What is it like to give birth in Gaza?

All you can do is share your heart and share joy and be fully present.

Lately, it’s been difficult to know what to say—or more crucially, do—when it comes to the ongoing genocide in Gaza (and yes, that has been reflected on this Substack, where I try to provide value to my readers as opposed to just staring at things in horror! I am trying to be better…)

Even when it feels like the tide of public opinion maybe—just might—be changing in the West, I’ve been struck with how little this changes the reality of our brothers and sisters in Palestine. While we have had some beautiful victories lately—such as Mahmoud Khalil’s freedom and Zohran Mamdani’s victory in New York City—I find myself wondering if our brothers and sisters in Gaza can feel these moments, if it means anything at all if our governments continue to support Israel, continue to make life completely unbearable.

Of course, the opposite—doing and saying nothing!—is even more unbearable. So, I was incredibly grateful for someone right here on Substack recommended that I speak to Dr. Sandra Adler Killen, an American registered pediatric nurse and international board-certified lactation consultant, about her recent mission to Gaza. As of this writing, she has gone on not one, but three deployments to Gaza and brought pre-natal care and lactation consultations to Palestinian women who, in spite of everything, are still having babies, bringing humanity into the world—which might be the most effective protest of all.

Here is an edited version of our conversation, which spans everything from the horrible realities of Israel’s genocide to the beauty of Palestinian men and women, supporting one another through love, care, food and poetry.

I hope you’ll read the whole thing and check out her list of resources for how you can help.

ANNA: You’ve done three deployments—the first in March 2024, the most recent, this past March. I’m curious about the changes that you’ve seen on the ground from your first trip to your most recent trip.

SANDRA: Huge, huge. So, it was basically about a year difference. And first of all, when I entered through Rafah, I didn't even recognize it. Rafah is flattened. It looked nothing like it did a year ago. So that was horrific, and I can only imagine how many bodies are still buried underneath the rubble.

There's nobody there. Of course, there's no place to live. They're forced out. But Rafah was where most of the refugees were when I was (last) there, or Deir El Balah or Khan Younes, because they had been forced out of the north into the south prior to the ceasefire.

In terms of the patient population, so much more hunger, so much more desperation, so much more illness. And when I entered this time, the day that my team was supposed to cross, was the day the ceasefire ended. So, the bombings I experienced were pretty consistent, there were drones and drone attacks and bombings my first deployment, but this was just non-stop. It's non-stop, and it was very close to us. So in the first visit, it felt like there was some respect for safe zones, and now those safe zones don't exist.

ANNA: Also just the destruction of hospitals and the fact that hospitals are a target, and there's just fewer places to get care must be affecting you and the people that you work with so much…

SANDRA: Of course. And then loss of water at times in the hospitals, loss of electricity in the hospitals. How do you function in a hospital without water and power? But yet, there is something very unique about Palestinian people; their commitment, love of their land and people is profound. I met people who could have left at the beginning of this war because they had the means and they had family outside, but they refused to leave their people.

Of course, as we know in most Arab cultures, there is also tremendous hospitality. Even though they had so little, they brought me food every single day. One mother kept telling me that the food would taste better if only she had the ingredients that she used to have—and it was still delicious.

Also, their sense of humor. We laughed and laughed and laughed. When I was there, my mother died and people that I barely knew held me while I sobbed and sobbed and sobbed, and the love and caring that I felt, the depth of their hearts, the grace, the compassion, it's just it's profound with everything they have been through. And yet, the level of grief, the level of sorrow, the level of depression…just holding all of these pieces, all of these pieces. I feel so blessed to be able to support and work side by side with colleagues that have the depth of human emotion, and are willing to fully be present to all of it.

When I ask all of my dearest friends, so what can I bring? What can I send you? How can I support you from a distance? They say: send us poems. Poetry, this is what we love. So I cannot tell you the amount of poetry that I share and that they've written, and that the beautiful poetry of the profound, you know, the depth, again, of their literacy and their hearts and emotions.

If you would like to send a poem to someone in Gaza, please get in touch with me and I’d be happy to facilitate that connection.

ANNA: That reminds me so much of so many of my experiences reporting in the Middle East as well. You know, we've talked about all the challenges that you're facing working in a hospital in these conditions, particularly with pregnant women with new moms. I was wondering, What does celebrating a birth look like in Gaza right now? Because this is still something that, miraculously, people are still getting pregnant and making babies and creating life.

