“The majority of our patients suffered from war injuries.”

Margie is an experienced Australian midwife with an extensive career with Médecins Sans Frontières (MSF) in some of the world’s most difficult locations in recent years. She has just come back from Yemen where she spent six weeks in Sa’ada hospital maternity department. She recounts the difficulties encountered by the Yemeni population.

“One morning I was in the women's ward when Ahmed, 13, came to see his sister Aisha, 11*. They had escaped death a few days before and had not seen each other since. They fell in each other’s arms and started crying. And I remember the whole staff and all the women present couldn’t hold back their tears. We knew their story and it was terrible.

Their house had been bombed in an air strike two days before. One of their brothers died during the shelling, crushed by the roof and the walls which fell on them. Their mother died few minutes after her arrival in the emergency room. Another brother was severely wounded and we couldn't save him. The two siblings were the only survivors, having lost their father many years before. They had head, back and leg injuries. They were so traumatized, with nowhere to stay and so scared to leave the hospital that they stayed with us for a week until one of their relatives came to take care of them.

Air strikes hit densely populated areas
Two air strikes hit densely populated areas where civilians were living during my time. When the catastrophe happened I was helping in the emergency and women’s ward.

After that I came frequently to Aisha, but only after two days I realised that she hadn’t even taken a shower. She still had the dust of their former house on her and was wearing the same clothes she had been wearing. I went to get her soap, shampoo and someone found her a clean dress so she could recover a bit of confidence and dignity. We don't only treat patients, we deal with human beings.

MSF has worked within the general hospital of Saada since May 2015. It had been a rather well-equipped structure but the conflict is creating lots of difficulties in providing care to patients. Some of the Yemeni staff members have left, we sometimes faced shortages in electricity, fuel or water and other essential needs such as oxygen, because the plant couldn't work or deliver it.

The future mothers faced lots of difficulties
The maternity ward was busy even though the mothers faced lots of difficulties accessing the hospital. We assisted an average of 40 to 60 deliveries per week. Some complicated cases were referred to another hospital in the city as we didn't have an obstetrician to handle caesareans or other obstetric/gynaecological surgery.

Transport was an issue for the women. The mothers didn't want to stay long. They wanted to go back to their homes with their families. They were anxious about getting hurt by shelling on their way to hospital or being away from their home and family when an air strike hit the neighbourhood. The mornings were very intense because  mothers were fearful of coming at night. Women often delivered at home (or on arrival!) and they came to the hospital afterwards when they themselves, or their newborn, was facing problems.

Most of the mothers we received had not received any antenatal care. It was simply too far, too costly or too dangerous to go to the maternity ward or see a doctor. Routine care is often neglected. If they came it was because they had a problem only.

After six months of war, food was becoming an issue, and lack of access to vaccination was also worrying, particularly in the surrounding areas.

Our team is amazing and inspiring
Fortunately we have a really good team. The national staff we worked with are amazing and it is inspiring to see them working and so dedicated in the midst of such a traumatized life. We are just passing through, but they live there and cannot leave. The surgeons are Yemeni and they are very good at their job. MSF was supporting the emergency department, wards, operating theatres and the maternity. We also had an international team to support the activities, including emergency doctor or emergency nurse, theatre nurse, logistics and team leaders, together with myself on a short-term assignment to assist the Yemeni medical team. Coming here was a long and tiring journey.  We went from Djibouti to Sana’a, then from Sana’a to Saada. At the beginning we were living and working in the hospital around-the-clock. Fortunately, now, the team has found a house close to the premises.

It was very interesting to work in an all-female area, though a bit frustrating sometimes. The culture is very traditional in this region and as soon as a man arrived all the women put their veils on. Because they are all covered, I sometimes didn't know who was a patient or who was a visitor. But at the same time, it created a preserved / separate, safe environment for the women, and I was privileged to be able to enter and glimpse the lives of women in that difficult context. It was here that you could really enter the life of this country with these women, both the staff and patients and their families. I had a translator and she helped me to understand them a lot. Relationships were built with the staff, often when we were sharing a meal together, sitting on the ground in the small office of the ward. They are such hospitable people and always willing to share whatever they have.

One strong memory in the maternity ward was of a woman who came to deliver her seventh child. She was close to delivery when bombing started, close enough to shake the buildings. We were all anxious, for her, for our lives too. Then after a few minutes the baby came, healthy and everything was fine after all, but what an incredibly difficult way to have to deliver your baby and for a new life to come into the world.”

*Both names and ages have been changed to preserve anonymity.

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Voices from the Field 13 August 2015