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Source: United Nations Children's Fund (UNICEF)
31 July 2008

A barrier to life

Azzun 'Atma, Occupied Palestinian Territory - July 2008

Restricted access to hospitals puts West Bank pregnant women at risk

Women in the northern West Bank village of Azzun ‘Atma, in the Occupied Palestinian Territory (OPT), reside only a few kilometers from three hospitals. However convenient the physical distance may seem, the reality is far more concerning. Due to security procedures triggered by the Israeli-Palestinian animosity, many pregnant women are currently living in fear that, when their time comes to give birth, they won’t be able to access a health-care facility.

In between the dreams of hopeful mothers-to-be and safe medical care, stands an electric gate. This barrier is manned by Israeli soldiers and remains unconditionally closed at night. Even daytime crossings are less than certain.

Six months ago, Benan Yusef, a small woman with a striking moon-shaped face, went into labor with her second child just before dawn. Her husband wasn’t there; he spends nights in Israel where he works in construction. Instead, she called his family, and together Benan and her relatives set out to the hospital in a nearby village called Qalqilya.

When they arrived at the gate, soldiers appeared to be preparing for its usual opening at five in the morning. They had come down from the guard tower and lifted the metal spikes that are placed across the road at night.

But no amount of persuasion could convince the soldiers to let the 28-year-old woman pass. “I was very afraid that the baby would die,” she remembers. “It was so cold. I kept trying to hold [the baby] back.”

Benan had no option but to rest in the back seat, waiting for the gate to open at its normal time. She felt the baby pressing down, but her mother-in-law told her to hold on and tried to cover her legs.

It was no use. Just as the car passed the gate, Benan told the driver to pull over and bright-eyed Aya was delivered in the dark by her mother-in-law. “The soldiers heard the sound of her voice,” she recalls. “We had nothing to wrap her in, so I put her in my jacket. But the water was all under me.”

Azzun ‘Atma has a visiting doctor who sees patients twice a week in a nurse-staffed clinic. However, if residents have more than a cold or minor illness on the days he is absent, they must travel to Qalqilya for proper care.

What happened to Benan is common place for many Palestinians who need to pass through the military gate in Qalqilya. The entrance is part of a 723-kilometer long complex of cement walls, barbed wire, patrol roads and guard towers that Israel is constructing throughout the West Bank. The barrier is needed for security reasons, Israel says, but its route was declared illegal in an advisory opinion by the International Court of Justice at The Hague in 2004.

The residents of Azzun ‘Atma are among some 10,000 Palestinians who live in five closed military areas created by the barrier in the northern occupied West Bank, according to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA).

If leaving Azzun ‘Atma isn’t an easy task, entering the village can be even harder. Only those with a proven address and a special permit are allowed to to pass through the gate. Azzun ‘Atma lies near the Israeli West Bank settlements of Oranit, Sha’are Tiqva and Elqana, which were built in part on the village’s land. The planned route of the barrier will ultimately separate the village from these settlements, while allowing free Israeli access to and from this settlement bloc. Residents of Azzun ‘Atma, on the other hand, are in a no-man’s land when it comes to services – such as health care.

Nineteen-year-old Muntaha Ahmed believes that as many as half of the village’s pregnant women leave Azzun ‘Atma before their due date to avoid having to pass the gate in an emergency.

“It is difficult to stay here,” she says. “What if your labor starts at night?” Muntaha expected to have a regular birth, but nevertheless went to stay with her family in nearby Ras Attiyeh ten days before her due date. Fortunately, she made the right decision; her doctor was forced to perform an emergency C-section and if she hadn’t been in the hospital, her pregnancy could have ended in tragedy.

Tamam Yusef (no relation to Benan) knew what to expect from childbirth. Nonetheless, she was warned by her doctor that due to her advanced age (41) she should give birth in a hospital. When her water broke in the middle of the night, however, the soldiers manning the gate wouldn’t allow her and her husband through.

“I have an emergency case,” he shouted at them. But they refused. They were looking down through the window in the tower,” the elder Yusef remembers. “They said, ‘If you don’t get out of here, we will shoot you.’”

After over an hour pleading with the soldiers to let them through, the couple had to drive back home. Tamam was so weak that she couldn’t get out of the car, but with the help of one of her daughters, who had studied nursing, she gave birth right there to her baby boy. Her daughter then helped her inside and they cut the umbilical cord.

“That was the worst thing,” Tamam says. “Afterwards, I learned that maybe if I had stayed sitting there in that position, the boy could have suffocated to death.”

The restrictions to health access affect many women in the OPT. Between January and early June 2007, 33 babies were born to mothers from Azzun ‘Atme. Twenty were delivered outside the enclave; of the home deliveries, none was attended by a trained midwife or doctor. This year, 24 babies have been born so far.

Even if a baby is born healthy in the village, complications can set in later. Benan Yusef, for example, suffered pain and had an infection after giving birth in the backseat of her in-laws car. While having her umbilical cord cut by a traditional birth attendant, in a village near Azzun ‘Atme, the new mother was injured. Days later, it became a serious infection that required surgery.

“I didn’t know when to push,” she says, almost ashamed. “There was no nurse like when I gave birth to the first one.”

But even giving birth to her first child, Naba’, was quite an affair. Benan went into labor in the afternoon, but the gate was closed to vehicles so she had to walk across the barrier to a car on the other side. “My water broke as I walked through and everyone was staring,” she recalls, admitting to feel quite humiliated at the time.

For nearly five years, the women of Azzun ‘Atma have had to negotiate this barrier to proper health. Even routine trips have become difficult. “You become resistant to going [out],” says Muntaha, cradling her two-month-old. “You have the kids with you, and it’s slow, and you have to wait in line.”

A preliminary survey carried out by OCHA and the United Nations Relief Works Agency, which provides services for Palestinian refugees, has shown that just over three percent of residents in closed areas such as Azzun ‘Atma are leaving their homes and moving to other areas due to hardship.

UNICEF is working with the ministry of health to target children and mothers in these hard-to-reach areas, working to provide basic vaccines and vitamin supplements, as well as improving child health monitoring. Logistical support to health professionals is also facilitated by UNICEF by providing them with a UN car so that they can access people in the enclave.

Still, no matter how much effort UNICEF or other supporters put into dealing with the problem, the women wish for a day when the closure on their village will be eased. “They have to open the gate [at night],” says Tamam Yusef. “Even if it is only for emergency cases.”

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