Life, Birth and Death in the Jordan Valley

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I have come to Palestine with a particular focus on women and women’s health. I am a midwife who has lived in Brighton for ten years. I work at the Royal Sussex County hospital. I joined the delegation to find out first hand the effect of the Israeli occupation on the women and their choices in childbirth. The quiet grinding everyday stress of living under occupation is a story not always told. The big incursions, the land seizures the dead children, shot for throwing stones make the headlines, the everyday problems of living under a power that wants to destroy you is not so newsworthy. I was expecting to find many stress related health conditions as well as the conditions of poverty and poor access to services. 

So far, I have spent two days with the Red Crescent primary health care centre in Tubas, the main town in the Jordon valley. The centre is modern, light, open and so clean. Coming from a hospital that is dark and dirty with the joint demons of MRSA and C.diff stalking the wards I almost felt we should send our management team to learn from the people here.

I was welcomed as I have been by everybody in Palestine with great friendship and coffee. The obstetric “doctora” comes three times a week for a morning, in that time she sees forty women. The Red Crescent provides the only cheap healthcare in Tubas; women pay 5 shekels for each appointment (about 60p). The women are seen first by a nurse who weighs each woman and takes her blood pressure. The woman then goes through to the Dr. who performs a very similar role to a midwife in England.

Each woman is seen, scanned and given an iron prescription to take away. The only difference to a midwife led clinic in the UK was there were several post menopausal women and some early pregnancy scanning at five or six weeks. Every woman was anemic, the nurse put this down to diet and money, although the Red Crescent prescribe and subsidize folic acid and iron this is still beyond the ability of some families to afford. In a normal Pharmacy supplements are 17 shekels (2.12 pounds), the Red Crescent asks 5 shekels, still beyond the reach of families in an area of high unemployment.

Everyone I ask here “what is the biggest problem you face as a healthcare provider” answers the same: The checkpoints. The purpose of the checkpoints in the Jordon valley is to harass, intimidate, control and humiliate the people who live here. Where health is concerned, checkpoints also kill people. One women’s group in the valley identified the checkpoint system as the greatest problem.

Everyone knew a story about a baby being born at a check point. The Nurse from the Red Crescent said “sometimes the baby gets cold, and he will die.” Although the doctora had not heard of any maternal deaths at the checkpoints recently it can only be a matter of time. Official statistics from the PICCR state that from 2000-2007, 68 women have given birth at a checkpoint, 4 have died and 34 infants gave died. When asked if she could say one thing to people in England, a woman from the Jordon valley said “Remove the checkpoints, that is all we want, make that your slogan”.

Women worry for the last two months of their pregnancy, “what if the baby comes at night and I can’t get to hospital in Nablus or Jenin.” In an uncertain security situation women will often choose early induction, caesarean section or stay with family or friends near the hospital. The stress of carrying your eighth child, knowing it could come in 20 minutes and not knowing if you could reach medical care must be terrible, never mind caring for the other seven and living under occupation. In the villages in the Jordon valley I was told that often the older women in the village will come to deliver the children, their training being their own ten births.

The most striking difference between women in Brighton and Tubas is the size of their families. The average family is five children. It is normal for women to have 8-10 children. This is apparently for many reasons. Over and over people told me “Arabs prefer a large family, it is stronger.” in between asking why I do not have children.

Infertility is a terrible problem to have in this society, especially when men can take another wife. Also there is a strong preference towards sons, boys are very valued. This is understandable in a kinship based culture where the boys will stay to care for their parents where a daughter will go to the family of her husband. This preference does not apparently extend to selective termination for gender as abortion as illegal here and “against Islam”, more likely the woman will just have to keep having babies till she gets a son.

The doctor scans all women very early 18-19 weeks pregnant and tells them the sex, as I sat in her clinic she told a woman she was carrying a daughter, to great sadness. The doctora told me: “It is better she knows now and has time to get used to it, I have seen many woman have a nasty shock at delivery.”

The poverty caused by the occupation and the ban on men going to work in Israel also has an effect on the women. The nurses at the centre told me they have seen an increase in domestic violence and divorce as men take their stress out on their wives. This is not a problem particular to Arabic society but the occupation exacerbates these issues, just one more way the Israeli’s make life more difficult.

The people I have met from the Red Crescent are educated, professional people, trying under stressful circumstances for very little pay to provide the best service they can. Their welcome was overwhelming as they shared their stories with me. The effects of the occupation stretched so much farther than I expected, it is not just by shooting bullets at ambulances that the soldiers attack the Palestinians but also through their everyday life grinding away the joy and dignity of something as basic and necessary as birth.

Soomar, Tubas, 2007

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