‘‘I’m overdue.”
“I just delivered and I have no baby clothes or diapers for the baby.”
“I’m bleeding, I’m a pregnant woman.”
“I’ve been drinking salt water for three days straight.”
These are just a few of the messages that Ferhan Güloğlu, a co-founder of the group Safe Birth in Palestine Project, has received on the organization’s Instagram account from women in Gaza. The group, which launched shortly after the Israel-Gaza war began, aims to provide long-distance medical care and advice to pregnant and postpartum women in the besieged region.
Thus far, Safe Birth in Palestine Project has provided Arabic language videos that give emergency unassisted birth instructions, and it is collaborating with local midwives on the development of an antenatal clinic. The group has also facilitated online consultations via Whatsapp between doctors who are members of the project and Palestinian women. Additionally, it has shepherded some medical supplies, including necessary vitamins, to Egypt’s border with the territory.
But reaching expecting and postpartum women in an increasingly isolated, war-torn territory has been difficult and dangerous. The group’s co-founders have medical training and experience working in disaster areas, and even they have been shocked by the conditions in Gaza. Though Safe Birth in Palestine has managed to provide some desperately needed expert counsel remotely, effective medical care for pregnant and birthing women is simply impossible to deliver via teleconference.
“I have nothing to say to them,” Güloğlu said of the women who message her group on Instagram. “There are pregnancy guidelines – the medical team is very well-versed in that. We are knowledgable in that. But health and nutrition are problems.”
The issues that Safe Birth in Palestine has encountered while trying to deliver aid give a glimpse into the extreme challenges that pregnant women, new mothers and children in the region are facing. As the crisis worsens, though, the group remains steadfast in its commitment to provide whatever care it can.
‘We were naive’
In the days following Hamas’s 7 October attack on Israel, Güloğlu, a DC-based medical anthropologist who specializes in reproductive politics and childbirth in the Middle East, sought to mobilize her networks to help the people in Gaza. So when her former colleague, Sare Davutoğlu, an Istanbul-based gynecologist who has worked with birthing women in disaster areas, reached out, she immediately agreed to partner on Safe Birth in Palestine Project.
Together, the founders connected with about 20 NGOs across the world that pledged to contribute aid and to work in solidarity. People in the US, Spain, Portugal, France and Turkey, after hearing about their efforts, reached out to ask how they could help. “I emailed them saying: ‘Look, something is unfolding in front of our eyes. It’s not just a huge humanitarian crisis, but this crisis is especially targeting pregnant and postpartum women,’” Güloğlu said. “This is a war on birthing people, this is a war on birth.”’
At the onset of the war, the UN estimated that there were more than 50,000 pregnant women in Gaza, with more than 180 births occurring each day. There are few remaining hospitals in the area – Israeli forces have conducted airstrikes near and on hospitals directly, damaging buildings and making it hard to provide services. The hospitals that are still in operation are struggling with a lack of resources and fatigued staff.
Even before the conflict, due to Israeli blockages, many Palestinian doctors lacked access to specialized neonatal training and equipment, and faced shortages of other medical supplies. But just one month after Israel’s bombardment began, doctors in Gaza were forced to perform caesarean sections without anesthesia. Some women are unable to deliver stillborn babies, as medical staff are overwhelmed by emergency patients following airstrikes. Others have been discharged within hours of their caesareans due to the influx of patients. Without prenatal treatment, conditions like pre-eclampsia, a blood pressure condition that can be fatal if not treated, go undiagnosed. And when babies are born, they lack critical postnatal care and a clean, stable home.
Many Palestinians are dying not just from bombardment, but also from starvation. Women who are breastfeeding, which is the main way to feed babies without access to formula, are advised to drink 16 cups of water a day, but finding clean water in Gaza is a major problem. For Safe Birth in Palestine, providing medical care to women who simply need sustenance has been one of its largest hurdles.
“We were naive,” Güloğlu said. “We were honestly hoping that there would be a safe corridor, safe zone for medical facilities … It’s one of the worst crises, if not the worst, on women and children. In Afghanistan, hospitals were a safe space, but here it’s not.”
