For some women it will be a day of celebrating achievements. For many others, though, International Women’s Day will offer no respite from the absence of even the most basic care for their unborn babies.
At the regional centre for one of the world’s largest medical humanitarian organisations, in Dubai, Saturday is a chance to raise awareness about the plight of hundreds of thousands of women in the region who still lack adequate access to proper maternal and neonatal care.
From a clean and organised eighth-floor office in a commercial tower block in Tecom, a team from the regional headquarters of Doctors Without Borders – or Medicins Sans Frontieres (MSF) – is deciding the best ways to tackle some of the shocking and inexcusable gaps in maternal and child health care still prevailing across the Middle East.
Its Delivering Hope campaign, launched to coincide with the March 8 celebrations, sits in stark contrast to some of the other landmarks for women being marked this weekend.
Worldwide, every day, 1,000 women die from pregnancy and childbirth related-complications.
In countries such as Afghanistan and Yemen, along with those that are temporarily housing hundreds of thousands of displaced refugees, the official numbers are shockingly high, but a lack of adequate research and statistics prevents the true scale of the problem from being known.
“One of the aspects that is pushing us further today is the fact that, particularly here in this region, we are working in various conflict areas,” says Dr Chiara Lepora, the programme manager for operations in the Middle East.
A trained medical practitioner, Dr Lepora has worked as a field doctor with MSF in the Darfur region of west Sudan, Liberia, Somalia, Chad, Cameroon and South Sudan since joining the organisation 12 years ago. She also taught Global Health and Humanitarian Affairs at the Josef Korbel School of International Studies at the University of Denver.
“There is a special attention when working in conflict areas given to wounded people. The indirect victims, however, are not the fighters themselves. They are the women and children who lose access to care completely.
“They are still going to go through the normal types of experiences that any women go through, but under very different circumstances. The difference is that when we work in these types of [conflict] areas our capacity to respond to this is challenged.”
MSF, a non-profit group, has a large presence in the Middle East, particularly in Afghanistan, Yemen and Iraq. The vast majority of its staff are recruited locally, most of them working with just a stipend instead of a salary. Between 5 and 10 per cent are expatriate staff.
“They may work with us because MSF provides them with the necessary equipment and drugs, and the safety aspect, and the humanitarian aspect,” says Dr Lepora, who acknowledges that the money they make can be as little as 10 per cent of the salaries earned by their counterparts working in more normal circumstances.
For MSF, the Delivering Hope campaign is a call for awareness rather than funding. It does not take money from any governments in the Middle East. The more awareness there is about the situation, it says, the easier it is to lobby governments for access and protection in areas that are difficult to reach and where normal health services have seriously diminished or even ceased altogether.
“Labour remains the moment that is most risky for a woman’s life,” Dr Lepora says. “There is a high risk of mortality when there are no skilled attendants, no drugs to intervene in case of complications, and no option to refer to caesarean section when it is needed.
“When we work in conflict situations it means one of these factors might be missing, and that is enough to create a high level of risk.
“One of the real problems is as soon as conflict situations arise, people tend to stay at home. This becomes very problematic when a women starts labour, so we try to support emergency transfers from houses or rural clinics in MSF ambulances, which are somewhat protected.”
The biggest cause of maternal deaths is haemorrhaging, which occurs in one in four of such cases followed by infection (15 per cent), which can often be treated easily with antibiotics, if they are available.
MSF has already had major successes in other parts of the world that it hopes to replicate in this region as the situation for some, especially displaced refugees, worsens.
In Sierra Leone and Burundi, where the maternal mortality rates are third and fifth highest in the world, civil wars have crippled the health systems.
In 2006, MSF started working in the Kabezi district of Burundi with the main aim of reducing maternal mortality. Three years earlier it began running a hospital in the Bo district of Sierra Leone. The two major challenges in both areas were a lack of adequate referral facilities for emergency obstetric and neonatal care, and poor geographic access to these for women with complicated pregnancies.
Thanks to MSF funding and staff, women are now able to take advantage of a package of emergency care that includes safe blood transfusions, neonatal resuscitation, assisted delivery and the administration of antibiotics. There is also a free ambulance service. The MSF services are the only ones of their kind in either region.
MSF statistics estimate that there was a 61 per cent decrease in maternal mortality in Bo district after the introduction of its services, and a 74 per cent reduction in Kabezi.
The organisation is trying to use this example to spur countries in the Middle East to appreciate the benefits of maternal care, which are often low on a list of priorities, especially when countries are in a state of, or recovering from, civil unrest.
A recent MSF report states: “Achieving these very encouraging results does not require a large investment, and the services do not need to be state of the art ... a common assumption is that improving access to emergency obstetric care is too costly, but MSF’s experience shows that this need not be the case.”
“Maternal health is not a mystery”, Dr Lepora says. “We know what needs to be done from the beginning to the end to get the maternal death rate to almost zero.”
The need for these sorts of humanitarian health programmes in this region is constantly growing as certain countries and areas face growing unrest or disruption.
According to the UNHCR, the UN Refugee Agency, there are almost 2.5 million registered Syrian refugees, of which 50.1 per cent are women and 18 per cent children younger than four years old.
“In general, if we talk about refugees, these are one of the populations that are more at risk,” Dr Lepora says. “Today there is a widespread concern with some specific international agencies in addressing problems related to maternal health.
“Having said that, one of the problems that remains in refugee camps concerns neonatal deaths.”
One of the organisation’s longest-running regional programmes is in Afghanistan, where it has worked since the early 1980s.
In 2012, it added to its portfolio and took on an 83-bed maternity hospital in Khost, which has 1,000 deliveries every month.
Recently, it completed a comprehensive report ahead of the withdrawal of western troops at the end of the year.
Despite this much-talked-about troop withdrawal and the supposed new stability in the country, the report highlights some serious and continuing problems.
“In the search for a success story, health care is repeatedly held up as a glowing example of state-building efforts,” it states. “Even though progress has undoubtedly been made in healthcare provisions since 2001, reported rates of maternal and infant mortality in Afghanistan remain among the highest in the world, casualties from violence are mounting, and unmet medical and humanitarian needs continue to soar.”
The United Nations listed reducing child mortality and improving maternal health as two of its eight Millennium Development Goals, created in 2000.
According to UN figures, 50 million babies worldwide are delivered without any skilled care and only half of women in developing regions received recommended health care during their pregnancies.
“The part that remains very concerning is the ... neonatal deaths,” Dr Lepora says, referring to babies who die within 28 days of birth.
“The tragic part is there are no statistics for this region. We have statistics from our own projects, but that is it.”
When it comes to the financial cost of saving lives, Dr Lepora refuses to adopt a common fund-raising tactic used by many large NGOs and charities.
“I don’t want people to think ‘if I give one dollar I will save one life’,” she says. “But what I can say is it’s an extremely cost-effective intervention.
“The impact that it has compared to the cost is extremely positive. But it’s not a silly problem, I wouldn’t want people to banalise it by saying ‘I gave a dollar, I saved a life’.
“The important thing at the moment for this campaign is people somewhat support the fact of raising awareness. All should go on Facebook and visit our page, understand what the content is, like it and share it with all their friends. The more awareness there is about how preventable these deaths are, the more we will be able to increase our intervention.”
* Visit www.facebook.com/msfuae to find out more about the organisation
