Have you ever thought about working as a midwife in areas needing humanitarian aid? Anna Kent, midwife in Dorset, and previous humanitarian aid midwife, shares some of the reality of working in these areas and points to how we can all help during humanitarian emergencies.
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 As news of the Russian invasion of Ukraine filled us with horror over a year ago, my first thought instinctively went to the pregnant women. Of course, everyone in conflict suffers, but having seen the devastating effect of humanitarian emergencies on women first hand, I had some insight into the harm that potentially awaited them. The bleak reality is, over 800 women die in pregnancy and birth globally each day, mainly due to no access to quality health care. If the health infrastructure of Ukraine collapsed, would this fate await these vulnerable women?
Stories of hope matter in these moments. It’s estimated that 265,000 women were pregnant in Ukraine when war broke out and about 80,000 births were expected over the next 3 months. Mariia Shostak, living in Ukraine’s capital city, Kyiv, is reported to have started contractions on 24th February 2022, the day the Russian Federation launched its military offensive. Mariia gave birth to the sounds of air raid sirens but was fortunate to have access to an operating theatre when she required an emergency caesarean section. Last reports state both she and her son are doing well, still living in Kyiv.
My experience of working in a war zone.
I was 26 years old, keen and eager, when I joined Médecins Sans Frontières (MSF or Doctors Without Borders) as a nurse, in 2007. MSF is a medical aid organisation which takes volunteer professionals from around the world to assist in humanitarian crises in over 70 countries. I was young, enthusiastic and hopeful that my skills as an emergency nurse would make me useful to a struggling population.
South Sudan at that time, had endured over 50 years of a civil war that had destroyed most infrastructures for health care and education. Over 2 million people had been killed, 4 million had been displaced. There were severe food shortages and many outbreaks of conflict. What I was to learn, the hard way, was the vast difference between reading about a country and experiencing the effects of war first hand.
I was full of nerves on my very first day as I flew into South Sudan from Kenya, aboard a rickety aid plane with tumbling boxes of cargo. As I gripped the print-out of Sudan facts and MSF protocols, I felt I was cramming for an exam I was unprepared for. Flies scrabbled around my ankles and the 50oC lunchtime heat felt almost unbearable with no air conditioning, as I tried desperately to look cool, calm and collected to my new colleagues.
When we touched down at one of the mud-hut clinics, a patient was carried on to the plane. Her stretcher was made from sticks, and she was suffering from an obstetric fistula.
I had never seen an obstetric fistula before, so this was an enormous shock as the woman was dying from sepsis and suffering faeces leaking through her vagina from a birth injury. It goes without saying that her suffering was appalling and so much worse than mine, but it was a hard lesson to learn that you cannot save everyone.
But there were wonderful, hopeful stories too. One of the first births I was clinically responsible for in South Sudan– bearing in mind I was not yet a trained midwife – was for Grace, who birthed triplets vaginally, far from any scans, birth units or neonatal services. To see the mum, whose life was saved with an emergency hysterectomy post birth, lift those babes in a basket above her head and walk off home down the mud runway will be a memory I hold dear for the rest of my life.
I went back to the UK after South Sudan to gain my first degree in Midwifery. After graduation, I went with MSF to Haiti where there had been a catastrophic earthquake. My next mission, in 2011, was a year-long placement in Bangladesh where I had overall responsibility for all female and pregnancy health in a refugee camp of 30,000 stateless Rohingya people.
I now live and work in Dorset, specialising in working with pregnant teenagers.
The day the war in Ukraine broke out, I felt the urge to go and help, as many of us did and do, but I am now the lone parent of my own vivacious six-year-old and my priority has to be her. But it was hard not to go, knowing that I now had the perfect skill-set to be helpful in a conflict zone. Plus working with MSF had been one of the richest, most meaningful experiences of my life, as well as the most challenging.
MSF is in Ukraine right now, providing medical care to people caught up in, or forced to flee, the fighting, as are other organisations.
There are a number of ways you and I can still help:
- Donate
Donating money to recognised organisations is a very powerful way to directly support their work. Always make sure you donate safely to organisations you trust. Donating money and not ‘stuff’ is often much more effective help as donated items such as blankets need to be sorted, washed, transported, all at great cost which can hinder emergency responses.
- Stay informed
Knowledge is power, and it is important that voices from the field, such as those of Mariia and Grace, are heard. We must not look away. However online security is also essential and only share information on social media which comes from verified sources. There is a lot of misinformation online.
- Volunteer locally
Many aid organisations, such as MSF, have volunteers within the UK and opportunities can be found on their websites.
- Volunteer or work in the field
To work for MSF as a midwife, you need to be a registered midwife with at least 2 years’ experience, with relevant practice in labour ward and difficult case management.  Most first projects will be for at least 6 months, mine was extended to a year. Currently, MSF does not ask you to be dual-trained a registered nurse or speak another language, but if you are fluent in another language; French, Spanish, Portuguese, Arabic, Russian, it will be an asset.
It is advisable to complete a tropical medicine diploma, unless you have extensive experience living or working in the tropics. I gained my Professional Diploma in Tropical Nursing from the London School of Hygiene and Tropical Medicine, and the skills learnt there were essential in my overseas work . This course is also run from the Liverpool School of Tropical Medicine .
- Have realistic expectations
Working within humanitarian aid has been one of the most rewarding experiences of my life. Witnessing humanity at its most raw and vulnerable, and being able to help, I believe gives our very existence meaning. However, I was very naïve and unprepared emotionally for how brutal life can be for pregnant women denied access to quality health care. My sense of reality, and of self, has at times been completely fractured, but I am fortunate I had a chance to rebuild and become whole again.
I am still proud of the work we achieved, I certainly do no regret it, but I would encourage anyone hoping to work away to deeply consider how this type of work may affect both them and their families around them. Support for this can also be found with the organisation you choose to work for.
- Hope
We must all keep our faith that things can and will get better for the women and birthing people in Ukraine, Sudan, and for the whole of humanity. Positive change is possible, but sometimes we have to fight for it.
Final Thoughts.
I love being a midwife. It is an absolute privilege to work with women, birthing people and their wider families at such an intimate and intense time. Working around the world has been an honour and reminds me that every woman deserves access to a dignified care and a trained midwife, and that is regardless to where in the world she happens to live.
Anna Kent, Midwife, Dorset and previous humanitarian aid midwife
April 2023
About Anna Kent
Anna Kent has helped women birth babies in war zones, caring for the most vulnerable women in the most vulnerable places in the world. But returning to the UK to work for the NHS, she soon learned that even at home the right to a safe birth was impossible to take for granted.
In her debut book Frontline Midwife, finding hope in life, death and birth, Kent shares her extraordinary experiences as a nurse, midwife and mother, illuminating the lives of women that are irreparably affected by compromised access to healthcare. This is at once an astonishing story of the realities of frontline humanitarian work and a powerful reminder of the critical, life-giving work of midwives, nurses and doctors at home and around the world.
Frontline Midwife, finding hope in life, death and birth, is out now with Bloomsbury Publishing UK.