A talk with the midwives Ilmen Alberte Rotwitt and Synne Holan
A talk with the midwives Ilmen Alberte Rotwitt and Synne Holan.
“We were in contact with our colleagues in Gaza the first 3 weeks after the war in Gaza started, but now we have lost contact with them. We are very worried. Many of our friends and colleagues live in Beit Hanoun and have had to flee south with their families. We do not have direct information about the situation for women and children other than from the news and information we have from other wars and crisis.”
Pregnant women and newborns are among the most vulnerable in war and conflict. There are currently around 50 000 pregnant women in Gaza, of which 5500 are due to give birth within this coming month, according to the UNFPA. The conditions under which women in Gaza give birth and for their newborns are currently extremely challenging.
The relentless bombardment of Gaza leads to premature and unsafe births. More women must give birth at home without a midwife or a doctor and without water, clean clothes, as it is unsafe or often impossible to get to the hospital. Hospitals are strained, as all resources go to receiving the constant flow of mass casualties. The biggest hospital in Gaza, Al Shifa hospital, has had to close its maternity ward to give space to injured patients. We get reports every day of horrible situations for women, children, and families, also of medical personnel who work under extreme conditions.
NORWAC has been implementing the Quality Maternal and Newborn Care project at the Al Shifa and Kemal Adwan hospitals in Gaza since 2020. It targets 250 midwives, as well as doctors and nurses, aiming to improve the quality of care for 20 000 women giving birth and their newborns annually.
The Midwifery NORWAC team consists of:
- Jamalat Ali, Midwife and coordinator in Gaza
- Ellen Blix, Midwife and professor at Oslo Met,
- Anne Elisabeth Bjerkreim, Midwife at OUS
- Ilmen Alberte Rotwitt, Midwife in the primary health care services,
- Synne Holan, Midwife.
This September, Alberte was in Gaza and conducted training in breast-feeding together with Jamalat. She met with Midwives and Doctors and visited hospitals and primary health clinics. Many would think that breastfeeding was the norm in Gaza and that every new mother just managed very well. But everywhere in the world women need support and help to start up this important process. New research and knowledge were presented and discussed everywhere she went.
The 17 year-long Israeli blockade of Gaza has severely impeded the health sector. It is not only a blockade of movement of people and goods, but a blockade of knowledge, making training programs like this very important. The blockade further leads to a chronic shortage of resources. One consequence of this is that there are not enough resources to give sufficient breastfeeding support to women after birth. This is one of the aspects the training programme has sought to change.
Other parts of the programme:
- Women’s right to have a companion of her choice throughout birth.
- Strengthening multidisciplinary teamwork within obstetric care.
- Improve documentation.
- Training for emergency situations in birth for mothers and newborn
- Implementing evidence-based practices such as delayed cord clamping, skin-to-skin. contact, and early breast feeding.
In crises like the one Gaza is facing now, breastfeeding is both extremely important and extremely challenging. Breast milk is the source of food and nutrition for the newborn but is also a vaccine protecting the baby against diseases. However, since the outbreak of this war, Israel has further tightened the blockade, by cutting the water and electricity as well as flow of goods into Gaza. This leaves the population on the brink of starvation, and thus increasingly malnourished and dehydrated. This, in addition to constant stress and high levels of adrenalin, can severely impede the quantity and quality of mothers´ breastmilk. Mothers are further forced to drink unsafe, salt water, making them ill. Infant formula might be hard to obtain, there is no water to clean bottles, and due to lack of electricity, it is not possible to boil the water for the formula. This leaves newborns and infants in Gaza at high risk of starvation, illness, and death.
In a crisis, one must keep in mind the long-term consequences as well. The war breaks down an entire health care system that has functioned quite well in spite of the blockade of Gaza. Systems for maternal and newborn care and child vaccination programs are stopped. This will have a huge impact on future health. Hospitals are strained. The biggest hospital in Gaza, Al Shifa, is only hours away from running out of fuel, putting all patients’ lives at risk, including premature babies in incubators.
Nobody knows the future, but our solidarity with Palestine will not end.
We look forward to seeing and working with our brave and clever colleagues in Gaza when this horrible war is over.