Samira al-Nasr has delivered thousands of babies over four decades in the city of Raqqa, but she says nothing was like the childbirth she attended two years ago as the handpicked midwife of the Islamic State.

Moments after an infant was born to a Turkish couple — an Islamic State fighter and his young wife — they tried to dress their newborn son in a custom-tailored military uniform. The father proudly declared that the child would grow up to become an Islamist militant. Nasr was revolted. She said she persuaded the father not to use the uniform, telling him the material was too coarse for the baby’s delicate skin.

Nasr, 66, is among the millions who lived under the Islamic State’s violent and austere rule in Syria and Iraq, but she witnessed a side of the militancy that perhaps no other outsider did. She was coerced, she said, into delivering countless babies for Islamic State families, attending the most intimate moments of their secluded lives, which she described as alternately ordinary and grotesque.

Entrusted by the Islamic State with delivering the “cubs of the caliphate” shortly after it captured Raqqa in 2014 and made the city its capital, Nasr began making house calls at all hours. During the three years she was shuttled by taxis and gunmen to the homes of Islamic State families, most of them foreign, Nasr’s emotions ran from fear to anger to helplessness, she said. There was none of the joy or pride that had sustained a career of midwifery delivering babies for a generation of Raqqans.

“They had no respect for the profession,” she said of the militants and their wives. “I was like a prop, not a caregiver. I would attend the birth and they would toss me out.”

The children of the “caliphate” were themselves treated as props. They were central characters in Islamic State propaganda videos, which often showed children of diverse European, Asian and African backgrounds studying Islamic State teachings, or playing and training with weapons. Other videos purported to show adolescent boys executing people deemed apostates or enemies.

In their private interactions, Nasr also found the Islamic State parents often to be cruel, but sometimes tender.

 The young women were mostly elated upon becoming mothers, and in a practice that seemed ignorant to Nasr but is actually increasingly common in the West, they all insisted on holding the newborns tight and breast-feeding them even before the umbilical cord was cut. The women would frequently whisper a few words of prayer in halting Arabic exalting the role of mothers in Islam while pressing the infants to their chests.

But the husbands imposed harsh rules. They forbade Nasr to give the women painkillers or other medicine while they were in labor. She said some of the women went through 10 hours of labor without the opioids or muscle relaxers that Nasr had routinely given to women in the past.

 “They wouldn’t let me give her a thing,” she recalled. “These women endured a lot of pain.”

The husbands claimed that the medication violated their religious tradition and offered platitudes about how the women would reap greater rewards from God for their suffering. The wives obediently agreed.

But Nasr said she knew better. The men were concocting these excuses because they feared she might poison the women, and she felt sorry for them.

“They just didn’t trust the medicine coming from me, an outsider,” she said. “They wouldn’t even let me give her a glass of water unless the husband poured it himself.”

When Nasr recalled the foreign women repeating their husbands’ bromides about rewards in the afterlife, she mimicked their heavily accented Arabic in a high-pitched voice, and her bright blue eyes welled up with tears of laughter.

Mostly, however, she remembered her experiences in delivering Islamic State babies with revulsion and anger. She felt humiliated by how she was treated. Nasr has a soft face and slow, labored walk, but she is a proud woman who knows her craft and is accustomed to respect. She also has a sharp tongue and has been used to giving commands and guidance — not being ordered about.

A sign outside Samira al-Nasr’s home in Raqqa reads: “Midwife Samira al-Nasr, Umm Alaa.” The last part means “Alaa’s mom,” a nickname she acquired after the birth of a son who would go on to become a doctor in Raqqa.

On the wall outside her home, largely spared the devastation suffered by her neighbors, hangs a sign advertising her services. It bears the name she’s widely known by: Umm Alaa. It means “Alaa’s mom,” a nickname she acquired after the birth of a son who would go on to become a doctor in Raqqa. Three bullet holes blemish the sign, a reminder of the ferocious battle last year as U.S.-allied forces ousted the Islamic State from the city.

The ordeal has left her bitter and confused. She is still reckoning with her role in helping the “caliphate” pursue its proclaimed goal of “remaining and expanding.”

