"We're living in a nightmare, and I hope one day to wake up from it," says Khawla from northwestern Syria. The desperation in her voice is palpable even on the telephone. She breathes heavily, trying to control her tears.

It's been just over three weeks since a devastating earthquake in Turkey and Syria claimed the lives of more than 50,000 people.

Khawla, who prefers her real name not to be published, says that every aftershock fills her with terror and the sight of so much destruction is taking its toll. "I don't know how much more of this we can bear," the 47-year-old says. "Death is all-present here."

Women hold families together in wartime

Khawla lives together in an apartment with her two brothers and her father. The building is still standing, but its water pipes and power supply were severely damaged in the quake. The walls are full of cracks.

"A lot of people in our building relocated to an emergency shelter or set up tents far away from here," Khawla explains. For her, these options are out of the question. "Where would I go as a woman?" she asks. In addition, she has to take care of her twin brothers who have Down syndrome, and her elderly father, who is ill, she says.

During the 12 years that war has plagued Syria, women are playing an increasingly important role in holding families together. Countless men have been killed, imprisoned, disabled or forced to flee the country.

In 2011, just 4% of women in Syria contributed the lion's share of the financial burden at home. That number has now risen to 22%, according to the aid organization CARE.

Khawla is one of these women. But since the quakes hit on February 6, her earnings have dried up. "I'm a hairdresser, so people usually come to see me for positive reasons," she says. "Things aren't as nice here anymore, which is why I'm out of work at the moment."

Khawla still has some savings, but she doesn't think these will last much longer.

Financial independence plays an key role in helping women build a life of dignity, according to political scientist Radwa Khaled-Ibrahim, who researches transnational feminist perspectives at the University of Marburg in Germany. She also works for the organization Medico International as a keynote speaker for emergency aid.

Syria heavily dependent on international aid

The war and the dire economic conditions in Syria have left 90% of the 4 million people living in the northwestern region of the country heavily reliant on international aid. The destruction in the wake of the earthquakes is now making matters even worse.

"The challenges for women are multifaceted," says Radwa Khaled-Ibrahim. Wartime trauma and harrowing experiences of fleeing compound their problems, as do the regional authorities.

According to the United Nations, women and children make up the majority of the population in northern Syria, many of whom have already been displaced numerous times inside of the country.

The region is ruled by Syrian rebels and Islamist militias from the Hayat Tahrir al-Sham (HTS) group, who aren't too concerned about keeping hospitals or schools in the province functioning. In the past few years, these institutions have been primarily kept afloat by international aid.

But many hospitals were damaged in the quakes and are also overburdened by the number of injured patients.

The United Nations Population Fund says that programs for woman and girls need a huge amount of investment. According to the UN, at least 350,000 thousand pregnant women in Syria and Turkey were endangered in the immediate aftermath of the quake.

Violence against women and child marriages on the rise

Huda Khayti, director of the Women's Center in the northwestern city of Idlib, says women and girls desperately need menstrual health items and clean toilets. Many of them are having trouble tending to their menstrual health because they're living in tents, emergency shelter or even cars. A lack of privacy is also a major concern.

Even before the earthquake in February, 7 million women and girls in the whole of Syria were in dire need of aid regarding sexual and reproductive health. It's equally important that they receive support when they experience gender-based violence. "The extent of the crisis has led to an increase in domestic violence against women and girls," says Radwa Khaled-Ibrahim from the University of Marburg.

She worries that the number of so-called child marriages could rise, especially since the economic situation is worsening and not all girls can attend school.

The situation is especially problematic because women in Syria's earthquake zones are almost impossible to reach, making it very difficult for aid workers to inform them about reproductive and sexual health. "In the camps on the border to Turkey, there's the added problem that no official papers are being processed. Marriages aren't documented, and those impacted have no legal recourse."

As for Khawla, she never married. She devotes most of her time to her brothers and tending to the household. Before the earthquake, she trained women in the Idlib Women's Center to be hairdressers. She hopes to be able to teach and interact with women again in the future.

In overwhelmingly conservative Syria, which is still ruled by a group that was once closely connected with al-Qaeda, jobs for women are hard to come by.

War and crises drive women from public life

"My brothers give me strength," Khawla says. She has decorated the apartment with a few pieces of furniture and other decorative items. "These things mean something to me," she explains. "This is all I own, and I'm afraid that another earthquake could take everything from me again."

Radwa Khaled-Ibrahim from the University of Marburg empathizes with Khawla's concerns. "For many people, an earthquake is a form of retraumatization; the loss of a place of refuge – no matter how fragile that place may have actually been."

For these reasons alone, the importance of psychosocial support can't be overstated. During and after major crises, the problems facing women are often relegated to the private sphere and their full impact is hidden from the public. Until now, women have mostly fought for spaces where they can enjoy self-determination. "These spaces must be protected and expanded and not just treated like side effects of a catastrophe," says Khaled-Ibrahim.

That's why the Idlib Women's Center, which is supported by Medico International, is such an important place. The slow arrival of international aid to northwestern Syria is increasing the feeling of desperation among those living there. The aid isn't nearly enough to meet the needs of everyone there, not by a long shot.

The European Union has managed to set up an air bridge to the capital, Damascus, but it lies an area controlled by Syria's authoritarian leader Bashar al-Assad. That means it's unlikely that aid will arrive in the opposition-controlled Northwest of the country any time soon. The Assad regime and its ally Russia will simply continue to bomb northwestern Syria.

"War is more predictable than an earthquake as strange as that sounds," says Khawla. She doesn't want to give up hope, but she's finding it harder to remain optimistic.

The world seems to have forgotten about Syria, she says. "It's almost like I've been denied a life of freedom and happiness."

This article was translated from German.