Johann Hari on the plight of pregnant women in the West Bank, where babies are dying needlessly
Published: 23 December 2006
In two days, a third of humanity will gather to celebrate the birth pains of a Palestinian refugee in Bethlehem - but two millennia later, another mother in another glorified stable in this rubble-strewn, locked-down town is trying not to howl.
Fadia Jemal is a gap-toothed 27-year-old with a weary, watery smile. "What would happen if the Virgin Mary came to Bethlehem today? She would endure what I have endured," she says.
Fadia clutches a set of keys tightly, digging hard into her skin as she describes in broken, jagged sentences what happened. "It was 5pm when I started to feel the contractions coming on," she says. She was already nervous about the birth - her first, and twins - so she told her husband to grab her hospital bag and get her straight into the car.
They stopped to collect her sister and mother and set out for the Hussein Hospital, 20 minutes away. But the road had been blocked by Israeli soldiers, who said nobody was allowed to pass until morning. "Obviously, we told them we couldn't wait until the morning. I was bleeding very heavily on the back seat. One of the soldiers looked down at the blood and laughed. I still wake up in the night hearing that laugh. It was such a shock to me. I couldn't understand."
Her family begged the soldiers to let them through, but they would not relent. So at 1am, on the back seat next to a chilly checkpoint with no doctors and no nurses, Fadia delivered a tiny boy called Mahmoud and a tiny girl called Mariam. "I don't remember anything else until I woke up in the hospital," she says now. For two days, her family hid it from her that Mahmoud had died, and doctors said they could "certainly" have saved his life by getting him to an incubator.
"Now Mariam is at an age when she asks me where her brother is," Fadia says. "She wants to know what happened to him. But how do I explain it?" She looks down. "Sometimes at night I scream and scream." In the years since, she has been pregnant four times, but she keeps miscarrying. "I couldn't bear to make another baby. I was convinced the same thing would happen to me again," she explains. "When I see the [Israeli] soldiers I keep thinking - what did my baby do to Israel?"
Since Fadia's delivery, in 2002, the United Nations confirms that a total of 36 babies have died because their mothers were detained during labour at Israeli checkpoints. All across Bethlehem - all across the West Bank - there are women whose pregnancies are being disturbed, or worse, by the military occupation of their land.
In Salfit, on the other side of the West Bank, Jamilla Alahad Naim, 29, is waiting for the first medical check-up of her five-month pregnancy. "I am frightened all the time," she says. "I am frightened for my baby because I have had very little medical treatment and I cannot afford good food ... I know I will give birth at home with no help, like I did with Mohammed [her last child]. I am too frightened to go to hospital because there are two checkpoints between our home [and there] and I know if you are detained by the soldiers, the mother or the baby can die out there in the cold. But giving birth at home is very dangerous too."
Hindia Abu Nabah - a steely 31-year-old staff nurse at Al Zawya Clinic, in Salfit district - says it is "a nightmare" to be pregnant in the West Bank today. "Recently, two of our pregnant patients here were tear-gassed in their homes ... The women couldn't breathe and went into premature labour. By the time we got there, the babies had been delivered stillborn."
Many of the medical problems afflicting pregnant women here are more mundane than Jamilla's darkest fears: 30 per cent of pregnant Palestinians suffer from anaemia, a lack of red blood cells. The extreme poverty caused by the siege and now the international boycott seems to be a key factor. The doctors here warn grimly that as ordinary Palestinians' income evaporates, they eat more staples and fewer proteins - a recipe for anaemia. There is some evidence, they add, that women are giving the best food to their husbands and children, and subsisting on gristle and scraps. The anaemia leaves women at increased risk of bleeding heavily and contracting an infection during childbirth.
Earlier this year, conditions for pregnant women on the West Bank - already poor - fell off a cliff. Following the election of Hamas, the world choked off funding for the Palestinian Authority, which suddenly found itself unable to pay its doctors and nurses. After several months medical staff went on strike, refusing to take anything but emergency cases. For more than three months, the maternity wards of the West Bank were empty and echoing. Beds lay, perfectly made, waiting for patients who could not come.
In all this time, there were no vitamins handed out, no ultrasound scans, no detection of congenital abnormalities. Imagine that the NHS had simply packed up and stopped one day and did not reopen for 12 weeks, and you get a sense of the scale of the medical disaster.
Some women were wealthy enough to go to the few private hospitals scattered across the West Bank. Most were not. So because of the international boycott of the Palestinians, every hospital warns there has been an unseen, unreported increase in home births on the West Bank.
I found Dr Hamdan Hamdan, the head of maternity services at Hussein Hospital, Bethlehem, pacing around an empty ward, chain-smoking. "This ward is usually full," he said. "The women who should be in this hospital - what is happening to them?"
They have been giving birth in startlingly similar conditions to those suffered by Mary 2,000 years ago. They have delivered their babies with no doctors, no sterilised equipment, no back-up if there are complications. They have been boycotted back into the Stone Age. The strike ended this month after the PA raised funds from Muslim countries - but the effects of stopping maternity services are only now becoming clear. Hindia Abu Nabah says: "There is a clear link between the deteriorating health situation and the international boycott.
Amid this horror, one charity has been supporting pregnant Palestinian women even as their medical services fell apart.
Merlin - one of the three charities being supported by the Independent Christmas Appeal - has set up two mobile teams, with a full-time gynaecologist and a paediatrician, to take medical services to the parts of the West Bank cut off by the Israeli occupation. They provide lab technicians and ultrasound machines - the fruits of the 21st century.
I travelled with the team to the Salfit region - scarred by Israeli settlements pumping out raw sewage on to Palestinian land - to see women and children desperately congregating around them seeking help. Amid the dozens of nervous women and swarms of sickly children, Rahme Jima, 29, is sitting with her hands folded neatly in her lap. She is in the last month of her pregnancy, and this is the first time she has seen a doctor since she conceived.
"The nearest hospital is in Nablus, and we can't afford to pay for the transport to get there through all the checkpoints," she says, revealing she is planning - in despair - to give birth at home. Even if she had the cash, she says she is "too frightened of being detained at the checkpoint and being forced to give birth there". She sighs, and adds: "I will be so relieved to finally be seen by a doctor, I have been so worried." But when she returns from seeing the doctor, she says: "I have anaemia, and they have given me iron supplements," supplied by Merlin. She can't afford to eat well; she lives with her husband and four children in a room in her mother-in-law's house, and her husband, Joseph, has been unemployed since his permit to move through the checkpoints expired. "The doctor says I should have been seen much earlier in my pregnancy. My baby will probably be born too small."
All the problems afflicting these 21st century Marys are paraded in Merlin's clinic. One terrified, terrorised mother after another presents herself to the specialists here, and leaves clutching packs of folic acid, calcium, iron and medicine. Dr Bassam Said Nadi, the senior medical officer for this area, says: "I thank Merlin for the specialist care they have brought. Not long ago, we didn't even have petrol in our cars. Alongside other organisations, they are helping us survive this terrible period in our country's history."
Merlin can only maintain these mobile clinics with your help. Leaning in the doorway of her bare clinic, Hindia Abu Nabah says: "Tell your readers that we need their help. There are no Hamas or Fatah foetuses. They don't deserve to be punished. I couldn't stand to look another anaemic woman in the eye and tell her that her baby will be underweight or malformed and we don't have iron supplements to give her. I can't go back to that. I can't."