No one leaves home unless home is the mouth of a shark. In this one sentence Somali-British poet Warsan Shire encapsulates all the atrocities that force people from their homes: natural disasters, persecution, unrest, torture, massacre, war.
There are 65.6 million forcibly displaced people around the world right now. That’s roughly the equivalent of the entire French population running homeless and in fear for their lives.
Among them are nearly 22.5 million refugees. Half of them are women and girls.
Although these figures show the magnitude and complexity of geopolitical, legal and human rights issues governments must deal with, they do not convey the sheer suffering refugees endure. With each humanitarian crisis emerge thousands of horrific stories.
And among all this chaos and brutality women who lost their families and homes when they needed them most, must face alone or share with strangers and foreigners the most intimate moment of their lives. Giving birth. Because women don’t stop giving birth during a humanitarian crisis.
Jeanna Deswert has volunteered in several refugee camps to offer women help and support as a midwife. She recounts her journey to NADJA and the many challenges healthcare workers and women refugees face when bringing a baby into the world.
Originally from Oregon, USA, Jeanna was living in Turkey when the Syrian civil war began. She witnessed the waves of refugees flooding across the border and saw the desperate need for humanitarian relief, particularly for maternal and reproductive healthcare.
Since birthing her two children Jeanna had always been interested in midwifery. After two years in Turkey, she decided to go back to the United States and attend a one-year intensive training program in Texas, with the aim to go and serve women in refugee camps.
She left for Greece as soon as she graduated from her midwifery training. Together with a nurse fluent in Arabic, who later became one of her best friends, she spent over a month in camps with Syrian refugees.
“We travelled to Turkey first, and planned to go from Turkey to Lesvos, in Greece, where there had been a huge influx of refugees coming into the island. While in Turkey, we met countless refugees who were settling into the streets of Istanbul. We talked to a lot of people and listened to a lot of harrowing stories. We knew this was nothing compared to what we were about to walk into in Greece.”
“I tried my best to minimize my expectations. I wanted to go with an open mind and an open heart and be able to provide the best care that I could”
Dedicated to providing the best possible care, Jeanna did a lot of preparation before her trip. She learned about the political aspects of the Syrian refugee crisis and the specific health issues related to it. With a background in Political Science she already had a solid knowledge of displaced populations. She read many books on global reproductive healthcare and refreshed her emergency skills.
She remembers walking into a refugee camp for the first time and feeling a deep sense of surreality.
“I was not surprised by what I saw. It was everything I thought it would be. It was devastating and heart-breaking.”
By the time they arrived in Lesvos, the government had taken control of operations. Jeanna and her friend went north, to the border of Greece and Macedonia, where they ultimately settled in a small camp called Eko.
“When we arrived, we were some of the first on the ground there to provide support. We established a mobile healthcare clinic and later a mobile women’s clinic to triage and respond to acute conditions and provide well woman care.”
Jeanna and her friend purchased medications and supplies using their own money and generous donations from around the world. But some medications specific to reproductive and maternal healthcare such as prenatal vitamins, birth control pills and antihemorrhagics were difficult to obtain. One of many challenges they faced.
“We also did not have easy access to emergency medical services. In the event we needed to transport a patient, we waited for hours for an ambulance at times. A lot of the referral systems were not yet in place, so it took a lot of guess work to figure out the appropriate channels to refer refugees [to hospitals] who needed extra medical support.”
Realising that pregnant and postpartum women were more reluctant to go to the mobile clinic Jeanna began doing outreach.
“I literally started at one end of the camp and began going tent to tent, finding the pregnant women, getting to know them, and making a basic registry. I provided prenatal care and postpartum follow-up to all of the women I came into contact with in that camp.”
With a lot of patience and time, Jeanna managed to gain their trust. “I just didn’t force it. I spent time in the camp, immersing myself in the life there, really getting to know the people who called that place ‘home’. By doing so I became a familiar face. My presence and my commitment in the camp spoke volumes.”
Jeanna overcame the language barrier with the help of her friend and a refugee who used to be an English teacher in Syria. “He would accompany me every single day in the camp and translate for me. He was well respected within the camp and that helped gain trust and bridge those gaps. He was an incredible support.”
“In the end, just being there, being present, listening to their stories, all of that meant more than speaking the same language ever would.”