SANDRA: Well, first of all, I should give you an idea of our team. So, with our team there so much of what I had to do was support them emotionally and try to lift up their spirits after with everything they've been going through day after day after day. As you can imagine, you're hearing the drones. You're hearing the bombs constantly around you. And I said, when you are with these newborn maybe newborn babies and mamas, you will not hear the drones. You will not hear the bombs. Your hearts will be fully present. You'll be fully connected. It's especially, I mean, in all areas of the hospital, but especially when you're working with, you know, birthing and mothers who just gave birth and seeing this new life, it becomes everything become goes down to like this hyper focus an experience where you really tune everything out. And I think that is what transpires with these mothers and the aunties and grandmothers that are there, friends, sisters, you know, they're still family that they have near near them, and some families do, thank goodness. And you just rejoice in this beautiful hope, this new hope. And I think the celebration is even more profound because of all the loss of life and knowing that this is the future of the Palestinian people in Gaza.

So the celebrations in the past have been, you know, handing out, sharing food with everybody around you and and now there is none. So all you can do is share your heart and share joy and be fully present.

ANNA: Do you have any specific memory that sticks out to you of a particular birth or moment like that?

SANDRA: Oh, there are. There's so many, so many, so many.

I think for me, probably one really strong memory was there was some mother that she's that gave birth and her grandmother, or excuse me, her mother, and yes, her mother and grandmother were with her and the depth of gratitude of that our team, at Gina was hyper focused on their emotional, mental health, their the health of the family.

That just the depth of appreciation, the depth of heart connection, the depth of joy from this particular family of literally just the hugs and the kisses and the gratitude every moment that our team was with this mother was there for about 40 hours. She had some complications after her C section, because most women who have vaginal births have to be discharged after three or four hours. That would never happen in this country. A C section. After 24 hours, you have surgery, you go home. There's just not capacity.

You cannot stay for very long because there are other mothers that are giving birth and they only have a few beds. So again, when there was full capacity and there were plenty of functioning hospitals, there was never an issue.

ANNA: Pregnancy and giving birth isn’t the only issue—there’s also so many (preventable) diseases that are costing people their lives. What did you see while you were there?

SANDRA: So the levels of malnutrition that we're seeing right now are profound. Women who would normally get or any, any person who would normally get a transfusion with a hemoglobin below eight, there isn't enough blood. Palestinian, even Palestinian people, even when they're trying to donate enough blood for their for their fellow Palestinians in Gaza that need it desperately. The blood is being used in the emergency room and for surgeries, and we have mothers that are coming in who must get transfusions. Their hemoglobins are so low and we don't have blood for them. So here they are going into labor, anemic, malnourished, trying to give birth to a baby. And we know how hard giving birth is, laboring is. It's called labor for a reason, and they're already coming in exhausted.

So how they're depleted their bodies are after this experience and then trying to provide breast milk for these mamas, for these babies, and when your body is so depleted and malnourished. Now we do recommend breastfeeding because it is the best, the best nutrition for newborn babies, in terms of protecting their health, and in these circumstances and conditions, we must do everything we can to protect their health, because of all the antibodies and different nutrients that breast milk has, that even if formula is available, it's not recommended. So unless a mother is severely, acutely malnourished, we still support them in providing breast milk, also, if they don't, and then all of a sudden, formula is not available because of the blockade, and it's very short supply now and and then women, if they can't get it, if they have to pay for it, don't have money to pay for it, then these babies are starving to death if we can't support them with with providing sufficient breast milk. So that's the focus of the work of our team.

We have seen a horrific, horrific increase of disease in the amount of congenital birth defects, premature births. Research needs to be done on the effects of all of the buildings, the toxins in the air, the asbestos in the air and in the soil from all of the bombings. You know, the the artillery that's now in the air and in the soil, the fact that they don't have ability to cook. Their homes have been destroyed, and they're running out of wood, so they're using plastics to fuel their fire, plastic bags, pieces of plastic, any kind of trash they can burn so they can cook whatever kind of rice they have, whatever they have left to feed their families. So we're seeing a huge amount of prematurity, a huge amount of congenital heart defects, a huge amount of cleft palate and cleft lip issues. So that we need to find out, you know, the ramifications again, of this, of this genocide, not just in terms of death, but in terms of long term health outcomes.

ANNA: What can people do from outside, both in terms of where places that are reliable to donate and what can people with certain skills do that the people that you're in touch with need support?

SANDRA: We’ve put together a resource guide. It’s basically a list of organizations that aren't just there are many wonderful NGOs that are still collecting money right now, but they're really ineffectual on the ground right now. I'm sure in the future that money will go to help and support, but being there, I know which organizations are doing the work actually being able to provide support and care directly to those suffering in this moment in time, right now.

It depends on your bandwidth, for your readers, and what they can do in in terms of, in terms of making a difference. And remember, I'm just one person who came up with an idea and and now the ripples of of just this one idea, you know, our team now is, they are the lead lactation experts in Gaza, and they're now being asked by all of the different clinics, NGOs and hospitals, to provide them with training so the ripples upon ripples upon ripples of what one person can do.

It's possible, you know, come up with an idea and just reach out and try to find the right people who can make it happen.

If you would like to send a poem to someone in Gaza, please get in touch with me and I’d be happy to facilitate that connection.