Thread by @safelyfedcanada

Attending the plenary session “The last healthcare professionals standing: an exploration of the role of midwifes in humanitarian and fragile settings at #ICM2023 A standing ovation honouring presenting midwife Tselyk Vira from Ukraine. #IYCFE

Also presenting, UNFPA’s Under-Secretary General and Executive Direcror @Atayeshe on how midwives stay and continue care when other hcps leave in times of disaster. She has five calls to action:

- improve preparedness and involve midwives in all phases of preparedness and response
- demand better and appropriate compensation and fully empower midwives to make decisions to save lives in the spot
- address supply chain problems, set up better referral networks
…/

- protect midwives and their families from threats and adequately fund security
- we need more psychosocial support for midwives themselves … midwives are in the same conditions as the crisis-affected population

Maria Floręncia Francisconi of Argentina, ICM board member, speaks to the psychosocial aspect saying we need to teach all midwives the skills they need to deal with the trauma inherent in an emergency response.

Using the Rohingya circumstance as an eg, @Atayeshe says in a well organized system with the expectation of delivery of a quality, and fair service, the midwife is the power making the judgements minute by minute and coordinating the rest of the team to save lives.

The midwifery philosophy of being with woman brings a necessary humility to these protracted conflicts and we will only need more of this as we face increasingly protracted conflict settings.

Vira Tselyk is now speaking of her experience when war broke out in her city of Chernihiv. She says they had to bring pregnant & birthing down to the bomb shelter. It was the worst experience of her life & in her career. Conditions were uncomfortable but necessary to save lives.

They put wooden doors on top of boxes to make beds for those who birthed. The rest sat on chairs. They thought it would be for just a few hours, but they were there for 42 days. Her mother, husband, and daughter were trapped in occupied areas and she lost connection with them.

They had no power, no heat, and it was winter with temperatures of -11/12C. Staff risked their lives to try to support the women, cooking food on an open fire, boiling water to keep newborns clean and warm. There were around 100 people in their shelter.

They normally have dozens of doctors and midwifes but they were down to 3 midwives, one doctor and an intern. They had to cook meals as mentioned, find strong men to carry women on stretchers, deal with the cold. They had to carry water from outside sources for food / hygiene.

But babies are still born. “We used to see happiness on the faces of women when they have babies in their arms but we saw fear and helplessness…. When the baby is born it cries… when I heard those babies crying it was louder than any shell. It was the most powerful sound.”

Those newborn baby cries provided us with the light of hope in those dark times. It is the hope that your nation will survive.

They supported 136 births in those 42 days including 2 triplet and 3 twin births.

Natalie Kanem says UNFPA was already active in the region. Their goal is to make sexual and reproduce health a first priority and not at the end of the line. They brought in rape kits, set up hot lines, and warnings for women to be careful accepting offers of help.

They joined w/ WHO & UNICEF to condemn military attacks on health care facilities. They flew in people to help. While we all must do what we can to help, “peace is the condition we need to properly do our jobs…we have to defend the peace.” She adds there is a gender dimension…/

And women have to speak up. The women of Ukraine, of Syria, of South Sudan have had enough.

Now we are hearing from Haitian midwife Jeffthanie Mathurin. She says women don’t stop getting pregnant or giving birth in humanitarian crises. They need access to reproductive health even more than before.

She describes the political violence and civil infighting in Haiti that, along with being prone to natural disaster, means many are displaced. Schools and hospitals are closed. GBV and maternal mortality rates are up.

She talks about how four midwives were recently kidnapped. Gangs and violence is increasing. She says midwives don’t know what they can do to change the situation. “We have not been prepared for this, who could ever imagine that people could live like this.”

The midwifery association has launched a mobile clinic to assist those impacted by GBV. They are continuing to try to help, but they are watching their midwives leave the country in search of safety.

Midwives have to leave their homes to work and they are afraid. The association is trying to find ways to help them to have strategies be safer. “We love Haiti. We want to stay…we know our presence is critical to reducing maternal morbidity and mortality…”

But is their love of their profession enough to risk their lives? And if they leave, who will help save lives of mothers and babies? They want to have courage to stay through earthquakes, through hurricanes, through violence.

Asked what they need the most, she says they need international help to make peace. “With peace we could better support our women.” They have a very high rate of maternal mortality rate now, and it needs to be safe for pregnant women to seek help and for midwives to provide it.

Francisconi Maria Florencia says the midwifery model of care is proven in disaster and conflict, and it’s important to ensure midwifery care isn’t displaced when medical services shift to responding to injuries in conflict.

.@Atayeshe says the violence that is described shows gang activity, even in peacetime, targets/impacts women and girls. It is a gendered impact. A they are offering video interviews to support those impacted by GBV so people don’t have to be revictimized having to retell stories

She says midwives facing these conditions are “facing the unimaginable.” And they go on for years. “When women’s bodies literally become the battleground, midwife associations need to speak up for peace.”

She says the funding apparatus is also broken, appeal after appeal, never fully funded … we have to insist that the legitimate claims of a refugee, of a displaced person… when a woman has to gather up her children and run…

They shouldn’t have to beg for what is their human right to shelter, safe access to care. She calls on midwives to stand up for this.

Maria Florencia Francisconi says she has worked with Doctors Without Borders and is proud that sexual and reproductive rights are a key component in all their work. It’s made clear that midwives are key to this work.

“We fail to understand that midwifes are part of the solution… yet we are generally not well integrated into the system, especially in emergency response.” She cites the ICM’s guidance on the role of the midwife in emergencies: internationalmidwives.org/assets/files/s…

She says governments need to do work to integrate midwifery, to increase support. Recently she was in Iraq where her colleagues said that midwifery schools are closing. Midwives are not practicing to their full scope in the day to day, never mind in crisis.

We are delivering lifesaving services in life threatening conditions. What can we do to improve the situation? She has three ideas:

- midwives can build stronger and more resilient systems. We do more than just help women deliver babies. Midwifery care can improve over 50 health related outcomes and we are essential health educators. We are essential to closing gaps in the recovery phase as well.

- when we include midwifes in healthcare response we get quality care. Midwives need to be prioritized right at the top of the response, our services are not less important.
- there is already a position statement but it has re-emerged more strongly and we should take advantage

We must take up our role in preparedness, rapid response, and in the recovery phase.
- the last idea is to acknowledge that women move forward no matter what, and midwives move with them. Even those who are not working as midwives … they are midwives.

Jeffthanie Mathurin adds that midwives provide critical reproductive health services and this is an area where they can have tremendous impact.

Vira Tselyk says midwives need to be part of the system to improve the quality of care. Midwifes are “shadows of doctors” and don’t have the ability to affect change in their own right. She hopes this is the time that change will happen.

Maria Florencia Francisconi says we have work to do to include midwives in essential emergency response and midwives must go with full support to deliver full services … to support reproductive health, breastfeeding, help beyond the birth.

Jeffthanie Mathurin says what is happening in Haiti now needs the world’s attention: many people, many babies, many mothers are dying every day and she wants to use this platform to draw attention to the situation to help her country.

.@Atayeshe says she was challenged by a youth leader from Bali to tell the story to make midwifery more attractive. She notes young people care about climate and we can appeal for them to look at this profession with its focus on caring and peace.

And she challenges midwifery leaders to look at the nexus issues … what will midwives do the day after the conflict, the day after the tsunami. She says we must work together on preparedness. And “women and girls must be at the top of the priority list.”

When we think about their needs, the whole community will be lifted up. And we must never give up on insisting about rights and choices.