DAMASCUS, Syria – Four years into Syria’s conflict, women have assumed prominent new roles in their families and communities, redefining a once-patriarchal society. One in four refugee families are now headed by women, serving as the sole breadwinners after their husbands are killed or left injured and unable to work. But alongside the newfound financial empowerment, many women have had difficulty adjusting to jobs that were previously restricted to male workers.

Their new roles include construction work, industrial production in steel factories, and the transportation of agricultural products. Others jobs are clearly hazardous, like menial work in chemical production factories, often performed without proper equipment or health insurance.

This new reality isn’t limited to families in Syria. Many of those who fled to neighboring countries have similar stories. In a refugee community in Lebanon, there are college students working several menial jobs at a time in order to provide for their families. Many work in construction, while others work in agriculture or manufacturing. A few manage to find teaching jobs or positions at local NGOs.

Most women quoted in a July UNHCR report on Syria’s new female workforce described ongoing financial challenges, such as a struggle to pay for housing, food and other essential household items. Some told U.N. researchers that they had already spent all their savings and were forced to sell their wedding rings for money.

Syrian women in Lebanon say that the salaries they draw – anywhere from $75 to $300 per month – are lower than the Lebanese average, which can hit $600 per month, and far less than what they would have been paid in Syria before the war.

The work, they say, takes a physical and emotional toll.

On a recent day in a Damascus intensive care unit, Umm Mohammad, 50, lay in her bed, her health deteriorating. Her 18-year-old son Hammar, sitting nearby, recounted her story.

In the summer of 2013, Umm Mohammad found herself the sole caretaker of her two younger sons, Hammar and 12-year-old Ammar. For days, she had been waiting to hear from her husband and 22-year-old eldest son, who had both been taken in for questioning by regime forces.

It wasn’t long before she started running out of money, and soon after, she took her two remaining boys and left the cheap rented house the family had been living in near Damascus.

Without a husband and without money, Umm Mohammed, who had always been a housewife, started looking for work. Her first job was at a construction site, where she was responsible for filling sand bags and casting building blocks. The physically demanding job left her exhausted and with barely enough money – $75 a month – to feed her sons. She soon left the construction site for a job in the dairy business where the pay was the same but the work was less exhausting.

But the dividends of her meager salary kept shrinking as food and rent prices spiked. As a result, she had to depend on aid given by local charities to make ends meet.

Meanwhile, she had been knocking on doors and talking to security personnel to find her missing husband and son. “One day, she was told that both my father and brother had been tortured to death in one of the detention centers,” Hammar says. “Stricken by grief, her physical health deteriorated.”

Now she is in the hospital, her remaining sons unsure of how they will make ends meet with the family’s remaining breadwinner unable to work.

Edited by Karen Leigh.