A former Miss Teen Bermuda who became an international award-winning midwife has spearheaded an attempt to make sure women in war-torn Syria get proper maternity care.

Pandora Hardtman set up a programme to promote safe births in the devastated Middle Eastern country.

Now she is running the project from a base in Turkey, only 75 miles from the city of Aleppo, which was captured from rebel forces in 2016 after heavy bombing by the Syrian Government.

Dr Hardtman said women travelled across the Syrian-Turkish border to benefit from her expertise.

She added that watching them climb on buses to return to the dangers of their homeland was one of the hardest parts of her job.

Dr Hardtman said: “The first time, I cried because literally I felt I was sending them back to their deaths.

“I don’t go any more, it’s too much. You have to take these measures to survive because it’s personal. It’s the coping skills that you learn over time.

“I can call their names and faces to mind now. I know their families.”

Dr Hardtman said her work in the Turkish border city of Gaziantep, where hundreds of thousands of Syrian refugees fled after a brutal civil war broke out, meant adapting to the reality that many pregnancies were the result of wartime rape and where women give birth in primitive conditions compared with Western countries.

She arrived in the region two years ago as a United Nations consultant to set up a programme to train Syrian nurses as midwives.

Dr Hardtman, who earlier worked in Bangladesh and has a doctorate in nursing practice, is now employed by G12, a German development agency.

She said: “The challenge with the Syrian conflict is that because it has been so protracted there is a huge focus on trauma care.

“When women are forced to flee because of displacement, it’s the maternal health services that can be thrown by the wayside.”

One of her first tasks was to find midwives already in northern Syria and bring them across the border for intensive training to raise their standards to International Confederation of Midwives levels and teach vital skills such as neonatal resuscitation. Dr Hardtman said: “Every time they come, it’s an act of faith.”

One woman hid under blankets with her baby son to get across the border because of passport problems, while another, responsible for delivery of babies in nine villages, had not left her mountain district for years.

Dr Hardtman said she worked in a strict Islamic environment in Bangladesh — but that it was still a shock to arrive in Gaziantep and face a room where Kurds and rebels were to be trained together, with the help of translators.

She explained: “The men and women are separated. I remember seeing 12 women completely in black, with only two faces I could visualise. I pulled out the condoms and they all screamed and turned around.”

Dr Hardtman later trained a group of male imams, who “by the end ... were blowing up condoms, filling them with shaving cream. It was truly one of my most unforgettable experiences.”

She said she had to change a plan to use bananas to teach sex education after she was told the erotic connotations of the fruit meant they were off-limits.

Dr Hardtman, a former Bermuda Institute pupil, added that light-hearted moments were rare amid the heartbreak and terror.

She said a young student on her midwifery programme died in an explosion in August.

Dr Hardtman added that protesters with placards, which accused the UN, a neutral global organisation, of having blood on its hands gathered outside a house she was in as Aleppo fell.

She watched as they were arrested by Turkish police and admitted: “I cried all night long”.

Dr Hardtman said: “The world has forgotten us. There are piles of dead babies. It’s pretty intense.” But she added: “Somehow we are doing it.”

Dr Hardtman, who won the American College of Nurse Midwives Distinguished Service Award last year, left the island in the late 1990s because of a hospital policy which prevented professional midwives from using their skills to the maximum.

She now lives in Georgia in the United States but has travelled all over the world as a midwifery specialist, including Rwanda, Nigeria, Indonesia and Mongolia.

Dr Hardtman said: “I kind of feel like ‘to whom much is given, much is required’. I guess I could have stayed at home but I refused to lose my skills that I had worked so hard for.”

And she added: “If the situation was not what it was, I wouldn’t be where I am, doing all this really cool stuff.”