I was linking to Cairo and used this patch to make it work,
--- cairo.h.orig 2016-06-19 22:41:04.000000000 -0700
+++ cairo.h 2016-12-22 23:22:34.000000000 -0800
@@ -53,9 +53,11 @@
#ifndef cairo_public
# if defined (_MSC_VER) && ! defined (CAIRO_WIN32_STATIC_BUILD)
# define cairo_public __declspec(dllimport)
+# elif defined (__WATCOMC__) && defined (__OS2__)
+# define cairo_public __declspec(__cdecl)
# else
# define cairo_public
# endif
#endif
CAIRO_BEGIN_DECLS
And of course create an OMF import lib