Pregnant and traumatised
At the heart of all their stories there is loss. The loss of loved ones, but also the loss of their homes, culture, values, language, identity. Defined as cultural bereavement the grief is intense and according to Jeanna, mirrors many mental health disorders. It is essential that health workers recognise the signs of trauma.
“Conflict and displacement impact and disrupt the ability for people to appropriately mourn loss and process grief. It is not just individual grief, it is entire communities, entire groups of people who are adversely affected and grieving.”
In January 2016 the UNFPA reported that among female Syrian refugees and women displaced inside Syria nearly 430,000 were pregnant
“The effect of grief can be overwhelming. It is imperative to have people who understand the difference between what is a normal versus an abnormal response to grief. It is important to understand the psychological reactions, which include post-traumatic stress disorder and place them in the appropriate context.”
Add to this the distress of living in camps and the high psychological stress due to the uncertainty of the future. It all has devastating effects on pregnant women. Suicide attempts. Self-induced abortions.
Jeanna cared for many desperate women. “I had a woman who [was going] into preterm labor, but absolutely refused to go to the hospital. I had to be very clear that if she delivered in the camp, her baby would be too small, and I did not have the resources to save her baby’s life. She was so distraught and did not want to bring a baby into this world under those circumstances.”
Hospitals, which should represent a safe healthcare haven, inspired fear. “There were a lot of stories circulating the camps about the treatment of women in the surrounding hospitals. There was also the fear of deportation and of the unknown. No one knew what to expect in the hospital setting.”
Jeanna witnessed outrageous abuse of power and severe obstetric violence from hospital staff. “A woman who had already delivered her baby was transported to hospital. The doctor cut her perineum without warning and then proceeded to suture her. There was absolutely no medical indication to warrant that act against her body after the birth.”
The cost of caring
Working daily in such a heart-wrenching environment had a big impact on Jeanna. She experienced the ‘cost of caring’: a profound emotional and physical exhaustion called compassion fatigue and a deep shift in world view, or ‘vicarious trauma’. Both common occurrences when working with victims of trauma.
“I rebelled against returning [home]. I wanted to be everywhere except back in the United States. When I returned I went through a period of time where I was so frustrated with the complacency of the people here.”
“I checked flights daily, I reworked my finances to free up funds to cover a trip back, I looked at ways to rearrange my schedule, just so I could return. I felt like my work there was not done. I felt like there was so much left to do and I felt like no one here cared. The crisis was nothing more than a small set of words occasionally sliding across the bottom of their TV screens.”
She recalls her last night at the camp, saying goodbye to the refugees.
“I vividly remember this moment where I climbed over the fence at the edge of the camp and I turned back, my hands holding the refugees’ hands through the cold wire, and I was hit with the magnitude and the weight of the fact that I had the option to leave.”
“I had an entire life waiting for me on the other side of this. I had the ability to climb that fence and leave. To fly to another country where I had a house, a warm bed, two beautiful, healthy children, and a job waiting for me. They didn’t. Their lives and their futures had been ripped away from them and they were literally stuck there, on the other side of that fence.”
The first couple of weeks back home were the hardest. It took Jeanna a long adjustment period to go back to the mundane after having poured her heart and soul into the camp.
“There was a depth of friendship and love that emerged in light of the crisis that is almost indescribable. It embodied a family dynamic. Everyone was so vulnerable and so real. We shared so many beautiful moments, so many tears, so many stories, so many laughs, and so much love.”
“We spent time sharing meals, tea and coffee. We were invited into their ‘homes’ and into their families. We all looked out for one another. The refugees had next to nothing, yet they were willing to give everything they had, without hesitation.”
Now with experience, it’s easier for Jeanna to keep things in perspective. Talking to her friend about the experience they shared also helps her cope. And more importantly: “It is also learning to accept that we did our best, we did what we could with what we had, and even if it doesn’t feel like it was enough, it was.”
Jeanna is an inspiration. Her determination, courage and passion to serve pregnant women in distress sets an example for us all. There are many ways we can contribute to make their lives in camps a bit more tolerable. Donations, fundraising and sending supplies, medications, hygiene kits and new-born packs. A small gesture on our part can make a great difference for a pregnant refugee.
Because beyond cultural or religious differences, beyond politics and economic constraints, beyond war and violence, it’s all about an innocent and beautiful baby coming into the world.
* To support Jeanna’s volunteering work in refugee camps you can send your donations via PayPal to firstname.lastname@example.org *