Finding holes in the system
Given these dire conditions, Safe Birth in Palestine can’t deliver the type of care it initially planned on contributing at the start of the war. The group has had to pivot and strategize about how to work within tight boundaries. It had aimed to send midwifery kits, Davutoğlu said, but was unable to include mobile ultrasound devices because the Israeli government said the metals in the devices could be used as weapons. It attempted to send medical kits, but they were blocked at the border. The organization’s contacts on the ground said it might be more than a year before they are able to get the items into Gaza.
Despite these roadblocks, the group started a fundraising campaign with Doctors Worldwide, an organization that Davutoğlu co-founded that has been active in Gaza for over 15 years. Safe Birth in Palestine provided Doctors Worldwide with lists of materially necessary items for birthing people and, through the money raised, Doctors Worldwide was able to to procure the items and distribute them via its staff in Gaza.
The guidelines for what materials can enter Gaza are changed “arbitrarily” by both the Egyptian and Israeli governments, according to Davutoğlu. She said safe Birth in Palestine was initially told that it would be able to send certain medical packages, but that they were turned away, meaning that medications that require specific containment, like insulin, expired. Current guidelines from the border governments stipulate that packages must be transparent, Davutoğlu said, and that they must email authorities ahead of time, informing what they are planning to send. Even so, she said, packages have been rejected at the border.
“As the crisis unfolded, we had to strategize as we go and it proved much harder than we expected,” Güloğlu said. “We are doing anything and everything that we can. So all these organizations we are in collaboration with ... We had to find holes in the system to deliver the aid.”
In late December and January, some British and US doctors were permitted into the strip. Members of Safe Birth in Palestine Project collected prenatal vitamins and other supplies for the doctors to take with them as they began to reach people who had been without treatment for more than 100 days.
Looking toward the future, the group recognizes that helping restore the medical system will require a long-term, dedicated team. Knowing the trauma that expectant women and their babies have experienced during the war, Davutoğlu and other members of the group who are trained in pregnant and perinatal psychology are already planning to provide specific psychological care once the war ends.
Güloğlu hosts weekly Zooms with doctors across the world to discuss the situation and prepare to help on the ground when more doctors are allowed to enter the region, perhaps following another ceasefire, the end of the war or during a medical delegation.
“We are not stopping after the ceasefire,” Güloğlu said. “We are dedicated to this in the rebuilding stage.”
Hope in the face of hopelessness
About a month ago, Güloğlu was helping an expectant mother of five who was displaced to Khan Younis. The woman was concerned because she had stopped feeling the baby’s movements. Güloğlu and the woman communicated via WhatsApp, but the woman lost internet access and was unable to reconnect for several days.
“Birth doesn’t wait. Pain doesn’t wait,” Güloğlu said. “Time is especially important. If you don’t feel the baby, you need to take immediate steps, so blackouts during those moments are especially horrendous. The care is very time-sensitive.”
Eventually, they reconnected and the woman tried to send medical documents for doctors to review them, but another blackout prevented it. Güloğlu does not know what happened to the woman or the baby.
“It has been beyond our imagination, beyond our wildest nightmare,” Güloğlu said.
Despite the bleakness of the situation, the difficulty in accommodating changing rules and regulations, Güloğlu said that the resiliency and hopefulness of Palestinian people, in general, and of expectant women and mothers, specifically, motivates her to keep going. “I got some messages saying, ‘thank you’ from a pregnant woman in Gaza. She said: ‘I didn’t think anybody cared, but now we know all these people that we never can meet in person – they do care.’ I think bringing these organizations together specifically for childbirth is meaningful to them.”
And though they are living through war and genocide, the birth of a new child remains a joyous occasion for women in Gaza.
“What amazes me the most about birth and about Palestinian resistance is the unyielding joy of it,” Güloğlu said. “Having a baby becomes a hopeful event, even in Gaza right now.”
