menstrual period, after they got her married months ago, before reaching puberty,” said a midwife in the Idlib region. “At the time, her husband was asking her to get pregnant and give birth. This was not the only case of its kind we encountered.”

“Several months ago, a woman asked us about methods that could help her 13-year-old daughter, who was about to get married, to get her period faster,” said a case worker in the Aleppo region. 

All this occurs despite the fact that, officially, these medicines cannot be sold without a medical prescription.

What Does the Law Say?  

We could not find a clear text criminalizing a person forcing a child to take medicine to speed up menstruation. However, Syrian lawyer Rehada Abdoush, asserted that Syrian law protects a child from the time it is a fetus until he or she reaches maturity. 

“Syrian law punishes those who harm or abuse a child by dropping their guardianship,” she said. “Anyone who harms a child shall be punished according to special laws, including the 2021 Child Rights Law. This law is in line with the Convention on the Rights of the Child, which was ratified by Syria in the 1990s.”

“The convention defines a child as: every human being below the age of 18, and defines family neglect as any act or omission that results in harm to the child,” Abdoush told TinyHand. “In this case [of forced puberty], girls are below the age of 18, and thus protected by this law.” 

“But how do you get your rights?” Abdoush asked. “This can be done, even if the victim is a minor, by resorting the case to the public prosecutor. The minor’s supervisor, who could be a school teacher, a doctor or the mother, can submit a complaint with the public prosecution. This refers the victim to forensics to assess the abuse. The person responsible will be punished for the crime, revocation of guardianship, or both.”

How to Apply the Law in Camps under Syrian Opposition Control?

Fahd Musa, Head of the Freedom and Human Rights Committee of the Free Lawyers’ Association in north Syria, said it is possible to resort to the judiciary, but this is up to the personal claimant. There are crimes for which the public prosecutor will move by itself, while others require filing a complaint. 

“The rule is that whoever causes harm to others is obliged to pay compensation,” Musa told TinyHand, “Of course, when there is a criminal offense and a personal claimant, the criminal courts in all these regions will put their hand on it.”

According to him, a physician or pharmacist can be held accountable for prescribing hormonal drugs and can be punished by the Salvation Government’s Ministry of Health. This may lead to temporarily or permanently closing the pharmacy, while the case may furthermore be referred to a criminal court.

False Menstruation

Specialists in obstetrics and gynecology say that giving drugs to induce menstruation can cause so-called false menstruation, which is a result of stimulating the ovaries and uterus with external hormones. This is a temporary menstruation linked to the presence of drugs. That is not the only possible negative effect.  

“Administering such drugs before puberty can cause an early menopause before the age of 35,” Dr. Kenan Ziyadoglu, a gynecologist and obstetrician, told TinyHand. “It may even cause uterine or ovarian cancer. Such pathologies result from interventions before the body is physiologically to take in manufactured exogenous hormones. This leads to the large and rapid multiplication of ova, which affects the uterine wall and the reproductive process.”

“Unfortunately, it is a very bad treatment,” he concluded, “It should not be prescribed to any girl under the age of 15.”

Also, If such medicines are taken when a girl is approaching puberty, and ovulation and pregnancy occurred, then she is highly prone to develop such complications as prenatal bleeding, anemia, miscarriages, premature birth and genetic abnormalities. 

Just as happened to Samar, who reached puberty and was forcibly married at 14. She got pregnant but had to abort her fetus due to her immature womb, which led to her divorce before turning 16.