C-sections without anaesthesia and needless deaths: the realities of Gaza's maternity care

Bombardments and shortages make caring for expectant mothers and babies almost impossible, a doctor tells The National

Nasser Medical Complex in Khan Younis, southern Gaza, following Israeli strikes All Photos: Dr Thalia Pachiyannakis

Dr Thalia Pachiyannakis, an obstetrics and gynecology doctor who served in Gaza this year, has told of the horrifying conditions pregnant women and medical staff face

At Nasser Medical Complex in June, Dr Pachiyannakis witnessed 30 to 50 deliveries every day, despite a lack of equipment and fuel

Squalid conditions near the hospital. A shortage of resources extends to soap and tissues, affecting hygiene and sterilisation.

Destruction around Nasser Medical Complex

Dr Pachiyannakis entered Gaza in a UN convoy. Their bulletproof cars were fired on by Israeli snipers, making it unsafe even for healthcare workers to enter the enclave

Makeshift tent accommodation adds to hardships faced by Palestinians in the area

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Israel's war on Gaza has wrecked maternity care in the enclave, as medics and midwives contend with few resources, higher rates of premature births and babies born severely unwell, an obstetrics and gynaecology doctor has told The National.

Hundreds of babies are dying needlessly because crucial items needed to care for mothers and their children are scarce, due to siege conditions imposed by Israel, said Dr Thalia Pachiyannakis, from Indiana in the US, who worked in Gaza this year. Babies who make it through labour arrive with signs of chronic malnutrition.

“Palestinian babies were very big, fat babies. But now, because the mothers are malnourished, the babies' growth is restricted,” Dr Pachiyannakis said.

The UN Population Fund sexual and reproductive health agency found in September that more than 17,000 pregnant women were on the brink of famine, with nearly 11,000 already experiencing severe food shortages.

Dr Pachiyannakis is one of a group of medics who travelled to Gaza to provide life-saving care, entering with a UN convoy.

Donkey cart to hospital

In June, when Dr Pachiyannakis worked at Al Nasser Medical Complex in Khan Younis, southern Gaza – the last hospital providing maternity and paediatric care in the area – 30 to 50 babies were born each day, despite a lack of equipment and power supplies.

Ambulances had been destroyed by Israeli bombing, forcing pregnant women to get to the hospital under their own initiative, often waiting until the last moment to arrive.

“Women come late to the hospital because of transportation. One patient took three hours to come to the hospital. She had to walk, take a donkey cart, hitch a ride and then come to the hospital,” she said.

In January, the Palestine Red Crescent Society reported that 121 ambulances had been targeted and 59 destroyed.

When Dr Pachiyannakis was at Al Nasser, staff had one foetal monitor for all the mothers in labour. With no way to effectively monitor all patients, doctors had no way of knowing if mothers and their babies were struggling, causing avoidable foetal deaths in cases with complications.

With limited access to anaesthetics and no pain medication, mothers have endured C-sections and other major surgery by taking general painkillers such as paracetamol to numb the pain.

As for post-partum care, there is none. Mothers are discharged from the hospital and have to walk to their tents, the unsanitary conditions creating a breeding ground for severe infections, Dr Pachiyannakis said.

“There were two women who had pus in their belly from infections. We had to do surgery again to take out the pus, but imagine, they get admitted for a few days with antibiotics and then you send them out again into the world,” she said.

Struggles with shortages

Doctors struggle to help patients because of the lack of equipment and supplies. Israel has been operating an almost total blockade in recent months, and what few aid lorries make it into the country are at risk of looting.

Even Dr Pachiyannakis and other colleagues, travelling with the UN, were given clear instructions not to bring in any medical aid to Gaza.

On arrival at the hospital, the shortage of resources at Al Nasser was beyond what they imagined, said Dr Pachiyannakis. No soap and tissues meant no sterilisation. The intensive care unit, hospital beds and machines could not be cleaned between patients.

“Sometimes, if an instrument falls on the ground in the operating room, you just pick it up from the floor, wash it with saline and use it again on the patient,” she said.

With no fuel deliveries, the hospital was trying to save what little supplies it had. This meant no air conditioning in the middle of summer. Dr Pachiyannakis recalls nurses wiping her sweat away, over and over again, as she operated, worried that her patients' wounds would be infected.

“It's 40 degrees Celsius, we're sweating in the operating room. And we're sweating into the wounds of the patient. We couldn't control it.”

When pregnant women visited every few weeks to check their babies' heartbeat and make sure they were alive, it was difficult to find gel for the ultrasound machine. There was also nothing to wipe the gel off the patient.

“I would wipe with my hands the gel off the patients, and then try to find water to wash my hands for the next patient,” she said.

Compounding these daily difficulties, doctors had nowhere to live. Dr Pachiyannakis said they lived in tents or at the hospital, while some locals would walk for an hour every day to their displaced families, after a day's work without pay.

“All the doctors have lost about 30 kilos. We were all sick with diarrhoea. We were wearing diapers. Adults are wearing diapers because we all had diarrhoea and vomiting,” she said with tears in her eyes.

Two bad choices

On average, women need about 1800 calories a day to meet their nutritional needs and a breastfeeding mother needs up to 2,800 calories a day to produce healthy milk, according to the US Centres for Disease Control.

With the UN warning of a looming famine, mothers in Gaza are faced with two bad choices: breastfeed and struggle to produce enough milk to feed their babies adequately; or try to lay their hands on formula milk, which is in short supply.

“I saw a child nine months old weighing only four kilograms. Babies in America are born [weighing] four kilograms. It's going to die if it doesn't get evacuated from Gaza for help,” Dr Pachiyannakis said.

Older children with yellow eyes and diarrhoea can be spotted in every corner of the hospital, she said. Severe dehydration causes their liver to fail, lowering their immunity and putting them at risk of infection, ultimately, causing them to die.

“If they're not going to die directly from the bombs, they will die from infection, malnutrition, starvation,” Dr Pachiyannakis said.

As well as the emotional toll of taking care of patients in such dire circumstances, Dr Pachiyannakis needed to prepare for the very real possibility she wouldn't make it home, drawing up a will in advance of her trip and making plans for her sister to move nearby to help care for her two children.

“When you go to Gaza, you prepare to never come back. But I don't know, it was like a calling. I had to go,” she said.

Almost as soon as she arrived, Dr Pachiyannakis was reminded of the danger, as Israeli snipers shot at the UN vehicle she was travelling in.

Once back in Indiana, Dr Pachiyannakis joined a team of 44 other doctors who also served in Gaza, fully intending to go back and assist Palestinians with their medical needs. But unexpectedly, she discovered she was pregnant, and held off her plans to join them.

She is expecting a daughter, and after her experience, it was easy for Dr Pachiyannakis to pick a name.

“Her name is going to be Jenna. It's 'Heaven' in Arabic … because of the people of Palestine,” said Dr Pachiyannakis.