Nasr said she had initially tried to resist working for Islamic State couples, but the consequences of not cooperating soon became clear: imprisonment or even execution in a public square. Her husband, a slightly built, bookish retired Arabic teacher, had been jailed for a few days after he tried to mediate between the feared Islamic State morality police and a neighbor who had run afoul of their strict code.

“What choice did I have?” Nasr asked. “I would do it against my will. Even if I was afraid or disgusted, it is irrelevant. I was forced to help them.”

Maternity ward services had been offered free by the Syrian government, but Islamic State administrators began imposing fees for these services at the hospital to raise revenue for their nascent city-state. They charged the equivalent of about $20 for a regular birth and $50 for a Caesarean section.

But the militants faced a problem, Nasr recounted. They did not trust local doctors and nurses to attend to their wives, fearing that the mothers and their newborns might be poisoned by a hospital staff hostile to their rule.

As the group consolidated its power in Raqqa in late 2014, Nasr and her husband were told by their Kurdish neighbor that he was being evicted. In his place came a Kenyan man, his wife, three adult sons and German daughter-in-law. Word spread in the neighborhood that he was an administrator for the Islamic State who went by the nickname Abu Walid and was in charge of the affairs of widows whose militant husbands had died fighting.

Not long after, Abu Walid introduced himself. He had noticed the sign advertising Nasr’s services and invited her to come to his place, which he called the “House of the Widow.”

Nasr declined, pretending to be too old and frail and saying she had retired from the profession. Abu Walid, who was armed, didn’t accept her refusal. He insisted she accompany him to the large house. There, Nasr recalled, she found pregnant women from an astonishing array of nations: There were Tunisians, Saudis, Egyptians, Yemenis, Somalis, Moroccans, Irishwomen, Frenchwomen, Germans, Russians, Turks and women from the Caucasus and African countries she could not identify.

She was also struck by the Syrian wives. The youngest were 13 and the oldest no more than 15. Over the next three years, Nasr said, she would sadly note that the Syrian wives were never older than 18 — an illustration of how the new rulers of Raqqa, mostly foreigners, had plundered the locals.

Samira al-Nasr, 66, sits in her living room in Raqqa with her husband, Hassan al-Hammam, 67. “They had no respect for the profession,” she said of the militants and their wives. “I was like a prop, not a caregiver. I would attend the birth and they would toss me out.”

“These were not humans,” she said of the militants. “They were a different kind of creature.”

Nasr said she doesn’t remember how many babies she delivered during the Islamic State occupation, saying that there were too many and that she had always hoped “each one would be the last.” But she does recall the last one vividly.

In the final days of the battle to evict the militants in October, she was summoned to the house of a Somali fighter and his Yemeni wife. The woman was already in labor and had a bleeding head wound. Nasr was told by the fighter that he was riding his motorcycle at high speed to avoid the U.S.-led coalition’s airstrikes and that his wife had fallen off the back of the bike.

The husband demanded that Nasr deliver the infant, she said, but forbade her to treat the woman’s injury. 

Sitting in her house, warmly decorated with caramel-colored floor cushions and an ornate peach Persian-style rug, Nasr said she has recently been reflecting on her time as the Islamic State’s preferred midwife, grappling with the morality of her actions. 

On the one hand, she said, she was forced to work for the Islamic State and had acted as anyone in her position would. Moreover, she felt a moral obligation to give medical attention to helpless and blameless children.

But on the other, Nasr suggested, by giving in to the militants and thus avoiding punishment or even death, she had courted devastating retribution from God.

Days before his 40th birthday in October, Nasr’s son Alaa had headed out into the city during an aerial barrage to provide medical attention to victims. Nasr had begged her son not to go, but he told her it would be a “dishonor to him as a doctor to not help people in need.”

Alaa was treating the survivors of an earlier airstrike when the building he was in was bombed. Alaa was killed.

“My heart is dark from the injustice,” Nasr said, now weeping. “My pain is deep.”

Mustafa Alali contributed to this report.

Photo editing by Olivier Laurent. Design and development by Jason Bernert.