Dear Editor
Because of continuing armed conflict in Gaza, at least 30% of pregnant women have high risk complications which will lead to death or permanent damage leading to major problems in future childbirth. This proportion will increase every week as conditions worsen. The 30% high-risk proportion is based on our eight years of experience in Liberia, an extremely poor country where malnutrition, lack of medical staff, operating facilities, and essential drugs has revealed that 30% of women have high risk conditions and need hospital care if they and their unborn babies are to survive. Similarly, in Gaza, without Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) most, if not all, of the high-risk pregnant women and their babies are likely to die.
The International Court of Justice (ICJ) [1] has delivered provisional measures [2] against the State of Israel under a claim by South Africa that Israel could have been conducting a genocide against the Palestinian people under their care and protection in the absence of a two-state solution to a long-standing source of conflict. One of the provisional measures indicated by the International Court of Justice (by 15 votes to 2) was (d) imposing measures intended to prevent births within the group.
According to United Nations agencies there are at least 50,000 pregnant women in Gaza [3]. The conditions of life continue to deteriorate rapidly with catastrophic levels of hunger, a serious shortage of safe water, electrical power and other essential utilities, a collapsing medical and health system, and a looming outbreak of contagious diseases. Health workers, especially those with special obstetric and neonatal skills, are being injured and killed with huge implications for the provision of hospital maternity care.
We propose that high-risk pregnant women be transferred as a matter of urgency, ideally to Israel, where appropriate hospital care for pregnant women and their unborn and newborn babies can be provided urgently as needed. Such high-risk conditions include severe maternal malnutrition, placental problems with potential for catastrophic haemorrhage, obstructed labour, severe pre-eclampsia with potential for brain haemorrhage, and severe anaemia.
Using this approach, all pregnant women in Gaza who are in their last 12 weeks of pregnancy would be urgently screened using clinical assessment, along with a portable ultrasound scanner if needed, to identify those who will likely need life-saving surgical intervention during pregnancy and delivery. Pregnant women who fulfil certain criteria indicating a high risk of death or damage during late pregnancy or delivery should be urgently medically evacuated to suitable hospitals outside Gaza but still in Israel. The evacuated mothers would have to be accompanied by a close female family member and their existing children, if needing the mother’s care, and these families would need to be supported in Israel by local, (probably Palestinian) families. After safe birth, families could, if they wish, and when/if, it is safe for them to do so, return to Gaza.
We would be willing to help undertake the screening component of the work needed to medically manage those at highest risk but would require major logistic, security and political support. We undertake such a maternity screening approach in our program in Liberia, West Africa and have much experience in this work. Or, if more appropriate, we would offer our expertise to help others do the screening and continue to advocate for the need for such a program.
A permanent ceasefire is the only option for adequate maternity and neonatal care provision for the whole Palestinian population.
For more information, please see the Press Release on our website: www.mcai.org.uk
References
1. International Court of Justice 2017-2024. Accessed 27 Jan 2024. https://www.icj-cij.org/home
2. Application of the convention on the prevention and punishment of the crime of genocide in the Gaza strip (South Africa v. Israel). 26 January 2024. Accessed 27 January 2024. https://www.icj-cij.org/sites/default/files/case-related/192/192-2024012…
3. Aljazeera News. 50,000 women pregnant in Gaza amid ‘decimation’ of its health system. WHO chief says the enclave’s infrastructure is being destroyed as UN agency warns of soaring healthcare needs. 24th December 2023.Accessed 26th January 2024. https://www.aljazeera.com/news/2023/12/24/50000-women-pregnant-in-gaza-a…
Proposal to help thirty percent of pregnant women with high-risk medical conditions and their unborn babies who could die in Gaza because of a lack of hospital-based emergency obstetric and neonatal healthcare.