In areas ravaged by conflict, the health needs of women are often neglected and ignored. As the bombs fall, the damage to infrastructure and communications affects the whole community but women are particularly at risk. They are often prevented from reaching a health facility to give birth safely, or to care for their sick children. In some conflict-torn areas they suffer sexual violence, including rape. And while the war-wounded and emergency cases get priority, women's needs, and in particular the needs of pregnant mothers and their children, are often given scant attention.

In the recent conflict in Gaza the lives of women and their young children in desperate need of health care were put at risk. Ambulances were unable to operate freely. Women in labour could not reach a safe place to have their babies – one woman gave birth in a donkey cart trying to reach hospital, delayed by the fighting.

In Somalia, over a decade of conflict has devastated health services and death rates among pregnant women are among the highest in the world (WHO statistics).Conflict adds to the suffering when women cannot access the scant services that do exist.

In the aftermath of war, the destruction of health services often prevents women returning to their homes and villages. The need to provide reproductive health care is particularly urgent. Without it, families cannot return to normality and start rebuilding their lives.

International Humanitarian Law requires that expectant mothers be the object of particular protection and respect. Nadine Puechguirbal, ICRC's Women and War adviser, stresses that during conflict, "International humanitarian law must be implemented …women must get access to a proper health care system and humanitarian workers must be allowed to do their jobs."

On International Women's Day, the ICRC demands more respect for international humanitarian law, and calls for a greater focus on the predicament of women who, because of war and its aftermath, do not receive basic health care for themselves and their babies.


SOMALIA - story

Few women in Somalia's war zone are as fortunate as Halima who managed to reach Mogadishu’s Keysaney Hospital in time for an emergency caesarean section which saved her life and that of her baby.

By the time she was operated on, she had been in labour for 24 hours. She and her husband had spent four hours in transit trying to find a hospital to take her because fighting made it impossible to reach the city’s maternity facility.

The trauma specialists in Keysaney Hospital have received training in war surgery from the ICRC. They are more familiar with war wounds than delivering babies. But the chaotic and dangerous conditions in Mogadishu mean they must take on all those who manage to survive the journey there.

When Halima arrived at the hospital, the surgeons were preparing to operate on a young man with a gun shot wound. He had to wait his turn while her baby was delivered. Halima's condition was critical but both mother and son survived.

In war zones pregnant women and their children have few resources and are at high risk. Survival is often a matter of chance. As the conflict drags on in Somalia, the situation for women is, if anything, worsening.



Additional information:

The number of Somali women dying in childbirth is estimated at 1400 per 100,000. It is one of 14 countries in the world with a maternal mortality rate of more than a thousand. By contrast Ireland has a maternal mortality rate of 1 per 100,000 (Unicef,2009).

Only 9 in a hundred thousand women make it to a hospital to give birth and only 33 in a hundred thousand have a person with any birthing skills present for their deliveries (Unicef, 2009.)

Keysaney and Medina Hospitals have treated more than 2,500 war casualties since January 2008.

The ICRC has been providing humanitarian assistance to the Somali population since 1977 working in close partnership with the Somali Red Crescent Society.

LIBERIA - story

In Liberia, a peace agreement was signed in 2003 and rebuilding is underway. But 14 years of conflict has left the country with a looted and destroyed health system.

The ICRC helped treat the wounded during the war and in the aftermath supports a broad programme to restore basic health services in areas of the country worst affected by the conflict. Part of that strategy is the reduction of the maternal mortality rate - estimated at 1200 in a hundred thousand (2005, latest UN statistics).

In a joint initiative with the Liberian Ministry of Health, the ICRC is training traditional birth attendants to achieve clean, safe deliveries and to refer women with problems to hospital quickly.

Eunice Ekenko, an ICRC health worker in Liberia confirms the need for this assistance, "we don’t have enough skilled staff which is because of the war. After the war most of the skilled staff fled away."

Beneta Kessely is a midwife trainer for the ICRC. She explains the role of the traditional birth attendants who come from and work with their own local communities: "Because they are already doing the work, we just need to improve their skills so they can do even better. And they have proved to be that way."

Before this programme, many traditional birth attendants had no formal training. With emphasis on the need for prompt referral to a health facility in the event of any problem, the women learn how to give immediate care to the mother and her newborn as well as the importance of nutrition, vaccination, malaria prophylaxis, family planning and hygiene.

It will take time to measure the full impact of the training, but the traditional birth attendants themselves believe it is helping the women in their communities. Sonnie Lombeh has completed the course and has taken her new-found skills back to her village: "I am already happy for the training that they have given us. Those things that we did not know, now I know them, I am happy.""


Additional information:

The number of Liberian women dying in childbirth is estimated at 1,200 per one hundred thousand – one of the worst maternal mortality rates in the world (UN statistics).

An estimated 37 women in a hundred thousand give birth in a hospital and only 51 in a hundred thousand have a skilled attendant present for delivery (UN statistics).

By September 2008, the ICRC in partnership with the Liberian Health Ministry had successfully trained almost 300 traditional midwives. During their six month training course the midwives develop their skills in antenatal care, deliveries, post partum and new-born care.

The ICRC has been active in Liberia since the onset of the first war in 1990 – providing emergency care and now in the reconstruction phase, assisting with the reconstruction of facilities and the training of staff.

SHOTLIST:

Date, location: Somalia, Keysaney Hospital/Medina Hospital, Mogadishu, Nov 2007; Liberia, Lofa County, Oct 2008
Production: ICRC
Sound: VO
Copyright: ICRC - Access all
Length: 9'45"

00:00 Somalia, Mogadishu, Keysaney hospital. Patients in hospital corridor, gunshot victim (Salad Mohammed Hassan) being washed and placed on trolley for surgery

00:25 shots of x -ray and bullet

00:30 Gunshot victim being taken to surgery

00:39 Surgeons putting on gowns, washing hands – preparing to operate

00:49 Woman (Halima) in obstructed labour groaning on stretcher

01:00 CU surgeons at work on caesarean

01:14 Baby born and being patted

01:21 Baby being placed on table

01:27 Cleaning baby

01:40 CU baby

01:44 Man carrying baby away from theatre

01:50 Interview with Abdulahie Hussein Abdi, general surgeon, Keysaney Hospital (English)
"Yes, she already finish. She's good ..the foetus is alive. It’s a male one. Her condition is very good now."

02:01 Abdulahie Hussein Abdi - continues
"Today there is fighting between the Ethiopian troops and other people and so its very difficult to reach there that’s why they brought her here and we make the operation for the list ..the emergency list."

02:16 The woman (Halima) being taken away on a stretcher


Liberia

02:24 Liberia, Lofa county, health clinic, mothers and young children, pregnant woman lying down - various

03:17 Interview Eunice Ekenko, ICRC (English)

"The shortage in Lofa County and the country as a whole is that we don’t have enough skilled staff which is because of the war. After the war most of the skilled staff fled away."

03:29 2nd interview with Eunice Ekenko, ICRC

"So, lack of skilled staff in all the facilities at all the levels made the nation to try and find a way to see how they can reduce maternal deaths and infant deaths."

03:43 Kaibeh Kollie, trained traditional midwife and Sonnie Lombeh, trained traditional midwife, strolling to classroom

04:10 Beneta welcomes the class


04:21 Interview Beneta Kessely, ICRC midwife trainer (English)

"The course was started because after our country broke down into crisis all the trained people left and went elsewhere to find better jobs. Some of them died. So areas were left without any medical people."

04: 41 Women in the class sing the "High Risk Song" which trains them to identify potential delivery risks ahead of time.

04:50 Interview Beneta Kessely, ICRC midwife trainer

"Traditional birth attendants. They live with the people in the communities. Some of them have already been doing deliveries but they didn’t have any formal training. So because of this we thought that if we train these people what they are doing will be better. Because they are already doing the work so we just need to improve their skills so they can do even better. And they are proved to be that way."

05:18 Sonnie Lombeh listening to the lecture

05:27 Interview Sonnie Lombeh, trained traditional midwife

"I am sitting here, I am already happy for the training that they have given us. Those things that we did not know, now I know them, I am happy."

05:37 Sonnie in the clinic attending to pregnant woman, using listening trumpet, various shots

06:09 Set up shots Eunice Ekenko

06:30 Interview Eunice Ekenko, ICRC, (English)

"Once the traditional midwife is trained and she becomes a Trained Traditional Midwife, when she goes back to the community, she takes back the knowledge she has gained through the training, through the six months training.

06:43 Kabbeah Kollie, trained traditional midwife explaining her delivery materials back in her home village

07:36 Interview Kabbeah Kollie, trained traditional midwife (English)

"My eyes were closed, now my eyes were open. Now, when we are helping a woman to deliver, both the mother and the child can live."

07:52 Exterior shots of mothers and children in the village….


08:38 Interview Nadine Puechguirbal, ICRC Women and War Adviser

(English) 08:38 "Pregnant women and nursing mothers are particularly at risk because they may require immediate and complete pre and post natal care as well as medical assistance for the delivery of the babies. In addition, women may be at risk of sexual violence in the context of impunity that prevails in war."

09:04 "The ICRC strongly emphasises that International Humanitarian law must be implemented and that women must get access to a proper health care system and that humanitarian workers be allowed to do their jobs. And the international humanitarian law already provides for that."

(French )09:26 "Le CICR demande à ce que le droit international humanitaire soit respecté, que les femmes enceintes puissent avoir accès à des soins médicaux appropriés et à ce que les travailleurs humanitaires qui oeuvrent dans le domaine médical puissent exercer leur travail en toute sécurité."

09:43 ends